{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T20:24:00Z","timestamp":1793910240658,"version":"4.8.0"},"reference-count":54,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2021,8,19]],"date-time":"2021-08-19T00:00:00Z","timestamp":1629331200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2021,8,19]],"date-time":"2021-08-19T00:00:00Z","timestamp":1629331200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springer.com\/tdm"},{"start":{"date-parts":[[2021,8,19]],"date-time":"2021-08-19T00:00:00Z","timestamp":1629331200000},"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>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To achieve a higher level of satisfaction in patients having undergone Total Knee Arthroplasty (TKA), a more personalized approach has been discussed recently. It can be assumed that a more profound knowledge of bony morphology and ligamentous situation would be beneficial. While CT\/MRI can give 3D information on bone morphology, the understanding of the ligamentous situation in different flexion angles is still incomplete. In this study, the dynamic gap widths of a large number of varus knees were assessed in various flexion angles, to find out whether all varus knees behave similar or have more individual soft tissue patterns. Additionally, it was investigated whether the amount of varus deformity or other patient factors have an effect on joint gap widths.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A series of 1000 consecutive TKA patients, including their CAS data and patient records were analyzed. Joint gap widths in multiple flexion angles (0\u00b0, 30\u00b0, 60\u00b0, 90\u00b0) were measured in mm and differences between the joint gaps were compared. A \u201cstandard\u201d varus knee was defined as follows: (1) Lateral extension gap greater than medial, (2) lateral flexion gap greater than medial, and (3) flexion gap greater than extension gap. The percentage of fulfillment was tested for each and all criteria. To measure the influence of varus deformity on gap width difference, three subgroups were formed based on the deformity. Data were analyzed at 0\u00b0, 30\u00b0, 60\u00b0 and 90\u00b0 flexion. The effect of patient factors (gender, BMI, age) on gap sizes was tested by performing subgroup analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Only 444 of 680 (65%) patients met all three varus knee criteria. The lateral extension gap (4.1\u00a0mm) was significantly larger than the medial extension gap (0.6\u00a0mm) in 657 (97%) patients and the gap difference highly correlated with the amount of varus deformity (\n                      <jats:italic>r<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090.62). In all flexion positions, however, no correlation between gap differences and varus deformity existed. Women had significantly larger extension and flexion gaps. Age and BMI showed no significant effect on gap widths.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Varus knees show a large inter\u2010individual variability regarding gap widths and gap differences. The amount of varus deformity correlates highly with the medio\u2010lateral gap difference in extension, but not in any flexion angle. As varus knees are not all alike, a uniform surgical technique will not treat all varus knees adequately and the individual gap sizes need to be analyzed and addressed accordingly with an individualized balancing technique. Which final balancing goal should be achieved needs to be analyzed in future studies.<\/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":"10.1007\/s00167-021-06688-4","type":"journal-article","created":{"date-parts":[[2021,8,19]],"date-time":"2021-08-19T13:34:38Z","timestamp":1629380078000},"page":"2600-2608","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":83,"title":["A single type of varus knee does not exist: morphotyping and gap analysis in varus OA"],"prefix":"10.1002","volume":"30","author":[{"given":"Heiko","family":"Graichen","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> Department for Arthroplasty, Sports\u2010Traumatology and General Orthopaedics Asklepios Orthopaedic Hospital Lindenlohe Lindenlohe 18 92421 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Kopfzentrum, Acqua Clinics Acqua Medical Group K\u00e4the Kollwitz Stra\u00dfe 64 04109 Leipzig Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael T.","family":"Hirschmann","sequence":"additional","affiliation":[{"name":"<!--<label>4<\/label>--> Department of Orthopaedic Surgery and Traumatology Kantonsspital Baselland M\u00fchlemattstrasse 26 4410 Liestal Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolfgang","family":"Scior","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department for Arthroplasty, Sports\u2010Traumatology and General Orthopaedics Asklepios Orthopaedic Hospital Lindenlohe Lindenlohe 18 92421 Schwandorf 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Hirschmann, Wolfgang Scior) confirms that he or she has no commercial affiliations that could constitute a conflict of interest in connection with the submitted article.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and its later amendments. Our evaluations were written exclusively in anonymized form and applicable data protection regulations were observed.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Written consent of all patients for data collection was obtained prior to Hospital entry.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}