{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T03:01:51Z","timestamp":1783479711595,"version":"3.55.0"},"reference-count":34,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2021,7,20]],"date-time":"2021-07-20T00:00:00Z","timestamp":1626739200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2021,7,20]],"date-time":"2021-07-20T00:00:00Z","timestamp":1626739200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springer.com\/tdm"},{"start":{"date-parts":[[2021,7,20]],"date-time":"2021-07-20T00:00:00Z","timestamp":1626739200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/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":[[2022,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>Recommendations for resecting distal femur and proximal tibia in mechanical and anatomical alignment techniques are standardized. Kinematic alignment propagates individualizing resection planes. Whether significant variation exists, to warrant departure from standardized resection planes, has not been shown thus far in a large cohort of knees and with a wide range of varus deformity. The null hypothesis of this study was that there was no phenotypic variation in varus osteoarthritic knees. The aim of this paper was to determine whether distinct phenotypes could be identified, based on variations in coronal femoral and tibial morphology, which could aid in surgical planning and categorizing varus knees for future studies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>2129 full\u2010leg weightbearing radiographs were analyzed (1704 preoperative; 425 of contralateral arthritic knee). Measurements made were of HKA (hip\u2010knee\u2010ankle angle), VCA (valgus correction angle), mLDFA (lateral mechanical distal femoral angle), aLDFA (lateral anatomical distal femoral angle), MPTA (medial proximal tibial angle), MNSA (medial neck shaft angle), TAMA (angle between tibial mechanical and anatomical axes), and TPDR (percentage length of tibia proximal to extra\u2010articular deformity).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Seven distinct types were identified covering 2021\u00a0knees, reducible to 4 broad phenotypes: 11% were Type 1 \u2018Neutral\u2019 knees showing values close to reported normal knees (mean VCA 5.5\u00b0, mLDFA 87\u00b0, aLDFA 81\u00b0). 38% were Type 2 \u2018Intra\u2010articular varus\u2019 with medial intra\u2010articular bone loss (mean mLDFA 90.9\u00b0, MPTA 85.4\u00b0, VCA of 5.7\u00b0). 41% were Type 3 \u2018Extra\u2010articular varus\u2019 with extra\u2010articular deformity (EAD). Type 3a had proximal tibial EAD; Type 3b had tibial diaphyseal EAD; Type 3c had femoral EAD (mean VCA 8.7\u00b0, HKA 166\u00b0), and severe medial bone loss (mean mLDFA 92\u00b0, MPTA 83\u00b0). 9% were Type 4 \u2018Valgoid type\u2019 with features of valgus knees: Type 4a had medial femoral bowing (mean VCA 2.9\u00b0); Type 4b had significant distal femoral valgus (mean mLDFA 85.3\u00b0, aLDFA 78.6\u00b0).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The null hypothesis that there was no phenotypic variation in varus osteoarthritic knees was rejected as considerable variation was found in coronal morphology of femur and tibia. Four broad phenotypic groups could be identified. Plane of the knee joint articular surface was quite variable. This has relevance to planning and performance of corrective osteotomies, unicompartmental and total knee arthroplasty.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>III, retrospective cohort study.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-021-06676-8","type":"journal-article","created":{"date-parts":[[2021,7,20]],"date-time":"2021-07-20T14:02:36Z","timestamp":1626789756000},"page":"2793-2805","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":30,"title":["Seven phenotypes of varus osteoarthritic knees can be identified in the coronal plane"],"prefix":"10.1002","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6622-7860","authenticated-orcid":false,"given":"Arun","family":"Mullaji","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> Consultant Orthopaedic Surgeon, Breach Candy Hospital, and Mullaji Knee Clinic 400036 Mumbai 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May 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 July 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 July 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"RS RB AS MH and HT have nothing to disclose. AM is an educational consultant for DePuy and receives royalties from DePuy and Springer.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The local ethics committee approved our study protocol prior to investigation (number: P13\/20).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}