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Slight under-correction using individualized intentional varus femoral cutting leads to favorable outcomes in patients with lateral femoral bowing and varus knee

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Abstract

Purpose

Restoration of neutral alignment is considered key in total knee arthroplasty (TKA). However, this may be undesirable and can result in medial soft-tissue over-release in patients with varus knee and lateral femoral bowing. This study aimed to determine whether individualized intentional varus distal femoral cutting yielded satisfactory clinical and radiological outcomes.

Methods

A total of 77 patients (91 knees) with varus knee (hip–knee–ankle axis ≥ 10°) and lateral femoral bowing > 5° underwent navigation-assisted primary TKA using individualized intentional varus distal femoral cutting. Knee Society scores, Western Ontario and McMaster Universities scores, and radiographs for limb alignment, implant alignment, and aseptic loosening were evaluated. Subgroup analyses were performed according to the limb alignment and coronal femoral component alignment (0° ± 3° vs. varus of > 3°).

Results

All clinical outcomes significantly improved at the final follow-up (p < 0.05 in all). The mechanical axis angle changed from 13.1° ± 2.7° to 2.8° ± 1.5°. The coronal femoral component angle at the final follow-up was 2.8° ± 1.3°. Radiolucent lines were observed in 6 cases (6.6%) and were less than 2 mm in all cases without progression. In subgroup analyses, no significant differences were observed in clinical outcomes (n.s. in all) and in the incidence of radiolucent lines (n.s. in limb alignment, n.s. in coronal femoral component alignment).

Conclusions

Individualized intentional varus distal femoral cutting yielded favorable clinical outcomes without complications at 5-year follow-up. Slight under-correction using intentional varus distal femoral cutting could be a viable option in patients with varus knee and lateral femoral bowing during navigation-assisted TKA.

Level of evidence

IV.

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Funding

No funding was received for this study.

Author information

Correspondence to Yong-Beom Park.

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Conflict of interest

There are no conflicts of interest to declare for any authors.

Ethical approval

All procedure performed in the study involving humans participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the Institutional Review Boards of Chung-Ang University Hospital (IRB no. 1600-003-253).

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Informed consent was obtained from all individual participants in the study.

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Lee, H., Lim, J., Lee, D. et al. Slight under-correction using individualized intentional varus femoral cutting leads to favorable outcomes in patients with lateral femoral bowing and varus knee. Knee Surg Sports Traumatol Arthrosc (2019). https://doi.org/10.1007/s00167-019-05577-1

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Keywords

  • Total knee arthroplasty
  • Navigation
  • Varus knee
  • Lateral femoral bowing
  • Distal femoral cut
  • Intentional varus