{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T14:34:59Z","timestamp":1792420499875,"version":"4.5.0"},"reference-count":42,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"13","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Journal of Bone and Joint Surgery"],"published-print":{"date-parts":[[2019,7,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Recent short-term studies of total knee arthroplasty (TKA) have claimed improved clinical outcomes and implant survival when aiming to restore constitutional joint kinematics, as compared with neutral mechanical axis alignment. However, implant durability may be compromised when aligned in varus or valgus. With use of data pooled from 3 long-term radiostereometric analysis (RSA) studies, the aim of the present study was to assess the effects of coronal alignment on tibial component migration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Coronal alignment parameters from full-leg radiographs were measured and the constitutional leg alignment was determined for each patient. We evaluated the effect of the postoperative hip-knee-ankle angle, relative to both the mechanical axis and the constitutional alignment, on tibial component migration. In-range knees were defined as within \u00b13\u00b0 of either the neutral mechanical axis or constitutional alignment of the patient. Analysis was performed with a linear mixed-effects model, corrected for study, age, sex, preoperative alignment, diagnosis, and body mass index.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>A total of 85 cemented TKAs were included, of which 3 were revised for aseptic loosening and another 4 were considered loose. The median follow-up was 11 years. No loose tibial components were observed in mechanically in-range knees, whereas all loose tibial components were out of range. Mechanically varus knees showed the highest mean migration (maximum total point motion) of 1.55 mm (95% confidence interval [CI], 1.16 to 2.01 mm) after 5 years, compared with 1.07 mm (95% CI, 0.63 to 1.64 mm) and 0.77 mm (95% CI, 0.53 to 1.06 mm) for valgus and in-range knees, respectively (p &lt; 0.001). In contrast, looking at constitutional alignment, loose tibial components were found among both constitutionally in-range and out-of-range knees. Mixed-model analysis showed comparable migration among constitutionally in-range, more-in-varus, and more-in-valgus aligned knees.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Mechanically out-of-range alignment, especially mechanical varus, led to higher tibial component migration. However, matching the constitutional alignment of the patient did not preclude high implant migration. RSA trials randomizing different alignment techniques are needed to confirm the results of the present study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\n                      <jats:underline>Level IV<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.18.00691","type":"journal-article","created":{"date-parts":[[2019,7,11]],"date-time":"2019-07-11T18:31:10Z","timestamp":1562869870000},"page":"1203-1212","source":"Crossref","is-referenced-by-count":60,"title":["The Effect of Coronal Alignment on Tibial Component Migration Following Total Knee Arthroplasty"],"prefix":"10.2106","volume":"101","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6159-7689","authenticated-orcid":false,"given":"Koen T.","family":"van Hamersveld","sequence":"first","affiliation":[{"name":"Departments of Orthopaedics (K.T.v.H. and R.G.H.H.N.) and Biomedical Data Sciences (P.J.M.-v.d.M.), Leiden University Medical Center, Leiden, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1439-0989","authenticated-orcid":false,"given":"Perla J.","family":"Marang-van de Mheen","sequence":"additional","affiliation":[{"name":"Departments of Orthopaedics (K.T.v.H. and R.G.H.H.N.) and Biomedical Data Sciences (P.J.M.-v.d.M.), Leiden University Medical Center, Leiden, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1228-4162","authenticated-orcid":false,"given":"Rob G.H.H.","family":"Nelissen","sequence":"additional","affiliation":[{"name":"Departments of Orthopaedics (K.T.v.H. and R.G.H.H.N.) and Biomedical Data Sciences (P.J.M.-v.d.M.), Leiden University Medical Center, Leiden, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"issue":"1","key":"bib1-20230810","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1007\/s11999-011-1936-5","article-title":"The Chitranjan Ranawat award: is neutral mechanical alignment normal for all patients? The concept of constitutional varus","volume":"470","author":"Bellemans","year":"2012","journal-title":"Clin Orthop Relat Res."},{"issue":"1","key":"bib2-20230810","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1302\/0301-620X.98B1.36403","article-title":"Neutral mechanical alignment: Is it Necessary?","volume":"98-B","author":"Allen","year":"2016","journal-title":"Bone Joint J."},{"issue":"7","key":"bib3-20230810","doi-asserted-by":"crossref","first-page":"893","DOI":"10.1302\/0301-620X.89B7.19091","article-title":"National Joint Registry for England and Wales. The role of pain and function in determining patient satisfaction after total knee replacement. Data from the National Joint Registry for England and Wales","volume":"89","author":"Baker","year":"2007","journal-title":"J Bone Joint Surg Br."},{"issue":"1","key":"bib4-20230810","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1007\/s11999-009-1119-9","article-title":"Patient satisfaction after total knee arthroplasty: who is satisfied and who is not?","volume":"468","author":"Bourne","year":"2010","journal-title":"Clin Orthop Relat Res."},{"issue":"11","key":"bib5-20230810","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1302\/0301-620X.96B11.34152","article-title":"Patient dissatisfaction following total knee replacement: a growing concern?","volume":"96-B","author":"Nam","year":"2014","journal-title":"Bone Joint J."},{"issue":"12","key":"bib6-20230810","doi-asserted-by":"crossref","first-page":"1487","DOI":"10.1007\/s00402-010-1064-9","article-title":"Varus malalignment has no influence on clinical outcome in midterm follow-up after total knee replacement","volume":"130","author":"Matziolis","year":"2010","journal-title":"Arch Orthop Trauma Surg."},{"issue":"12","key":"bib7-20230810","doi-asserted-by":"crossref","first-page":"3443","DOI":"10.1007\/s11999-011-1988-6","article-title":"Residual varus alignment does not compromise results of TKAs in patients with preoperative varus","volume":"469","author":"Magnussen","year":"2011","journal-title":"Clin Orthop Relat Res."},{"issue":"10","key":"bib8-20230810","doi-asserted-by":"crossref","first-page":"2325","DOI":"10.1007\/s00167-013-2481-4","article-title":"Slight undercorrection following total knee arthroplasty results in superior clinical outcomes in varus knees","volume":"21","author":"Vanlommel","year":"2013","journal-title":"Knee Surg Sports Traumatol Arthrosc."},{"issue":"7","key":"bib9-20230810","doi-asserted-by":"crossref","first-page":"907","DOI":"10.1302\/0301-620X.96B7.32812","article-title":"A randomised controlled trial of kinematically and mechanically aligned total knee replacements: two-year clinical results","volume":"96-B","author":"Dossett","year":"2014","journal-title":"Bone Joint J."},{"issue":"11","key":"bib10-20230810","doi-asserted-by":"crossref","first-page":"2117","DOI":"10.1007\/s00264-015-2743-5","article-title":"Does varus alignment adversely affect implant survival and function six years after kinematically aligned total knee arthroplasty?","volume":"39","author":"Howell","year":"2015 Nov","journal-title":"Int Orthop."},{"issue":"6","key":"bib11-20230810","doi-asserted-by":"crossref","first-page":"1743","DOI":"10.1007\/s00167-016-4136-8","article-title":"PSI kinematic versus non-PSI mechanical alignment in total knee arthroplasty: a prospective, randomized study","volume":"25","author":"Calliess","year":"2017","journal-title":"Knee Surg Sports Traumatol Arthrosc."},{"issue":"1","key":"bib12-20230810","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1007\/s11999-016-4844-x","article-title":"The Chitranjan S. 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