The influence of femoral and tibial bony anatomy on valgus OA of the knee

  • Bernhard Springer
  • Ulrich Bechler
  • Wenzel Waldstein
  • Kilian Rueckl
  • Cosima S. Boettner
  • Friedrich BoettnerEmail author



Approximately 10% of all patients that require a total knee arthroplasty present with valgus osteoarthritis (OA) of the knee. Valgus OA goes along with posterolateral bone loss and lateral soft tissue tightness. The role of malalignment on the development of OA is not fully understood. The current study investigates whether the femoral offset (FO), femoral mechanical–anatomical (FMA) angle, anatomical lateral distal femur angle (aLDFA), mechanical lateral distal femur angle (mLDFA), medial proximal femur angle (MPFA), medial proximal tibia angle (MPTA) or lateral distal tibia angle (LDTA) differ in patients with valgus OA of the knee.


FO, FMA angle, aLDFA, mLDFA, MPFA, MPTA and LDTA were assessed and compared between 100 consecutive knees with minimal valgus OA (50 male, 50 female) and 100 consecutive knees with minimal varus OA (50 male, 50 female).


FO was significantly higher in males with valgus OA (p = 0.002) and females with varus OA (p = 0.01). The observed values for the FMA angle were significantly higher in males with valgus OA (p = 0.002) and females with varus OA (p = 0.041). The aLDFA and mLDFA were significantly smaller in all patients with valgus OA (p < 0.001). No differences between the varus and valgus groups were detected regarding MPFA (males: p = 0.052; females: p = 0.719). Tibial measurements showed significantly higher values for the MPTA (p < 0.001) in both valgus groups and no difference for LDTA (men: p = 0.139; women: p = 0.196).


Bony alterations in the femoral anatomy seem to be more important than in the tibial anatomy. While in male patients with valgus OA, the main anatomic variation is the hypoplasia of the lateral femoral condyle, in females both decreased femoral offset of the hip as well as hypoplasia of the lateral condyle are present.

Level of evidence



Valgus osteoarthritis Varus osteoarthritis Femoral offset Lateral distal femur angle Anatomy of the femur Total knee replacement Total knee arthroplasty 



This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors

Compliance with ethical standards

Conflict of interest

Dr. Boettner has received royalties by Smith and Nephew and Orthodevelopment. Dr. Boettner has also received compensation by Smith and Nephew, Orthodevelopment and DePuy. All other authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human 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. This article does not contain any studies with animals performed by any of the authors. Number of ethical approval: 2018-0697-CR1 IRB- contact person:


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  1. 1.Adult Reconstruction and Joint Replacement DivisionHospital for Special SurgeryNew YorkUSA
  2. 2.Department of Orthopaedics, Vienna General HospitalMedical University of ViennaViennaAustria

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