{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T13:04:16Z","timestamp":1784811856028,"version":"3.55.0"},"reference-count":23,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Knee Surg &amp; Relat Res"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Limb length discrepancy (LLD) following total knee arthroplasty (TKA) may affect functional outcomes and patient satisfaction. However, relative impact of coronal and sagittal plane deformity correction on change in limb length (CLL) following TKA are still not fully understood. The aim of this study is to guide the surgeon regarding the expected change in limb lengths following correction of coronal and sagittal plane deformities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective study comprised 237 primary TKAs conducted by a single surgeon from August 2024 to July 2025. Preoperative deformities consisted of 215 varus and 22 valgus knees. Standing anteroposterior radiographs of full length were used to assess the hip\u2013knee\u2013ankle (HKA) angle and limb length before and after the operation. Flexion contracture was assessed through clinical measurement. Correlation and multivariable regression analyses were conducted to ascertain predictors of limb length alteration, while adjusting for possible confounders such as patient height and polyethylene insert thickness. A regression-based predictive model was subsequently developed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Mean limb length showed a notable increase after TKA (10.4\u2009\u00b1\u20099.1\u00a0mm;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001). The preoperative HKA angle showed a significant positive correlation with CLL in both varus and valgus knees and remained the strongest independent predictor (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001 for varus;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.046 for valgus). Preoperative flexion contracture did not show a significant independent association with CLL. Patient height and the thickness of the polyethylene insert did not have a notable effect on changes in limb length.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>TKA leads to consistent limb lengthening, mainly caused by the correction of coronal plane deformities. Estimating limb length changes before surgery can aid in surgical planning and patient counseling, especially in cases of unilateral or staged bilateral TKA.<\/jats:p>\n                    <jats:p>\n                      <jats:italic>Level of evidence<\/jats:italic>\n                      III, Retrospective comparative cohort study\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s43019-026-00334-4","type":"journal-article","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T12:45:00Z","timestamp":1784810700000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Assessment of change in limb length following correction of coronal and sagittal plane deformities in patients undergoing total knee arthroplasty: a retrospective study"],"prefix":"10.1186","volume":"38","author":[{"given":"Soutrik","family":"Kundu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyuck Min","family":"Kwon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Byung-Woo","family":"Cho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun Young","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Woo-Suk","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kwan Kyu","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,23]]},"reference":[{"key":"334_CR1","doi-asserted-by":"publisher","first-page":"660","DOI":"10.1007\/s00167-009-0755-7","volume":"17","author":"PC Verdonk","year":"2009","unstructured":"Verdonk PC, Pernin J, Pinaroli A, Ait Si Selmi T, Neyret P (2009) Soft tissue balancing in varus total knee arthroplasty: an algorithmic approach. Knee Surg Sports Traumatol Arthrosc 17:660\u2013666","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"334_CR2","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1007\/s00264-018-4116-3","volume":"43","author":"R Rossi","year":"2019","unstructured":"Rossi R, Cottino U, Bruzzone M, Dettoni F, Bonasia DE, Rosso F (2019) Total knee arthroplasty in the varus knee: tips and tricks. Int Orthop 43:151\u2013158","journal-title":"Int Orthop"},{"key":"334_CR3","doi-asserted-by":"publisher","first-page":"16","DOI":"10.5435\/00124635-200201000-00004","volume":"10","author":"PJ Favorito","year":"2002","unstructured":"Favorito PJ, Mihalko WM, Krackow KA (2002) Total knee arthroplasty in the valgus knee. J Am Acad Orthop Surg 10:16\u201324","journal-title":"J Am Acad Orthop Surg"},{"key":"334_CR4","volume":"16","author":"T Noguchi","year":"2024","unstructured":"Noguchi T, Hirao M, Okamura G, Tsuiji S, Hashimoto J (2024) Midterm outcomes after total knee arthroplasty with lateral approach for valgus knee deformity in patients with rheumatoid arthritis. Cureus 16:e58197","journal-title":"Cureus"},{"key":"334_CR5","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1080\/17453674.2020.1724674","volume":"91","author":"TW Wainwright","year":"2020","unstructured":"Wainwright TW (2020) Consensus statement for perioperative care in total hip replacement and total knee replacement surgery: enhanced recovery after surgery (ERAS\u00ae) society recommendations. Acta Orthop 91:363","journal-title":"Acta Orthop"},{"key":"334_CR6","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1007\/s11999-009-1119-9","volume":"468","author":"RB Bourne","year":"2010","unstructured":"Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD (2010) Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res 468:57\u201363","journal-title":"Clin Orthop Relat Res"},{"key":"334_CR7","doi-asserted-by":"crossref","unstructured":"Baker PN, van der Meulen JH, Lewsey J, Gregg PJ. The role of pain and function in determining patient satisfaction after total knee replacement. Data from the National Joint Registry for England and Wales. J Bone Joint Surg Br. 2007;89:893\u2013900.","DOI":"10.1302\/0301-620X.89B7.19091"},{"key":"334_CR8","first-page":"181","volume":"50","author":"R Gandhi","year":"2007","unstructured":"Gandhi R, de Beer J, Petruccelli D, Winemaker M (2007) Does patient perception of alignment affect total knee arthroplasty outcome? Can J Surg 50:181\u2013186","journal-title":"Can J Surg"},{"key":"334_CR9","doi-asserted-by":"publisher","first-page":"2678","DOI":"10.1007\/s00167-015-3866-3","volume":"24","author":"SH Kim","year":"2016","unstructured":"Kim SH, Rhee SM, Lim JW, Lee HJ (2016) The effect of leg length discrepancy on clinical outcome after TKA and identification of possible risk factors. Knee Surg Sports Traumatol Arthrosc 24:2678\u20132685","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"334_CR10","doi-asserted-by":"publisher","first-page":"437","DOI":"10.1007\/s00264-019-04411-0","volume":"44","author":"K Fujita","year":"2020","unstructured":"Fujita K, Kabata T, Kajino Y, Tsuchiya H (2020) Optimizing leg length correction in total hip arthroplasty. Int Orthop 44:437\u2013443","journal-title":"Int Orthop"},{"key":"334_CR11","doi-asserted-by":"publisher","first-page":"1199","DOI":"10.1007\/s00590-020-02683-6","volume":"30","author":"P Hinarejos","year":"2020","unstructured":"Hinarejos P, S\u00e1nchez-Soler J, Leal-Blanquet J, Torres-Claramunt R, Monllau JC (2020) Limb length discrepancy after total knee arthroplasty may contribute to suboptimal functional results. Eur J Orthop Surg Traumatol 30:1199\u20131204","journal-title":"Eur J Orthop Surg Traumatol"},{"key":"334_CR12","doi-asserted-by":"publisher","DOI":"10.1016\/j.otsr.2024.104005","volume":"111","author":"S Marmor","year":"2025","unstructured":"Marmor S, Kerroumi Y, Rigoulot G, Bouch\u00e9 PA (2025) Change in lower limb length following total knee arthroplasty. Orthop Traumatol Surg Res 111:104005","journal-title":"Orthop Traumatol Surg Res"},{"key":"334_CR13","doi-asserted-by":"publisher","first-page":"138","DOI":"10.1097\/BLO.0b013e3181560d99","volume":"464","author":"SD Ulrich","year":"2007","unstructured":"Ulrich SD, Bhave A, Marker DR, Seyler TM, Mont MA (2007) Focused rehabilitation treatment of poorly functioning total knee arthroplasties. Clin Orthop Relat Res 464:138\u2013145","journal-title":"Clin Orthop Relat Res"},{"key":"334_CR14","doi-asserted-by":"publisher","first-page":"633","DOI":"10.12968\/hmed.2017.78.11.633","volume":"78","author":"B Kayani","year":"2017","unstructured":"Kayani B, Pietrzak J, Donaldson MJ, Konan S, Haddad FS (2017) Treatment of limb length discrepancy following total hip arthroplasty. Br J Hosp Med (Lond) 78:633\u2013637","journal-title":"Br J Hosp Med (Lond)"},{"key":"334_CR15","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1016\/j.arth.2004.02.018","volume":"19","author":"WJ Maloney","year":"2004","unstructured":"Maloney WJ, Keeney JA (2004) Leg length discrepancy after total hip arthroplasty. J Arthroplasty 19:108\u2013110","journal-title":"J Arthroplasty"},{"key":"334_CR16","first-page":"271","volume":"18","author":"BP Chalmers","year":"2022","unstructured":"Chalmers BP, LaGreca M, Addona J, Sculco PK, Haas SB, Mayman DJ (2022) Characterizing the magnitude of and risk factors for functional limb lengthening in patients undergoing primary total knee arthroplasty. HSS 18:271\u2013276","journal-title":"HSS"},{"key":"334_CR17","doi-asserted-by":"publisher","first-page":"1856","DOI":"10.1016\/j.arth.2013.03.024","volume":"28","author":"MJ Chang","year":"2013","unstructured":"Chang MJ, Kang YG, Chang CB, Seong SC, Kim TK (2013) The patterns of limb length, height, weight and body mass index changes after total knee arthroplasty. J Arthroplasty 28:1856\u20131861","journal-title":"J Arthroplasty"},{"key":"334_CR18","doi-asserted-by":"publisher","first-page":"1029","DOI":"10.1080\/14397595.2018.1436119","volume":"28","author":"T Ohmori","year":"2018","unstructured":"Ohmori T, Kabata T, Kajino Y, Inoue D, Taga T, Yamamoto T, Takagi T, Yoshitani J, Ueno T, Ueoka K, Tsuchiya H (2018) Three-dimensional limb lengthening after total knee arthroplasty in a simulation study. Mod Rheumatol 28:1029\u20131034","journal-title":"Mod Rheumatol"},{"key":"334_CR19","doi-asserted-by":"publisher","DOI":"10.1016\/j.jofri.2019.100343","volume":"19","author":"M Ramezani","year":"2019","unstructured":"Ramezani M, Shokri V, Ghanbari A, Salehi Z, Niknami KA (2019) Stature estimation in Iranian population from x-ray measurements of femur and tibia bones. J Forensic Radiol Imaging 19:100343","journal-title":"J Forensic Radiol Imaging"},{"key":"334_CR20","doi-asserted-by":"publisher","first-page":"1199","DOI":"10.1007\/s00590-020-02853-6","volume":"31","author":"AA Khalifa","year":"2021","unstructured":"Khalifa AA, Mullaji AB, Gendy AN, Ahmed AM, Bakr HM, Khalifa YE, Abdelaal AM (2021) Prediction of leg length change (LLC) after correcting varus and flexion deformity in patients undergoing TKA. Eur J Orthop Surg Traumatol 31:1199\u20131205","journal-title":"Eur J Orthop Surg Traumatol"},{"key":"334_CR21","doi-asserted-by":"publisher","first-page":"127","DOI":"10.4055\/cios20224","volume":"13","author":"A Applebaum","year":"2021","unstructured":"Applebaum A, Nessim A, Cho W (2021) Overview and spinal implications of leg length discrepancy: narrative review. Clin Orthop Surg 13:127\u2013134","journal-title":"Clin Orthop Surg"},{"key":"334_CR22","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1016\/S0966-6362(00)00067-9","volume":"12","author":"M Walsh","year":"2000","unstructured":"Walsh M, Connolly P, Jenkinson A, O\u2019Brien T (2000) Leg length discrepancy--an experimental study of compensatory changes in three dimensions using gait analysis. Gait Posture 12:156\u2013161","journal-title":"Gait Posture"},{"key":"334_CR23","doi-asserted-by":"publisher","DOI":"10.1016\/j.otsr.2009.04.001","author":"P Massin","year":"2009","unstructured":"Massin P, Petit A, Odri G, Ducellier F, Sabatier C, Lautridou C, Cappelli M, Hulet C, Canciani JP, Letenneur J, Burdin P (2009) Total knee arthroplasty in patients with greater than 20 degrees flexion contracture. Orthop Traumatol Surg Res. https:\/\/doi.org\/10.1016\/j.otsr.2009.04.001","journal-title":"Orthop Traumatol Surg Res"}],"container-title":["Knee Surgery &amp; Related Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s43019-026-00334-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s43019-026-00334-4","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s43019-026-00334-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T12:45:03Z","timestamp":1784810703000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s43019-026-00334-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,23]]},"references-count":23,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["334"],"URL":"https:\/\/doi.org\/10.1186\/s43019-026-00334-4","relation":{},"ISSN":["2234-2451"],"issn-type":[{"value":"2234-2451","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,23]]},"assertion":[{"value":"17 March 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 June 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 July 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This study was approved by the Institutional Review Board of Severance Hospital, Yonsei University School of Medicine (4-2025-1048). The requirement for informed consent to participate was waived by the Institutional Review Board because of the retrospective nature of the study.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The requirement for informed consent to publish was waived by the Institutional Review Board because no identifiable personal data were included.","order":2,"name":"Ethics","label":"Consent to publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"33"}}