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The hypothesis was that different amounts of bone resection would be required depending on the alignment strategy chosen. Through visualisation of the corresponding bone sections, it was hypothesised, it would be possible to assess which of the different alignment strategies would require the least amount of change to the soft tissues for the chosen phenotype, whilst still ensuring acceptable alignment of the components, and thus could be considered the most ideal alignment strategy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Simulations of the different alignment strategies (mechanical, anatomical, constrained kinematic and unconstrained kinematic) in relation to their bone resections were performed on five common exemplary varus knee phenotypes. VAR<jats:sub>HKA<\/jats:sub>174\u00b0 VAR<jats:sub>FMA<\/jats:sub>87\u00b0 VAR<jats:sub>TMA<\/jats:sub>84\u00b0, VAR<jats:sub>HKA<\/jats:sub>174\u00b0 VAR<jats:sub>FMA<\/jats:sub>90\u00b0 NEU<jats:sub>TMA<\/jats:sub>87\u00b0, VAR<jats:sub>HKA<\/jats:sub>174\u00b0 NEU<jats:sub>FMA<\/jats:sub>93\u00b0 VAR<jats:sub>TMA<\/jats:sub>84\u00b0<jats:italic>,<\/jats:italic> VAR<jats:sub>HKA<\/jats:sub>177\u00b0 NEU<jats:sub>FMA<\/jats:sub>93\u00b0 NEU<jats:sub>TMA<\/jats:sub>87\u00b0 and VAR<jats:sub>HKA<\/jats:sub>177\u00b0 VAL<jats:sub>FMA<\/jats:sub>96\u00b0 VAR<jats:sub>TMA<\/jats:sub>81\u00b0. The phenotype system used categorises knees based on overall limb alignment (i.e. hip knee angle) but also takes into account joint line obliquity (i.e. TKA and FMA) and has been applied in the global orthopaedic community since its introduction in 2019. The simulations are based on long\u2010leg radiographs under load. It is assumed that a change of 1\u00b0 in the alignment of the joint line corresponds to a displacement of the distal condyle by 1\u00a0mm.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In the most common phenotype VAR<jats:sub>HKA<\/jats:sub>174\u00b0 NEU<jats:sub>FMA<\/jats:sub>93\u00b0 VAR<jats:sub>TMA<\/jats:sub>84\u00b0, a mechanical alignment would result in an asymmetric elevation of the tibial medial joint line by 6\u00a0mm and a lateral distalisation of the femoral condyle by 3\u00a0mm, an anatomical alignment only by 0 and 3\u00a0mm, a restricted by 3 and 3\u00a0mm, respectively, whilst a kinematic alignment would result in no change in joint line obliquity. In the similarly common phenotype 2 VAR<jats:sub>HKA<\/jats:sub>174\u00b0 VAR<jats:sub>FMA<\/jats:sub>90\u00b0 NEU<jats:sub>TMA<\/jats:sub>87\u00b0 with the same HKA, the changes are considerably less with only 3\u00a0mm asymmetric height change on one joint side, respectively, and no change in restricted or kinematic alignment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study shows that significantly different amounts of bone resection are required depending on the varus phenotype and the alignment strategy chosen. Based on the simulations performed, it can, therefore, be assumed that an individual decision for the respective phenotype is more important than the dogmatically correct alignment strategy. By including such simulations, the modern orthopaedic surgeon can now avoid biomechanically inferior alignments and still obtain the most natural possible knee alignment for the patient.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-023-07351-w","type":"journal-article","created":{"date-parts":[[2023,2,22]],"date-time":"2023-02-22T04:04:33Z","timestamp":1677038673000},"page":"1840-1850","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":58,"title":["The impact of different alignment strategies on bone cuts in total knee arthroplasty for varus knee phenotypes"],"prefix":"10.1002","volume":"31","author":[{"given":"Benjamin L.","family":"Schelker","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopedic Surgery and Traumatology Kantonsspital Baselland 4101 Bruderholz Switzerland"},{"name":"<!--<label>2<\/label>--> Department of Clinical Research, Research Group Michael T. Hirschmann, Regenerative Medicine and Biomechanics University of Basel 4001 Basel Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C\u00e9line S.","family":"Moret","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopedic Surgery and Traumatology Kantonsspital Baselland 4101 Bruderholz Switzerland"},{"name":"<!--<label>2<\/label>--> Department of Clinical Research, Research Group Michael T. Hirschmann, Regenerative Medicine and Biomechanics University of Basel 4001 Basel Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel P.","family":"Sava","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopedic Surgery and Traumatology Kantonsspital Baselland 4101 Bruderholz Switzerland"},{"name":"<!--<label>2<\/label>--> Department of Clinical Research, Research Group Michael T. 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