{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:49:19Z","timestamp":1786978159425,"version":"build-2736575974"},"reference-count":32,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T00:00:00Z","timestamp":1751846400000},"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>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Achieving neutral coronal mechanical alignment in knee arthroplasty is traditionally considered crucial for implant longevity and function. However, recent studies suggest alternative alignment strategies. This study examines the correlation between preoperative and postoperative coronal alignment and patient\u2010reported outcome measures (PROMs) at midterm follow\u2010up. We hypothesised that preserving a patient's constitutional alignment would yield superior results, whereas overcorrection toward neutral alignment would lead to poorer outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data from 369 knee arthroplasties in 335 patients at a tertiary hospital, all performed aiming for mechanical alignment, was analysed. Coronal alignment and joint line obliquity were measured pre\u2010 and postoperatively using long\u2010leg radiographs. coronal plain alignment of the knee (CPAK) classification was determined. PROMs, including the Oxford knee score (OKS), pain visual analogue scale (VAS) and EuroCol 5\u2010dimensions (EQ.5D) VAS scores, were collected with a mean (standard deviation) follow\u2010up period of 5.7 (1.6) years. Logistic regression was used to assess the association between coronal radiological measurements, CPAK classification, and PROMs, adjusting for age, sex and body mass index (BMI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      No significant association was observed between maintaining the same coronal CPAK phenotype at the mid\u2010term follow\u2010up and patient outcomes. Patients who achieved postoperative neutral coronal alignment had a comparable mean OKS yet demonstrated a higher likelihood of reporting an excellent OKS. In cases where coronal alignment was over\u2010corrected and crossed over from valgus to varus or vice versa, the OKS was 5.3 points lower (\u22129.3, \u22121.2, 95% confidence interval [CI]:\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.011), with an odds ratio [OR] of 3.1 (1.5, 6.7, 95% CI:\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.003) for a poor OKS, comparing patients who did not cross over to the opposite coronal alignment.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>At the mid\u2010term follow\u2010up, patients with postoperative neutral coronal alignment demonstrated similar outcomes to those who maintained their preoperative constitutional alignment. Patients who had crossover from varus to valgus or vice versa exhibited significantly poorer results.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level II.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ksa.12742","type":"journal-article","created":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T08:55:04Z","timestamp":1751878504000},"page":"3629-3636","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Neutral and constitutional coronal alignment yield similar outcomes in total knee arthroplasty at mid\u2010term follow\u2010up using the coronal plane alignment of the knee classification"],"prefix":"10.1002","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6155-6502","authenticated-orcid":false,"given":"Eran","family":"Keltz","sequence":"first","affiliation":[{"name":"Division of Orthopaedic Surgery Rambam Health Care Campus Haifa Israel"},{"name":"Department of Orthopaedic Surgery Western Health Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saud","family":"Almaslmani","sequence":"additional","affiliation":[{"name":"Department of Surgery, Faculty of Medicine Al\u2010Qunfudhah, Umm Al\u2010Qura University Makkah Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eugenie","family":"Ng","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Western Health Melbourne Victoria Australia"},{"name":"Australian Institute for Musculoskeletal Science (AIMSS) The University of Melbourne and Victoria University St. Albans Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oren","family":"Tirosh","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Western Health Melbourne Victoria Australia"},{"name":"School of Health and Biomedical Sciences RMIT University Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Libby","family":"Spiers","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Western Health Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Vogrin","sequence":"additional","affiliation":[{"name":"Australian Institute for Musculoskeletal Science (AIMSS) The University of Melbourne and Victoria University St. Albans Victoria Australia"},{"name":"Department of Medicine (St Vincent's Health) University of Melbourne Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phong","family":"Tran","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Western Health Melbourne Victoria Australia"},{"name":"Australian Institute for Musculoskeletal Science (AIMSS) The University of Melbourne and Victoria University St. Albans Victoria Australia"},{"name":"School of Health and Biomedical Sciences RMIT University Melbourne Victoria 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