The constitutional knee anatomy in the coronal plane includes the distal femoral joint line obliquity (DFJLO) which in most patients is in slight valgus positioning. Despite this native anatomy, the mechanical positioning of the femoral component during primary total knee arthroplasty (TKA) often ignores the native DFJLO opting to place the femur in a set degree of valgus that varies upon the practitioner's practice and experience. Unfortunately, this technique is likely to generate high rate of distal lateral femoral overstuffing. This anatomical mismatch might be a cause of anterior knee pain and therefore partly explain the adverse functional outcomes of mechanically aligned (MA) TKA. Our study aims at assessing the relationship between constitutional knee anatomy and clinical outcomes of MA TKA. We hypothesized that a negative relationship would be found between the constitutional frontal knee deformity, the distal femoral joint line obliquity, and functional outcomes of MA TKA with a special emphasize on patellofemoral (PF) specific outcomes. One hundred and thirteen patients underwent MA TKA (posterior-stabilized design) for primary end-stage knee osteoarthritis. They were prospectively followed for one year using the New KSS 2011 and HSS Patella score. Residual anterior knee pain was also assessed. Knee phenotypes using anatomical parameters (such as HKA, HKS, DFJLO and LDFA (Lateral distal femoral angle)) were measured from preoperative and postoperative lower-limb EOS® images (Biospace, Paris, France). We assessed the relationship between the knee anatomical parameters and the functional outcome scores at 1 year postoperatively.Introduction
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