Does the Preoperative Varus Deformity Influence the Survival of Postoperative Neutral-Aligned TKAs? An Analysis With a Minimum 5-Year Follow-Up.

Background: Postoperative neutral alignment may be an important factor for longevity of total knee arthroplasty (TKA). In knees with severe varus deformity, greater soft tissue release and bone resection were required to achieve neutral alignment. We investigated the relationship between the severity of preoperative varus deformity and longevity of neutral-aligned TKAs.
Methods: Of the 723 knees in patients who underwent primary TKA for varus-type osteoarthritis between November 1998 and June 2009, 496 knees aligned neutrally (the postoperative mechanical hip-knee-ankle [HKA] axis angle ranged between -3° and 3°) and followed up for at least 5 years were included in the study. The mean follow-up period was 9.28 years. Patients were divided into 4 groups based on their preoperative HKAs: mild (0° < HKA ≤ 5°, n = 79), moderate (5° < HKA ≤ 10°, n = 204), severe (10° < HKA ≤ 15°, n = 149), and very severe (HKA > 15°, n = 64) groups. Failure was defined as need for revisional TKA for mechanical reason. Survival was analyzed by Kaplan-Meier method and log-rank test.
Results: The overall failure rate was 2.02% (10 of 496 prostheses). The cumulative survival rates of neutral-aligned TKAs at 10 years were 97.4% (95% confidence interval [CI], 93.9%-100%), 99.0% (95% CI, 97.6%-100%), 97.8% (95% CI, 95.4%-100%), and 96.9% (95% CI, 92.6%-100%) in mild, moderate, severe, and very severe varus groups, respectively. There were no significant differences between group survival rates (P = .395).
Conclusion: The severity of preoperative varus deformity did not affect survival rates of neutral-aligned TKAs over 10 years.
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