{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T09:20:34Z","timestamp":1758273634328,"version":"3.37.3"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,2,4]],"date-time":"2021-02-04T00:00:00Z","timestamp":1612396800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,2,4]],"date-time":"2021-02-04T00:00:00Z","timestamp":1612396800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["51323007"],"award-info":[{"award-number":["51323007"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>For pre-operative osteoarthritis (OA) patients with varus knee, previous studies showed inconsistent results. Therefore, we conducted this study to better identify the association of Hospital for Special Surgery (HSS) score and mechanical alignment. 44 patients (51 knees) with constitutional varus knee caused by combined deformities (LDFA (lateral distal femoral angle)\u2009&gt;\u200990\u00b0and MPTA (medial proximal tibial angle)\u2009&lt;\u200985\u00b0)) were selected and analyzed with a mean follow-up period of 14\u00a0months after total knee arthroplasty (TKA). From January 2015 to December 2016, patients were collected consecutively after primary TKA. After filtering, fifty-one knees (44patients) were analyzed with a mean follow-up period of 14\u00a0months. All patients were divided into two groups based on post-operative hip-knee-ankle (HKA) acute angle: varus mechanical alignment (VMA) group (HKA\u2009&lt;\u2009\u2212 3\u00b0) and neutral mechanical axis (NMA) group (\u2212 3\u00b0\u2009\u2264\u2009HKA\u2009\u2264\u20093\u00b0). 30 knees were included in the NMA group, and 21 knees in the VMA group. Comparisons of HSS between NMA group and VMA group were performed. After adjusting for age and Body Mass Index (BMI) confounders, Compared with NMA group, the HSS score in VMA group decreased by 0.81 units (95% CI, \u2212 3.37 to 1.75) <jats:italic>p<\/jats:italic>\u2009=\u20090.5370). For pre-operative constitutional varus knee caused by combined deformities in chinese populations, no significant association between post-operative lower limb mechanical alignment and HSS score was found.<\/jats:p>","DOI":"10.1038\/s41598-021-81285-6","type":"journal-article","created":{"date-parts":[[2021,2,4]],"date-time":"2021-02-04T11:08:10Z","timestamp":1612436890000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Association of HSS score and mechanical alignment after primary TKA of patients suffering from constitutional varus knee that caused by combined deformities: a retrospective study"],"prefix":"10.1038","volume":"11","author":[{"given":"Zhifeng","family":"Zhang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei","family":"Chai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guanghui","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qida","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhenxian","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xinyao","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pingping","family":"Wei","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yanwei","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhongmin","family":"Jin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yusheng","family":"Qiu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,2,4]]},"reference":[{"key":"81285_CR1","doi-asserted-by":"publisher","first-page":"173","DOI":"10.2106\/00004623-197961020-00003","volume":"61","author":"J Insall","year":"1979","unstructured":"Insall, J., Scott, W. N. & Ranawat, C. S. The total condylar knee prosthesis. A report of two hundred and twenty cases. J. Bone Jt. Surg. 61, 173\u2013180 (1979).","journal-title":"J. Bone Jt. Surg."},{"key":"81285_CR2","doi-asserted-by":"publisher","first-page":"709","DOI":"10.1302\/0301-620X.73B5.1894655","volume":"73","author":"RS Jeffery","year":"1991","unstructured":"Jeffery, R. S., Morris, R. W. & Denham, R. A. Coronal alignment after total knee replacement. J. Bone Jt. Surg. 73, 709\u2013714 (1991).","journal-title":"J. Bone Jt. Surg."},{"key":"81285_CR3","doi-asserted-by":"publisher","first-page":"857","DOI":"10.1302\/0301-620X.96B7.33946","volume":"96-B","author":"MP Abdel","year":"2014","unstructured":"Abdel, M. P. et al. Coronal alignment in total knee replacement: historical review, contemporary analysis, and future direction. Bone Jt. J. 96-B, 857 (2014).","journal-title":"Bone Jt. J."},{"key":"81285_CR4","doi-asserted-by":"publisher","first-page":"1052","DOI":"10.1302\/0301-620X.96B8.33747","volume":"410","author":"E Thienpont","year":"2014","unstructured":"Thienpont, E., Schwab, P. E. & Fennema, P. J. B. J. J. A systematic review and meta-analysis of patient-specific instrumentation for improving alignment of the components in total knee replacement. Bone Jt. J. 410, 1052\u20131061 (2014).","journal-title":"Bone Jt. J."},{"key":"81285_CR5","doi-asserted-by":"crossref","unstructured":"Insall, J. J. C. O. & Research, R. Rationale of the Knee Society clinical rating system. 248 (1989).","DOI":"10.1097\/00003086-198911000-00004"},{"key":"81285_CR6","first-page":"261","volume":"9","author":"APJK Davies","year":"2002","unstructured":"Davies, A. P. J. K. Rating systems for total knee replacement. Orthopedics 9, 261\u2013266 (2002).","journal-title":"Orthopedics"},{"key":"81285_CR7","first-page":"184","volume":"399","author":"CM Bach","year":"2002","unstructured":"Bach, C. M. et al. Scoring systems in total knee arthroplasty. Bone Jt. J. 399, 184 (2002).","journal-title":"Bone Jt. J."},{"key":"81285_CR8","doi-asserted-by":"publisher","first-page":"7","DOI":"10.4103\/2152-7806.76144","volume":"2","author":"BP Walcott","year":"2011","unstructured":"Walcott, B. P., Hanak, B. W., Caracci, J. R., Redjal, N. & Coumans, J. V. C. E. J. S. N. I. Trends in inpatient setting laminectomy for excision of herniated intervertebral disc: Population-based estimates from the US nationwide inpatient sample. Surg. Neurol. Int. 2, 7 (2011).","journal-title":"Surg. Neurol. Int."},{"key":"81285_CR9","doi-asserted-by":"crossref","unstructured":"Bourne, R. B., Chesworth, B. M., Davis, A. M., Mahomed, N. N. & Charron, K. D. J. Patient satisfaction after total knee arthroplasty: Who is satisfied and who is not? 468, 57\u201363.","DOI":"10.1007\/s11999-009-1119-9"},{"key":"81285_CR10","doi-asserted-by":"crossref","unstructured":"Robertsson, O., Dunbar, M., Pehrsson, T. r., Knutson, K. & Lidgren, L. J. A. O. Patient satisfaction after knee arthroplasty: A report on 27,372 knees operated on between 1981 and 1995 in Sweden. 71, 262\u2013267.","DOI":"10.1080\/000164700317411852"},{"key":"81285_CR11","doi-asserted-by":"crossref","unstructured":"Scott, C. E. H., Howie, C. R., MacDonald, D., Biant, L. C. J. J. o. B. & Volume, J. S. B. Predicting dissatisfaction following total knee replacement: A prospective study of 1217 patients. 92-B, 1253\u20131258.","DOI":"10.1302\/0301-620X.92B9.24394"},{"key":"81285_CR12","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1007\/s11999-011-1936-5","volume":"470","author":"J Bellemans","year":"2012","unstructured":"Bellemans, J., Colyn, W., Vandenneucker, H. & Victor, J. The Chitranjan Ranawat award: Is neutral mechanical alignment normal for all patients? The concept of constitutional varus. Clin. Orthop. Relat. Res. 470, 45\u201353. https:\/\/doi.org\/10.1007\/s11999-011-1936-5 (2012).","journal-title":"Clin. Orthop. Relat. Res."},{"key":"81285_CR13","doi-asserted-by":"publisher","first-page":"2873","DOI":"10.1007\/s00167-016-3994-4","volume":"25","author":"P Vandekerckhove","year":"2017","unstructured":"Vandekerckhove, P. et al. The relationship between constitutional alignment and varus osteoarthritis of the knee. Knee Surg. Sports Traumatol. Arthrosc. 25, 2873\u20132879. https:\/\/doi.org\/10.1007\/s00167-016-3994-4 (2017).","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."},{"key":"81285_CR14","doi-asserted-by":"publisher","first-page":"2325","DOI":"10.1007\/s00167-013-2481-4","volume":"21","author":"L Vanlommel","year":"2013","unstructured":"Vanlommel, L., Vanlommel, J., Claes, S. & Bellemans, J. Slight undercorrection following total knee arthroplasty results in superior clinical outcomes in varus knees. Knee Surg. Sports Traumatol. Arthrosc. 21, 2325\u20132330. https:\/\/doi.org\/10.1007\/s00167-013-2481-4 (2013).","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."},{"key":"81285_CR15","doi-asserted-by":"publisher","first-page":"1506","DOI":"10.1007\/s00167-017-4507-9","volume":"26","author":"RD Rames","year":"2018","unstructured":"Rames, R. D., Mathison, M., Meyer, Z., Barrack, R. L. & Nam, D. No impact of under-correction and joint line obliquity on clinical outcomes of total knee arthroplasty for the varus knee. Knee Surg. Sports Traumatol. Arthrosc. 26, 1506\u20131514. https:\/\/doi.org\/10.1007\/s00167-017-4507-9 (2018).","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."},{"key":"81285_CR16","doi-asserted-by":"crossref","unstructured":"Nishida, K. et al. Remaining mild varus limb alignment leads to better clinical outcome in total knee arthroplasty for varus osteoarthritis. (2016).","DOI":"10.1007\/s00167-016-4260-5"},{"key":"81285_CR17","first-page":"471","volume":"81","author":"E Thienpont","year":"2015","unstructured":"Thienpont, E., Cornu, O., Bellemans, J. & Victor, J. Current opinions about coronal plane alignment in total knee arthroplasty: A survey article. Acta Orthop. Belg. 81, 471\u2013477 (2015).","journal-title":"Acta Orthop. Belg."},{"key":"81285_CR18","doi-asserted-by":"publisher","first-page":"639","DOI":"10.1007\/s00264-007-0391-0","volume":"32","author":"SS Morgan","year":"2008","unstructured":"Morgan, S. S. et al. The influence of postoperative coronal alignment on revision surgery in total knee arthroplasty. Int. Orthop 32, 639\u2013642. https:\/\/doi.org\/10.1007\/s00264-007-0391-0 (2008).","journal-title":"Int. Orthop"},{"key":"81285_CR19","doi-asserted-by":"publisher","first-page":"1319","DOI":"10.1302\/0301-620x.99b10.Bjj-2017-0066.R1","volume":"99","author":"TJ Shelton","year":"2017","unstructured":"Shelton, T. J., Nedopil, A. J., Howell, S. M. & Hull, M. L. Do varus or valgus outliers have higher forces in the medial or lateral compartments than those which are in-range after a kinematically aligned total knee arthroplasty? Limb and joint line alignment after kinematically aligned total knee arthroplasty. Bone Jt. J. 99, 1319\u20131328. https:\/\/doi.org\/10.1302\/0301-620x.99b10.Bjj-2017-0066.R1 (2017).","journal-title":"Bone Jt. J."},{"key":"81285_CR20","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-642-59373-4","volume-title":"Principles of Deformity Correction","author":"F Dror Paley","year":"2002","unstructured":"Dror Paley, F. Principles of Deformity Correction (Springer, Berlin, 2002)."},{"key":"81285_CR21","first-page":"1796","volume":"34","author":"T Derek","year":"2007","unstructured":"Derek, T., Cooke, V., Sled, E. A. & Scudamore, R. A. Frontal plane knee alignment: A call for standardized measurement. J. Rheumatol. 34, 1796\u20131801 (2007).","journal-title":"J. Rheumatol."},{"key":"81285_CR22","doi-asserted-by":"publisher","first-page":"S171","DOI":"10.1016\/j.arth.2017.02.064","volume":"32","author":"RM Meneghini","year":"2017","unstructured":"Meneghini, R. M., Grant, T. W., Ishmael, M. K. & Ziemba-Davis, M. Leaving residual varus alignment after total knee arthroplasty does not improve patient outcomes. J. Arthroplasty 32, S171\u2013S176. https:\/\/doi.org\/10.1016\/j.arth.2017.02.064 (2017).","journal-title":"J. Arthroplasty"},{"key":"81285_CR23","doi-asserted-by":"publisher","first-page":"3488","DOI":"10.1007\/s00167-016-4260-5","volume":"25","author":"K Nishida","year":"2017","unstructured":"Nishida, K. et al. Remaining mild varus limb alignment leads to better clinical outcome in total knee arthroplasty for varus osteoarthritis. Knee Surg. Sports Traumatol. Arthrosc. 25, 3488\u20133494. https:\/\/doi.org\/10.1007\/s00167-016-4260-5 (2017).","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."},{"key":"81285_CR24","first-page":"627","volume":"9","author":"A Slupik","year":"2007","unstructured":"Slupik, A. & Bialoszewski, D. Comparative analysis of clinical usefulness of the Staffelstein Score and the Hospital for Special Surgery Knee Score (HSS) for evaluation of early results of total knee arthroplasties. Preliminary report. Ortop. Traumatol. Rehabil. 9, 627\u2013635 (2007).","journal-title":"Ortop. Traumatol. Rehabil."},{"key":"81285_CR25","doi-asserted-by":"publisher","first-page":"728","DOI":"10.3109\/17453674.2015.1059689","volume":"86","author":"J Stucinskas","year":"2015","unstructured":"Stucinskas, J. et al. Moderate varus\/valgus malalignment after total knee arthroplasty has little effect on knee function or muscle strength. Acta Orthop. 86, 728\u2013733 (2015).","journal-title":"Acta Orthop."},{"key":"81285_CR26","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-017-4507-9","author":"RD Rames","year":"2017","unstructured":"Rames, R. D., Mathison, M., Meyer, Z., Barrack, R. L. & Nam, D. No impact of under-correction and joint line obliquity on clinical outcomes of total knee arthroplasty for the varus knee. Knee Surg. Sports Traumatol. Arthrosc. https:\/\/doi.org\/10.1007\/s00167-017-4507-9 (2017).","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."},{"key":"81285_CR27","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-018-4092-7","author":"D Saragaglia","year":"2018","unstructured":"Saragaglia, D. et al. Influence of the post-operative axis on the clinical results of total knee replacement for severe varus deformities: Does a slight residual varus improve the results?. Int. Orthop. https:\/\/doi.org\/10.1007\/s00264-018-4092-7 (2018).","journal-title":"Int. Orthop."},{"key":"81285_CR28","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1016\/j.knee.2008.09.008","volume":"16","author":"SA Sampath","year":"2009","unstructured":"Sampath, S. A., Voon, S. H., Sangster, M. & Davies, H. The statistical relationship between varus deformity, surgeon\u2019s experience, BMI and tourniquet time for computer assisted total knee replacements. Knee 16, 121\u2013124. https:\/\/doi.org\/10.1016\/j.knee.2008.09.008 (2009).","journal-title":"Knee"},{"key":"81285_CR29","doi-asserted-by":"publisher","first-page":"1368","DOI":"10.1007\/s00167-009-0870-5","volume":"17","author":"J Dargel","year":"2009","unstructured":"Dargel, J., Feiser, J., Gotter, M., Pennig, D. & Koebke, J. Side differences in the anatomy of human knee joints. Knee Surg. Sports Traumatol. Arthrosc. 17, 1368\u20131376. https:\/\/doi.org\/10.1007\/s00167-009-0870-5 (2009).","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."},{"key":"81285_CR30","doi-asserted-by":"publisher","first-page":"1068","DOI":"10.1002\/jor.22644","volume":"32","author":"EJ Miller","year":"2014","unstructured":"Miller, E. J., Pagnano, M. W. & Kaufman, K. R. Tibiofemoral alignment in posterior stabilized total knee arthroplasty: Static alignment does not predict dynamic tibial plateau loading. J. Orthop. Res. 32, 1068\u20131074 (2014).","journal-title":"J. Orthop. Res."}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-81285-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-81285-6","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-81285-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,3]],"date-time":"2022-12-03T03:28:49Z","timestamp":1670038129000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-81285-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,4]]},"references-count":30,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021,12]]}},"alternative-id":["81285"],"URL":"https:\/\/doi.org\/10.1038\/s41598-021-81285-6","relation":{},"ISSN":["2045-2322"],"issn-type":[{"type":"electronic","value":"2045-2322"}],"subject":[],"published":{"date-parts":[[2021,2,4]]},"assertion":[{"value":"9 March 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"31 December 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 February 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"3130"}}