{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T23:30:39Z","timestamp":1777419039862,"version":"3.51.4"},"reference-count":35,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2021,5,27]],"date-time":"2021-05-27T00:00:00Z","timestamp":1622073600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2021,5,27]],"date-time":"2021-05-27T00:00:00Z","timestamp":1622073600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"},{"start":{"date-parts":[[2021,5,27]],"date-time":"2021-05-27T00:00:00Z","timestamp":1622073600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>To report the early clinical and radiographic outcomes of custom total knee arthroplasty (TKA) in knees that had prior osteotomies and\/or extra\u2010articular fracture sequelae.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The authors retrospectively analysed a consecutive series of 444\u00a0knees that received custom TKA between 2016 and 2019 and identified 41\u00a0knees that had prior extra\u2010articular events (osteotomies or fracture sequelae). Patients responded to pre\u2010 and post\u2010operative (&gt;\u200912\u00a0months) questionnaires, including Knee Society Score (KSS), Oxford Knee Score (OKS), Forgotten Joint Score (FJS) and Knee injury and Osteoarthritis Outcome Score (KOOS). Net improvements were calculated by subtracting pre\u2010 from post\u2010operative scores. In addition to a preoperative CT scan, pre\u2010 and post\u2010operative long\u2010leg weight\u2010bearing radiographs were obtained, on which the hip\u2013knee\u2013ankle (HKA) angle, femoral mechanical angle (FMA, between femoral mechanical axis and joint line) and tibial mechanical angle (TMA, between tibial mechanical axis and joint line) angles were measured, and alignment was planned within a \u2018target zone\u2019 of FMA and TMA within 85\u00b0\u201395\u00b0 and HKA angle within 175\u00b0\u2013183\u00b0. Agreements between preoperative, planned and post\u2010operative angles were calculated using intra\u2010class correlation coefficients (ICC).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>From the initial 41\u00a0knees, 3 had incomplete post\u2010operative data and 1 was revised for painful stiffness due to uncorrected rotational malunion, leaving 37\u00a0knees for analysis. Twenty had prior osteotomies (tibia, <jats:italic>n<\/jats:italic>\u2009=\u200918, femur, <jats:italic>n<\/jats:italic>\u2009=\u20092), 8 had isolated fractures (tibial, <jats:italic>n<\/jats:italic>\u2009=\u20093; femoral, <jats:italic>n<\/jats:italic>\u2009=\u20095), and 9 had both osteotomies and fractures. Postoperative coronal alignments were 90.4\u00b0\u2009\u00b1\u20092.4\u00b0 for FMA, 89.3\u00b0\u2009\u00b1\u20092.6\u00b0 for TMA and 179.9\u00b0\u2009\u00b1\u20093.0\u00b0 for HKA angle. Agreements between planned and achieved alignments were fair to excellent, and 29 (78%) knees were within the \u2018target zone\u2019. At a mean follow\u2010up of 15\u2009\u00b1\u20095\u00a0months, all clinical scores had improved significantly (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Custom TKA granted satisfactory clinical outcomes and a low complication rate in knees that had prior osteotomies and\/or extra\u2010articular fracture sequelae. Using custom implants and strategies for coronal alignment, 29 (78%) of the 37\u00a0knees were successfully aligned within the \u2018target zone\u2019, and 35 (95%) of the 41\u00a0knees did not require ligament release.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>IV.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-021-06619-3","type":"journal-article","created":{"date-parts":[[2021,5,26]],"date-time":"2021-05-26T22:02:40Z","timestamp":1622066560000},"page":"1212-1219","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Custom TKA enables adequate realignment with minimal ligament release and grants satisfactory outcomes in knees that had prior osteotomies or extra\u2010articular fracture sequelae"],"prefix":"10.1002","volume":"31","author":[{"given":"Jeremy","family":"Daxhelet","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> Ramsay Sant\u00e9, H\u00f4pital Priv\u00e9 Jean Mermoz Centre Orthop\u00e9dique Santy Lyon France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tarik","family":"A\u00eft\u2010Si\u2010Selmi","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Ramsay Sant\u00e9, H\u00f4pital Priv\u00e9 Jean Mermoz Centre Orthop\u00e9dique Santy Lyon France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacobus H.","family":"M\u00fcller","sequence":"additional","affiliation":[{"name":"<!--<label>2<\/label>--> ReSurg SA Rue Saint\u2010Jean 22 1260 Nyon Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9656-987X","authenticated-orcid":false,"given":"Mo","family":"Saffarini","sequence":"additional","affiliation":[{"name":"<!--<label>2<\/label>--> ReSurg SA Rue Saint\u2010Jean 22 1260 Nyon Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Salvatore","family":"Ratano","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Ramsay Sant\u00e9, H\u00f4pital Priv\u00e9 Jean Mermoz Centre Orthop\u00e9dique Santy Lyon France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Louka","family":"Bondoux","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Ramsay Sant\u00e9, H\u00f4pital Priv\u00e9 Jean Mermoz Centre Orthop\u00e9dique Santy Lyon France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kalin","family":"Mihov","sequence":"additional","affiliation":[{"name":"<!--<label>3<\/label>--> University Hospital \u201cSaint Marina\u201d Varna Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michel P.","family":"Bonnin","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Ramsay Sant\u00e9, H\u00f4pital Priv\u00e9 Jean Mermoz Centre 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March 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 May 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 May 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"JD has nothing to declare. TASS reports personal fees from DePuy-Synthes and from Symbios. JHM has nothing to declare. MS has nothing to declare. SR has nothing to declare. LB has nothing to decalre. KM has nothing to declare. MPB reports personal fees from DePuy Synthes, Wright Medical, Integra and Symbios.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"All patients had provided written informed consent for the use of their data and images for research and publishing purposes and the institutional review board approved the study in advance (IRB reference number: COS-RGDS-2021-01-003-AITSISELMI-T; Ramsay Sante\u0301 Comite\u0301 d\u2019Ethique).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}