Degree of Coronal Alignment Correction Can’t Predict Knee Function in Total Knee Replacement

Abstract Background: Whether neutral alignment brings better clinical outcomes is controversial. Consideration of the preoperative knee condition of patients and some limitations of previous studies, we suggested that other index may be more important than a generic target of 0° ± 3° of a neutral axis to reflect changes in coronal alignment after total knee replacement (TKR). The purpose of this study was to explore the relationship between alignment and functional outcome with a new grouping method and the concept of correction rate. Methods: The study included 358 knees, the mean follow-up period was 3.62 years. A new grouping method was adopted to divide patients into three groups based on the degree of correction of mechanical femoral – tibial angle (MFTA): under-correction (n = 128), neutral (n = 209) and over-correction (n = 21). Hospital for Special Surgery (HSS) score were compared among the 3 groups. In addition, we also attempt to further explore whether the concept of correction rate can predict postoperative functional score. Results: HSS score showed significant improvement in all groups. There was no difference in HSS score (88.27 vs 88 vs 85.62)or incremental scores (26.23 vs 25.22 vs 22.88) based on the postoperative alignment category for the degree of correction of MFTA at the last follow-up. The correlational analyses also didn’t show any positive results.Conclusion: TKR is a soft tissue procedure and clinical outcome depends on many factors, only reaching neutral alignment after surgery may not mean a good clinical result. Therefore, categorization of optimal coronal alignment after TKR may be impractical. But we still believe that the concept of correction rate and new grouping method are worthy of research which can reflects the preoperative knee condition and the change of coronal alignment. Perhaps it can be better used in TKR in the future. Level of evidence: III.