Prospective cohort of 198 patients (214 knees) undergoing kinematically aligned TKA with patient-specific guides. Asks whether postoperative alignment category (in-range, varus outlier, or valgus outlier) affects functional outcomes or catastrophic failure rate. Minimum follow-up was 31 months (mean 38 months).
Conventional TKA dogma holds that tibial varus beyond the mechanical axis is a technical error requiring correction — something to flag on a postoperative scanogram and document as malalignment.
This study reframes that assumption: the native tibial joint line averages 3° varus relative to the mechanical axis, so any technique that restores prearthritic anatomy will routinely produce 'varus outlier' tibial components by conventional criteria.
When evaluating a postoperative scanogram after kinematically aligned TKA, do not reflexively interpret varus tibial positioning as a failure of technique. Ask instead whether the component matches the patient's contralateral joint line.
The zero catastrophic failure rate and equivalent Oxford Knee Scores across all alignment categories at 3 years mean you can counsel patients that the varus-appearing tibial cut is intentional and supported by outcomes data. Not a deviation to be corrected.
Prospective cohort of 198 patients (214 knees) undergoing kinematically aligned TKA with patient-specific guides. Asks whether postoperative alignment category (in-range, varus outlier, or valgus outlier) affects functional outcomes or catastrophic failure rate. Minimum follow-up was 31 months (mean 38 months).
Conventional TKA dogma holds that tibial varus beyond the mechanical axis is a technical error requiring correction — something to flag on a postoperative scanogram and document as malalignment.
This study reframes that assumption: the native tibial joint line averages 3° varus relative to the mechanical axis, so any technique that restores prearthritic anatomy will routinely produce 'varus outlier' tibial components by conventional criteria.
When evaluating a postoperative scanogram after kinematically aligned TKA, do not reflexively interpret varus tibial positioning as a failure of technique. Ask instead whether the component matches the patient's contralateral joint line.
The zero catastrophic failure rate and equivalent Oxford Knee Scores across all alignment categories at 3 years mean you can counsel patients that the varus-appearing tibial cut is intentional and supported by outcomes data. Not a deviation to be corrected.