Preoperative Valgus Alignment Does Not Predict Inferior Outcome of Total Knee Arthroplasty

Abstract

Background

Preoperative valgus deformity is present in an estimated 10–20% of patients undergoing total knee replacement (TKR).

Questions/Purposes

The objective of this study was to compare the Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores after TKR in a matched cohort of patients with preoperative valgus and varus deformities.

Methods

This is a matched cohort study of 162 patients with varus native knees and 162 patients with valgus native knees who underwent TKR and were prospectively followed in our institutional registry. Patients matched were based on age, BMI, sex, and severity of preoperative knee deformity, which was classified as mild, moderate, severe varus or valgus, or no deformity. Outcomes were evaluated using the WOMAC preoperatively and at 6 weeks, 3 months, 6 months, and 1 year postoperatively.

Results

No significant difference was found between the matched varus and valgus cohorts in all WOMAC subdomain scores except for a marginally worse stiffness at 1 year in patients with valgus deformity (WOMAC stiffness, 75.1 varus vs. 70.1 valgus; P = 0.049). This is below the minimal clinically important difference for WOMAC scores. There was no significant difference in postoperative varus/valgus alignment between the two groups (P = 0.092)

Conclusion

We found no clinically significant difference in any of the WOMAC domains in patients with preoperative varus deformity versus valgus deformity within the first year after TKR. These findings may allow surgeons to more appropriately counsel patients with osteoarthritis with valgus deformity that they can expect similar outcomes compared to patients with varus deformity.

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Funding

No extramural funding was received.

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Correspondence to Cynthia A. Kahlenberg MD.

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Conflict of Interest

Cynthia A. Kahlenberg, MD; Myra Trivellas, BS; and Yuo-yu Lee, MS have declared that they have no conflict of interest. Douglas E. Padgett, MD, reports other from American Joint Replacement Registry, Journal of Arthroplasty, and The Hip Society and personal fees from PixarBio and DJ Orthopaedics outside the work.

Human/Animal Rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).

Informed Consent

Informed consent was obtained from all patients for being included in the study.

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Disclosure forms provided by the authors are available with the online version of this article.

Additional information

Level of Evidence: III: Retrospective Cohort Study.

Investigation was performed at Hospital for Special Surgery.

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Kahlenberg, C.A., Trivellas, M., Lee, Y. et al. Preoperative Valgus Alignment Does Not Predict Inferior Outcome of Total Knee Arthroplasty. HSS Jrnl 14, 50–54 (2018). https://doi.org/10.1007/s11420-017-9576-2

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Keywords

  • valgus
  • varus
  • tibiofemoral alignment
  • total knee arthroplasty
  • alignment