{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T04:28:02Z","timestamp":1782880082689,"version":"3.54.5"},"reference-count":28,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2021,11,9]],"date-time":"2021-11-09T00:00:00Z","timestamp":1636416000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2021,11,9]],"date-time":"2021-11-09T00:00:00Z","timestamp":1636416000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springer.com\/tdm"},{"start":{"date-parts":[[2021,11,9]],"date-time":"2021-11-09T00:00:00Z","timestamp":1636416000000},"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":[[2022,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>It is not shown whether anatomical variations exist in valgus arthritic limbs as to support individualized component and limb alignment. The null hypothesis was that there was no phenotypic variation of coronal femoro\u2010tibial morphology in valgus knees. The aim was to determine whether distinct phenotypes of valgus knees could be identified to help surgical planning and classifying valgus knees for outcome studies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Full\u2010leg weight\u2010bearing radiographs of 233\u00a0knees (182 preoperative; 51 of contralateral arthritic knee) were measured for 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 TBA (tibial bowing angle).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Nine phenotypes were identified encompassing all 233\u00a0knees which could be clubbed into 4 broad types. Type 1\u00a0Neutral knees (12.5%) had almost normal values (mean VCA 5.3\u00b0, mLDFA 86.9\u00b0, aLDFA 81.1\u00b0). Type 2 \u2018Intra\u2010articular valgus\u2019 (22.7%) showed lateral compartment bone loss (mean mLDFA 83.9\u00b0; MPTA 90.2\u00b0). Type 3 \u2018Extra\u2010articular valgus\u2019 (35.2%) had extra\u2010articular deformity: 3a showed valgus femoral bowing (mean VCA 2.7\u00b0); 3b valgus tibial bowing; 3c showed valgus tibial bowing with lateral femoral condyle wear (mean mLDFA 84.3\u00b0). Type 4 \u2018Varus\u2019 type (29.6%) had features of varus knees: 4a had varus femoral bowing (VCA 8.3\u00b0); distal femur in 4b was akin to varus knees (mean mLDFA 89.3\u00b0) with lateral tibial bone loss (mean MPTA 91.2\u00b0). 4c had varus tibial bowing and deficient lateral femoral condyle (mLDFA 83.7\u00b0). 4d had varus tibial bowing and lateral tibial bone loss (mean MPTA 89.8\u00b0).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The study identified four broad groups of valgus arthritic knees with nine phenotypes based on coronal plane variations in femoro\u2010tibial morphology. This study may be of value in planning and performing corrective osteotomies, and planning the optimal position of femoral and tibial components in unicompartmental and total knee arthroplasty. The classification presented in this study may aid in categorizing valgus knees for outcome studies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>IV.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-021-06796-1","type":"journal-article","created":{"date-parts":[[2021,11,9]],"date-time":"2021-11-09T00:00:22Z","timestamp":1636416022000},"page":"2895-2904","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":30,"title":["Valgus arthritic knees can be classified into nine phenotypes"],"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 Bhulabhai Desai Road 400036 Mumbai India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ritesh","family":"Bhoskar","sequence":"additional","affiliation":[{"name":"<!--<label>2<\/label>--> Associate Orthopaedic Surgeon, Mullaji Knee Clinic 400036 Mumbai India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhimanyu","family":"Singh","sequence":"additional","affiliation":[{"name":"<!--<label>2<\/label>--> Associate Orthopaedic Surgeon, Mullaji Knee Clinic 400036 Mumbai India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Murtaza","family":"Haidermota","sequence":"additional","affiliation":[{"name":"<!--<label>3<\/label>--> Fellow in Arthroplasty Breach Candy Hospital 400036 Mumbai India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,11,9]]},"reference":[{"key":"e_1_2_10_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2017.02.028"},{"key":"e_1_2_10_3_2","doi-asserted-by":"publisher","DOI":"10.1055\/s\u20100037\u20101603340"},{"key":"e_1_2_10_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2017.09.018"},{"key":"e_1_2_10_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.otsr.2009.04.005"},{"key":"e_1_2_10_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010019\u201005509\u2010z"},{"key":"e_1_2_10_7_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11420\u2010017\u20109576\u20102"},{"key":"e_1_2_10_8_2","doi-asserted-by":"publisher","DOI":"10.1136\/ard.16.4.494"},{"key":"e_1_2_10_9_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00264\u2010016\u20103340\u2010y"},{"key":"e_1_2_10_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010017\u20104558\u2010y"},{"key":"e_1_2_10_11_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12891\u2010018\u20102335\u20109"},{"key":"e_1_2_10_12_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301\u2010620X.103B2.BJJ\u20102020\u20101050.R1"},{"key":"e_1_2_10_13_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010018\u20105331\u20106"},{"key":"e_1_2_10_14_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010020\u201006030\u20104"},{"key":"e_1_2_10_15_2","first-page":"1","article-title":"The effect of knee joint rotation in the sagittal and axial plane on the measurement accuracy of coronal alignment of the lower limb","volume":"9","author":"Moon H","year":"2020","journal-title":"BMC Musculoskelet Disord"},{"key":"e_1_2_10_16_2","doi-asserted-by":"crossref","unstructured":"MullajiA ShahR BhoskarR SinghA HaidermotaM ThakurHSeven phenotypes of varus osteoarthritic knees can be identified in the coronal plane.Knee Surg Sport Traumatol Arthrosc(2021)10.1007\/s00167\u2010021\u201006676\u20108","DOI":"10.1007\/s00167-021-06676-8"},{"key":"e_1_2_10_17_2","unstructured":"MullajiAB KhalifaAA ShettyG OrthMS ThakurHComparison with navigation of a novel three\u2010step technique for improving accuracy of the distal femoral resection during conventional TKA: a case\u2010control study.J Knee Surg(2021)10.1055\/s\u20100041\u2010173145834237781"},{"key":"e_1_2_10_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2009.06.013"},{"key":"e_1_2_10_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2012.04.014"},{"key":"e_1_2_10_20_2","doi-asserted-by":"publisher","DOI":"10.5005\/jp\/books\/11661_1"},{"key":"e_1_2_10_21_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623\u2010200412000\u201000013"},{"key":"e_1_2_10_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.otsr.2017.07.010"},{"key":"e_1_2_10_23_2","doi-asserted-by":"crossref","unstructured":"Sappey\u2010MarinierE BataillerC SwanJ MalatrayM ChezeL ServienEet al. Primary osteoarthritic knees have more varus coronal alignment of the femur compared to young non\u2010arthritic knees in a large cohort study.Knee Surg Sport Traumatol Arthrosc(2020)10.1007\/s00167\u2010020\u201006083\u20105","DOI":"10.1007\/s00167-020-06083-5"},{"key":"e_1_2_10_24_2","doi-asserted-by":"publisher","DOI":"10.5792\/ksrr.17.003"},{"key":"e_1_2_10_25_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010014\u20103496\u20101"},{"key":"e_1_2_10_26_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010019\u201005734\u20106"},{"key":"e_1_2_10_27_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00402\u2010017\u20102626\u2010x"},{"key":"e_1_2_10_28_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010017\u20104570\u20102"},{"key":"e_1_2_10_29_2","doi-asserted-by":"publisher","DOI":"10.1177\/230949900701500108"}],"container-title":["Knee Surgery, Sports Traumatology, Arthroscopy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00167-021-06796-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00167-021-06796-1\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00167-021-06796-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"},{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1007\/s00167-021-06796-1","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,19]],"date-time":"2025-10-19T08:56:34Z","timestamp":1760864194000},"score":1,"resource":{"primary":{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/10.1007\/s00167-021-06796-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,9]]},"references-count":28,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2022,9]]}},"alternative-id":["10.1007\/s00167-021-06796-1"],"URL":"https:\/\/doi.org\/10.1007\/s00167-021-06796-1","archive":["Portico"],"relation":{},"ISSN":["0942-2056","1433-7347"],"issn-type":[{"value":"0942-2056","type":"print"},{"value":"1433-7347","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,9]]},"assertion":[{"value":"11 August 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 October 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 November 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":"RB AS and MH 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":"Institutional Ethics Committee approval: (Number P13\/20).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Taken from all patients.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}