Kinematically aligned total knee arthroplasty is as effective in severe varus deformities as in mild deformities
Bibliographic record
Abstract
PURPOSE: This study compares the clinical outcomes and radiological measures of kinematic alignment total knee arthroplasty (KA-TKA) in patients with severe knee deformities to those with mild varus. METHODS: This retrospective cohort study included 145 patients with <10° varus malalignment and 145 patients with >10° varus. All cases underwent KA-TKA performed by a single surgeon using the same techniques between 2015 and 2022. The following variables were compared between groups: (1) demographic data, (2) clinical assessments including ROM, pre- and postoperative Oxford knee score (OKS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), as well as postoperative knee society score (KSS) and forgotten joint score (FJS) and (3) radiographic parameters including femoral mechanical angle (FMA), tibial mechanical angle (TMA) and hip-knee-ankle (HKA). All postoperative data were collected after 2-9 years of follow-up (median: 6 years). RESULTS: Preoperative parameters, including age, sex, height, weight, body mass index (BMI) and side of operation, were not significantly different between groups. Preoperative WOMAC and Oxford knee score (OKS) scores were significantly worse in the severe group (p < 0.001). However, both scores improved significantly more in the severe varus knees postoperatively. Postoperative KSS (mild: 87.31 ± 14.35 vs. severe: 83.79 ± 24.82, p = 0.93) and FJS (mild: 91.83 ± 8.09 vs. severe: 91.38 ± 12.16, p = 0.23) did not show significant differences. Though pre- and postoperative ROMs were significantly lower in the severe group (p < 0.001), they improved significantly in both groups without significant difference (p = 0.16). Preoperative HKA was 173.85 ± 1.79 degrees in the mild group and 159.83 ± 7.59 degrees in the severe group (p < 0.001). There was also a significant difference in preoperative FMA (p < 0.001) and TMA (p = 0.003) between groups. KA-TKA corrected HKA (13.44 ± 5.78 vs. 3.92 ± 2.36) and TMA (6.19 ± 5.41 vs. 2.10 ± 3.26) significantly more in patients with severe varus knee (p < 0.001). CONCLUSION: KA-TKA enhances clinical outcomes in individuals with severe knee varus to a degree comparable to those with mild varus. This technique achieves a more profound correction of HKA alignment in severe cases than in mild cases. KA-TKA may be a viable approach, but further prospective comparative studies are needed, especially in patients with severe deformities. LEVEL OF EVIDENCE: Level III.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".