{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T03:18:22Z","timestamp":1791343102781,"version":"4.3.1"},"reference-count":29,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2025,6,5]],"date-time":"2025-06-05T00:00:00Z","timestamp":1749081600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["esskajournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>To assess the symmetry of coronal alignment in the lower limbs of patients with knee osteoarthritis to evaluate whether the contralateral lower limb can serve as a reliable reference for guiding coronal positioning and alignment in total knee arthroplasty (TKA) surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This is a multicentric cross\u2010sectional observational study. Preoperative full\u2010leg weight\u2010bearing radiographies from patients with knee osteoarthritis treated with a TKA between 2022 and 2024 were analyzed. Radiological parameters were measured in both lower limbs: medial proximal tibial angle, tibial mechanical angle (TMA), lateral distal femoral angle, femoral mechanical angle (FMA), hip\u2013knee\u2013ankle angle (HKA) and Kellgren\u2013Lawrence. Lower limb coronal symmetry was assessed using the HKA, coronal plane alignment of the knee (CPAK) and phenotypes classifications. The relationship between concordance rates and osteoarthritis severity and symmetry was also analyzed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Seventy\u2010six patients were included. The operated\u2010to\u2010contralateral concordance for the HKA classification was 57%. It was higher when the operated knee was neutral (81%), compared to varus (58%) or valgus (27%). The CPAK concordance was 38%; it was similar across different CPAK types. The phenotype classification concordance was only 11%; 30% for the HKA parameter, 39% for FMA and 34% for TMA. There was no relationship between osteoarthritis severity or symmetry and coronal concordance rates.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Patients with knee osteoarthritis have poor side\u2010to\u2010side symmetry in lower limb coronal alignment. The concordance rate was 56% for the HKA classification, 39% for the CPAK classification and 11% for the phenotype classification. Therefore, the contralateral lower limb may not be a reliable reference for guiding coronal positioning and alignment in TKA surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>Level III.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ksa.12714","type":"journal-article","created":{"date-parts":[[2025,6,5]],"date-time":"2025-06-05T04:23:57Z","timestamp":1749097437000},"page":"3621-3628","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Poor side\u2010to\u2010side symmetry limits the use of the contralateral limb as a reliable reference for guiding coronal positioning and alignment in total knee arthroplasty"],"prefix":"10.1002","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4760-2730","authenticated-orcid":false,"given":"Oriol","family":"Pujol","sequence":"first","affiliation":[{"name":"Knee Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital Universitat Aut\u00f2noma de Barcelona (Departament de Cirurgia) Barcelona Spain"},{"name":"Knee Surgery Unit iMove Traumatology Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7567-1317","authenticated-orcid":false,"given":"Pedro","family":"Hinarejos","sequence":"additional","affiliation":[{"name":"Knee Surgery Unit, Orthopaedic Surgery Department, Hospital del Mar Universitat Aut\u00f2noma de Barcelona Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-9753-2913","authenticated-orcid":false,"given":"Albert","family":"Pons","sequence":"additional","affiliation":[{"name":"Knee Surgery Unit, Orthopaedic Surgery Department, Hospital Sant Joan de D\u00e9u de Manresa \u2013 Fundaci\u00f3 Althaia Universitat de Vic Manresa 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