Mid-Term Clinical and Radiological Results at a Tertiary Care Hospital in Turkiye: Is Residual Varus Really Important After MechanicallyAligned Total Knee Arthroplasty?

Introduction: Traditionally, in total knee arthroplasty (TKA), it is aimed to keep the mechanical axis of the lower extremity neutral (mechanical alignment: 3 degrees varus-valgus in the coronal plane) to improve long-term outcomes. This study aimed to assess the mid-term radiological and clinical results of patients with postoperative residual varus (more than 3 degrees of varus) after mechanically-aligned TKA. Methods: A total of 616 individuals who had undergone TKA for primary knee osteoarthritis between 2008 and 2013 in our tertiary care hospital were retrospectively examined. All TKAs were performed with the mechanical alignment strategy. For radiological evaluation, hip-knee-ankle (HKA) angle, knee alignment angle (KAA), mechanical medial proximal tibial angle (mMPTA), knee inclination (KI), joint line orientation angle relative to ground (JLOA-G), posterior tibial slope (PS), joint line convergence angle (JLCA) were measured. Besides, patients' latest radiographs were screened for any clue of aseptic loosening or mechanical failure. Knee Society Score (KSS) (knee and functional subgroups), and Lysholm, Oxford, and Tegner scores were used for clinical evaluation. In addition, knee flexion and extension limitations were assessed. Results: After applying the exclusion criteria, a minimum of five- year follow-up result of 110 patients was demonstrated. There were 101 females (92%) and nine males (8%). The mean follow-up time was 65.8 +/- 6.3 months (range: 60.8-75.8 years). The mean age was 65.9 +/- 7.7 years (range: 39 to 89 years). The preoperative mean mechanical axis angle of the lower extremity was 17.3 degrees +/- 7.8 degrees (range: 13.4-43.9 degrees), whereas it was 8.3 degrees +/- 3.6 degrees (range: 3.2-19.8 degrees) postoperatively. The preoperative mean flexion angle was 90.7 degrees +/- 23.8 degrees (range: 40130 degrees), and the extension limitation was -2.5 degrees +/- 7.4 degrees (range: -40-0 degrees), whereas, postoperatively, they were 102.8 degrees +/- 15.4 degrees (range from 40 degrees to 150 degrees) and -3.7 degrees +/- 7.5 degrees (range from -40 degrees to 0 degrees), respectively. The latest follow-up's mean KSS knee subgroup was 67 +/- 18.4 (range: 12-93), the mean KSS functional subgroup was 74 +/- 23.6 (range: 20-100), the mean Lysholm score was 81.7 +/- 15.7 (range:25-100), the mean Tegner score was 3.65 +/- 0.99 (range: 1-5), the mean Oxford score was 37.4 +/- 6.5 (range: 9-48). There was no patient with aseptic loosening or mechanical failure. Conclusions: In the mid-term follow-up of patients with residual varus after mechanically-aligned TKA, satisfactory clinical and radiological results were obtained without aseptic loosening or implant failure.