{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T00:32:57Z","timestamp":1760920377642,"version":"build-2065373602"},"reference-count":51,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2014,5,15]],"date-time":"2014-05-15T00:00:00Z","timestamp":1400112000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2014,5,15]],"date-time":"2014-05-15T00:00:00Z","timestamp":1400112000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2014,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>To prospectively investigate whether preoperative functional flexion axis in patients with osteoarthritis\u2010 and varus\u2010alignment changes after total knee arthroplasty and whether a correlation exists both between preoperative functional flexion axis and native limb deformity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A navigated total knee arthroplasty was performed in 108 patients using a specific software to acquire passive joint kinematics before and after implant positioning. The knee was cycled through three passive range of motions, from 0\u00b0 to 120\u00b0. Functional flexion axis was computed using the mean helical axis algorithm. The angle between the functional flexion axis and the surgical transepicondylar axis was determined on frontal (<jats:italic>\u03b1<\/jats:italic><jats:sup>F<\/jats:sup>) and axial (<jats:italic>\u03b1<\/jats:italic><jats:sup>A<\/jats:sup>) plane. The pre\u2010 and postoperative hip\u2010knee\u2010ankle angle, related to femur mechanical axis, was determined.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Postoperative functional flexion axis was different from preoperative only on frontal plane, while no differences were found on axial plane. No correlation was found between preoperative <jats:italic>\u03b1<\/jats:italic><jats:sup>A<\/jats:sup> and native limb deformity, while a poor correlation was found in frontal plane, between <jats:italic>\u03b1<\/jats:italic><jats:sup>F<\/jats:sup> and preoperative hip\u2010knee\u2010ankle angle.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Total knee arthroplasty affects functional flexion axis only on frontal plane while has no effect on axial plane. Preoperative functional flexion axis is in a more varus position respect to the transepicondylar axis both in pre\u2010 and postoperative conditions. Moreover, the position of the functional axis on frontal plane in preoperative conditions is dependent on native limb alignment, while on axial plane is not dependent on the amount of preoperative varus deformity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>IV.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-014-3054-x","type":"journal-article","created":{"date-parts":[[2014,5,14]],"date-time":"2014-05-14T10:59:08Z","timestamp":1400065148000},"page":"1728-1735","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Does total knee arthroplasty modify flexion axis of the knee?"],"prefix":"10.1002","volume":"22","author":[{"given":"F.","family":"Iacono","sequence":"first","affiliation":[{"name":"2nd Orthopaedics and Traumatologic Clinic Rizzoli Orthopaedic Institute Via Pupilli 1 40136 Bologna 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