Retrospective cohort of 6070 primary TKAs examining how postoperative tibial component alignment, femoral component alignment, overall tibiofemoral alignment, and preoperative BMI individually predict aseptic implant failure — and whether intentionally malaligning one component to compensate for a malaligned partner restores acceptable survival.
When planning TKA, target tibial component ≥90° to the tibial axis and femoral component <8° valgus as independent goals — if your tibial cut is in varus, do not try to rescue overall alignment with an over-corrected valgus femoral cut, as this compounds rather than cancels the failure risk.
In obese patients (especially BMI ≥41), technical precision in tibial alignment becomes even more critical, as the combination of varus tibial malalignment and high BMI carries a greater than 1-in-5 failure rate.
Retrospective cohort of 6070 primary TKAs examining how postoperative tibial component alignment, femoral component alignment, overall tibiofemoral alignment, and preoperative BMI individually predict aseptic implant failure — and whether intentionally malaligning one component to compensate for a malaligned partner restores acceptable survival.
When planning TKA, target tibial component ≥90° to the tibial axis and femoral component <8° valgus as independent goals — if your tibial cut is in varus, do not try to rescue overall alignment with an over-corrected valgus femoral cut, as this compounds rather than cancels the failure risk.
In obese patients (especially BMI ≥41), technical precision in tibial alignment becomes even more critical, as the combination of varus tibial malalignment and high BMI carries a greater than 1-in-5 failure rate.