Slight under-correction using individualized intentional varus femoral cutting leads to favorable outcomes in patients with lateral femoral bowing and varus knee

Knee Surg Sports Traumatol Arthrosc. 2020 May;28(5):1579-1586. doi: 10.1007/s00167-019-05577-1. Epub 2019 Jun 22.


Purpose: Restoration of neutral alignment is considered key in total knee arthroplasty (TKA). However, this may be undesirable and can result in medial soft-tissue over-release in patients with varus knee and lateral femoral bowing. This study aimed to determine whether individualized intentional varus distal femoral cutting yielded satisfactory clinical and radiological outcomes.

Methods: A total of 77 patients (91 knees) with varus knee (hip-knee-ankle axis ≥ 10°) and lateral femoral bowing > 5° underwent navigation-assisted primary TKA using individualized intentional varus distal femoral cutting. Knee Society scores, Western Ontario and McMaster Universities scores, and radiographs for limb alignment, implant alignment, and aseptic loosening were evaluated. Subgroup analyses were performed according to the limb alignment and coronal femoral component alignment (0° ± 3° vs. varus of > 3°).

Results: All clinical outcomes significantly improved at the final follow-up (p < 0.05 in all). The mechanical axis angle changed from 13.1° ± 2.7° to 2.8° ± 1.5°. The coronal femoral component angle at the final follow-up was 2.8° ± 1.3°. Radiolucent lines were observed in 6 cases (6.6%) and were less than 2 mm in all cases without progression. In subgroup analyses, no significant differences were observed in clinical outcomes (n.s. in all) and in the incidence of radiolucent lines (n.s. in limb alignment, n.s. in coronal femoral component alignment).

Conclusions: Individualized intentional varus distal femoral cutting yielded favorable clinical outcomes without complications at 5-year follow-up. Slight under-correction using intentional varus distal femoral cutting could be a viable option in patients with varus knee and lateral femoral bowing during navigation-assisted TKA.

Level of evidence: IV.

Keywords: Distal femoral cut; Intentional varus; Lateral femoral bowing; Navigation; Total knee arthroplasty; Varus knee.

MeSH terms

  • Adult
  • Aged
  • Arthroplasty, Replacement, Knee / methods*
  • Bone Malalignment / diagnostic imaging
  • Bone Malalignment / surgery*
  • Female
  • Femur / diagnostic imaging
  • Femur / surgery*
  • Genu Varum / diagnostic imaging
  • Genu Varum / surgery*
  • Humans
  • Knee Joint / diagnostic imaging
  • Knee Joint / surgery*
  • Male
  • Middle Aged
  • Osteoarthritis, Knee / diagnostic imaging
  • Osteoarthritis, Knee / surgery*
  • Retrospective Studies