{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T14:54:12Z","timestamp":1791384852690,"version":"4.3.3"},"reference-count":31,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["esskajournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To evaluate functional outcomes and implant survival following medial unicompartmental knee arthroplasty (UKA) in patients with anteromedial osteoarthritis and preoperative varus deformity \u226510\u00b0 and to identify postoperative alignment thresholds that optimize outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients with preoperative varus \u226510\u00b0 who underwent medial mobile\u2010bearing UKA were retrospectively analysed and matched 1:1 to knees with preoperative varus &lt;10\u00b0, yielding 132 pairs (264 knees) with similar baseline characteristics. Primary outcomes were revision rates and the Oxford Knee Score (OKS). Full\u2010length standing radiographs were used to measure the hip\u2013knee\u2013ankle angle (HKA), joint\u2010line convergence angle (JLCA), extra\u2010articular deformity (EAD), mechanical medial proximal tibial angle (mMPTA), mechanical lateral distal femoral angle (mLDFA) and joint\u2010line obliquity (JLO) and determine functional knee phenotypes. Univariate curve\u2010adjusted regression assessed the influence of alignment on OKS, and receiver operating characteristic (ROC) analysis defined the alignment range within which the Patient\u2010Acceptable Symptomatic State (PASS) was achieved.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      At a mean follow\u2010up of 10.1\u2009\u00b1\u20093.3 years, OKS did not differ between groups (40.6\u2009\u00b1\u20098.0 vs. 38.8\u2009\u00b1\u20095.7, n.s.), nor did revision\u2010free survival (92.3% vs. 90.2% at 10 years,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.618). In knees with preoperative varus \u226510\u00b0, postoperative JLCA correlated with OKS (\n                      <jats:italic>R<\/jats:italic>\n                      <jats:sup>2\u2009<\/jats:sup>\n                      =\u20090.43,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), whereas HKA, EAD, mMPTA, mLDFA and JLO showed no association (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&gt;\u20090.05). JLCA outside 0\u00b0\u20135\u00b0 varus yielded inferior OKS (35.6\u2009\u00b1\u200911.0 vs. 42.4\u2009\u00b1\u20096.2,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.022) and lower PASS achievement (33% vs. 70%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.011). Insert thickness \u22657\u2009mm was associated with lower OKS (32.1\u2009\u00b1\u200912.1 vs. 41.2\u2009\u00b1\u20095.9,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.004) and reduced PASS (30% vs. 81%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.046).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Medial UKA in knees with preoperative varus deformity \u226510\u00b0 achieved functional outcomes and implant survival comparable to matched knees with varus &lt;10\u00b0, provided postoperative JLCA is restored to 0\u00b0\u20135\u00b0 varus and excessive insert thickness is avoided. Intraoperative insert upsizing should prompt reassessment for ligamentous insufficiency or compartment overstuffing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level III.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ksa.70636","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T14:10:21Z","timestamp":1791382221000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Preoperative varus \u226510\u00b0 does not compromise outcome after medial unicompartmental knee arthroplasty, whereas postoperative joint\u2010line convergence angle and insert thickness influence functional results: A matched\u2010pair analysis"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2031-7411","authenticated-orcid":false,"given":"Johannes","family":"Weishorn","sequence":"first","affiliation":[{"name":"Department of Orthopaedics Heidelberg University Hospital, Ruprecht\u2010Karls\u2010University Heidelberg Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stella","family":"Bonnmann","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics Heidelberg University Hospital, Ruprecht\u2010Karls\u2010University Heidelberg Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3687-9830","authenticated-orcid":false,"given":"Raphael","family":"Trefzer","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics Heidelberg University Hospital, Ruprecht\u2010Karls\u2010University Heidelberg Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8715-4875","authenticated-orcid":false,"given":"Mustafa","family":"Hariri","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics Heidelberg University Hospital, Ruprecht\u2010Karls\u2010University Heidelberg Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9841-3000","authenticated-orcid":false,"given":"Paul","family":"Mick","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics Heidelberg University Hospital, Ruprecht\u2010Karls\u2010University Heidelberg Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5364-1552","authenticated-orcid":false,"given":"Andr\u00e9","family":"Lunz","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics Heidelberg University Hospital, Ruprecht\u2010Karls\u2010University Heidelberg Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9439-0841","authenticated-orcid":false,"given":"Tilman","family":"Walker","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics Heidelberg University Hospital, Ruprecht\u2010Karls\u2010University Heidelberg Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9876-2083","authenticated-orcid":false,"given":"Kevin\u2010Arno","family":"Koch","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics Heidelberg University Hospital, Ruprecht\u2010Karls\u2010University Heidelberg Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,7]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"crossref","first-page":"890","DOI":"10.1007\/s00167-021-06467-1","article-title":"Similar rates of return to sports and BMI reduction regardless of age, gender and preoperative BMI as seen in matched cohort of hypoallergenic and standard cobalt chromium medial unicompartmental knee arthroplasty","volume":"30","author":"D'Ambrosi R","year":"2022","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"e_1_2_13_3_1","doi-asserted-by":"crossref","first-page":"1251","DOI":"10.1016\/j.arth.2022.12.043","article-title":"Impact of proximal tibial varus anatomy on survivorship after medial unicondylar knee arthroplasty","volume":"38","author":"Erlichman RE","year":"2023","journal-title":"J 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the native alignment in young non\u2010osteoarthritic patients","volume":"27","author":"Hirschmann MT","year":"2019","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"e_1_2_13_10_1","doi-asserted-by":"crossref","first-page":"3324","DOI":"10.1002\/ksa.12703","article-title":"Cemented mobile\u2010bearing medial unicompartmental knee arthroplasty provides long\u2010term implant survival and sustained functional performance in young and active patients aged 60 or below","volume":"33","author":"Koch KA","year":"2025","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"e_1_2_13_11_1","doi-asserted-by":"crossref","DOI":"10.1002\/jeo2.70230","article-title":"Long\u2010term outcome of periprosthetic joint infection following unicompartmental knee arthroplasty: a single\u2010centre case series","volume":"12","author":"Koch KA","year":"2025","journal-title":"J Exp 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varus deformities greater than ten degrees: survival analysis at a mean ten year follow\u2010up","volume":"43","author":"Puliero B","year":"2019","journal-title":"Int Orthop"},{"key":"e_1_2_13_21_1","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.otsr.2018.11.005","article-title":"Kinematic alignment technique for medial OXFORD UKA: an in\u2010silico study","volume":"105","author":"Rivi\u00e8re C","year":"2019","journal-title":"Orthop Traumatol Surg Res"},{"key":"e_1_2_13_22_1","doi-asserted-by":"crossref","first-page":"608","DOI":"10.1002\/ksa.70019","article-title":"Kinematically aligned total knee arthroplasty is as effective in severe varus deformities as in mild deformities","volume":"34","author":"Sarzaeem MM","year":"2025","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"e_1_2_13_23_1","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1186\/s40634-023-00655-3","article-title":"Significant correlations between postoperative outcomes and various limb and component alignment strategies in medial unicompartmental knee arthroplasty: a systematic review","volume":"10","author":"Sava MP","year":"2023","journal-title":"J Exp Orthop"},{"key":"e_1_2_13_24_1","doi-asserted-by":"crossref","first-page":"4303","DOI":"10.1002\/ksa.12779","article-title":"Medial unicompartmental knee arthroplasty after knee osteotomy is safe and effective in the absence of excessive valgus overcorrection","volume":"33","author":"Schweizer C","year":"2025","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"e_1_2_13_25_1","doi-asserted-by":"crossref","first-page":"5597","DOI":"10.1038\/s41598-024-56285-x","article-title":"Factors predicting lower limb alignment after Oxford medial unicompartmental knee arthroplasty","volume":"14","author":"Shih HT","year":"2024","journal-title":"Sci Rep"},{"key":"e_1_2_13_26_1","doi-asserted-by":"crossref","first-page":"1869","DOI":"10.1007\/s00264-025-06563-8","article-title":"Imageless 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Exp Orthop"},{"key":"e_1_2_13_29_1","first-page":"265","article-title":"[Successful medial unicompartmental knee arthroplasty\u2010What are the most important surgical tricks?]","volume":"53","author":"Waldstein W","year":"2024","journal-title":"Orthopadie (Heidelberg, Germany)"},{"key":"e_1_2_13_30_1","doi-asserted-by":"crossref","first-page":"1658","DOI":"10.1007\/s00167-018-5299-2","article-title":"Minimally invasive Oxford unicompartmental knee arthroplasty ensures excellent functional outcome and high survivorship in the long term","volume":"27","author":"Walker T","year":"2019","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"e_1_2_13_31_1","doi-asserted-by":"crossref","first-page":"1748","DOI":"10.1007\/s00167-014-3240-x","article-title":"Downhill walking gait pattern discriminates between types of knee arthroplasty: improved physiological knee functionality in UKA versus TKA","volume":"23","author":"Wiik AV","year":"2015","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"e_1_2_13_32_1","doi-asserted-by":"crossref","first-page":"5477","DOI":"10.1007\/s00167-023-07599-2","article-title":"Image\u2010based robotic\u2010arm assisted unicompartmental knee arthroplasty provides high survival and good\u2010to\u2010excellent clinical outcomes at minimum 10 years follow\u2010up","volume":"31","author":"Zambianchi F","year":"2023","journal-title":"Knee Surg Sports Traumatol Arthrosc"}],"container-title":["Knee Surgery, Sports Traumatology, 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