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Alignment parameters included the anatomical lateral distal femoral angle (aLDFA), medial proximal tibial angle (MPTA), joint line convergence angle (JLCA) and femorotibial angle (FTA). Changes were tested using paired\n                      <jats:italic>t<\/jats:italic>\n                      tests, and associations were modelled using Gaussian generalized linear models adjusted for age, sex, body mass index and baseline Kellgren\u2013Lawrence (K\u2013L) grade. Group differences among K\u2013L\u2009\u2264\u20091, 2 and \u22653 were tested by one\u2010way analysis of variance with Tukey's Honestly Significant Difference, and within\u2010group correlations were assessed using Pearson's coefficient.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 2974 knees were analysed. Baseline K\u2013L grades were: 0: 164 (5.5%), 1: 1975 (66.4%), 2: 694 (23.3%), 3: 135 (4.5%) and 4: 6 (0.2%). Over 5 years, FTA increased by 0.3\u00b0 (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). aLDFA also shifted 0.3\u00b0 toward the varus (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), whereas MPTA and JLCA remained stable. A higher baseline K\u2013L grade was independently associated with varus progression, particularly when driven by decreased MPTA and increased JLCA. Consistent with the multivariable analysis, the K\u2013L\u2009\u2265\u20093 group exhibited a significant MPTA decrease and a 2.6\u00b0 varus shift in FTA. By contrast, K\u2013L\u2009\u2264\u20092 groups showed no significant change in MPTA, whereas FTA showed a slight varus shift with a modest JLCA increase. In all subgroups, FTA change correlated with changes in aLDFA (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.48\u20130.54), MPTA (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u2009\u22120.55 to \u22120.46) and JLCA (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.21\u20130.48), with all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Coronal alignment shifted slightly toward varus over 5 years. In advanced OA, progression reflected a decreased MPTA and increased JLCA, with a modest aLDFA increase.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level I, prognostic studies\u2014high\u2010quality prospective cohort study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ksa.70300","type":"journal-article","created":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T13:41:13Z","timestamp":1769694073000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Advanced radiographic osteoarthritis is associated with 5\u2010year coronal varus progression in alignment and bone morphology in a community\u2010based cohort of older adults"],"prefix":"10.1002","author":[{"given":"Yugo (\u60a0\u543e)","family":"Morita","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, 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