The advantage of navigation for knee with lateral femoral bowing in total knee arthroplasty

J Orthop Surg (Hong Kong). 2020 Sep-Dec;28(3):2309499020965679. doi: 10.1177/2309499020965679.


Purpose: We have analyzed the surgical outcomes of primary total knee arthroplasty (TKA) using computer-assisted (CA) navigation in terms of postoperative coronal alignment depending on preoperative lateral femoral bowing.

Methods: We conducted a retrospective study of patients who have undergone navigated primary TKA from January 2016 through January 2020. Two hundred and ninety-nine cases with lateral femoral bowing of 3° or less were assigned to group 1, 95 cases of lateral femoral bowing between 3° and 5° were assigned to group 2, and 89 cases with lateral femoral bowing of more than 5° were assigned to group 3. The postoperative mechanical hip-knee-ankle (mHKA) angle was measured from scanograms, which were taken 3 months after surgery. The appropriate range of coronal alignment was set as 0 ± 3°.

Results: The number of outliers of mHKA occurred was 31 cases (10.4%) in group 1, 17 cases (17.9%) in group 2, and 17 cases (19.1%) in group 3. There was a significant correlation between the degree of lateral femoral bowing and the occurrence rate of mHKA outliers. Multiple variables logistic regression analysis showed occurrence rate of outliers in group 3 to be 2.04 times higher than group 1. After adjusting the patient's age, sex, body mass index, and preoperative HKA deformity, the occurrence rate of outliers in group 3 was still 1.96 times higher than group 1.

Conclusion: The benefit of CA navigation during TKA in obtaining coronal alignment within 0 ± 3° may be lessened when the preoperative lateral femoral bowing is severely advanced.

Keywords: lateral femoral bowing; navigation; outlier; total knee arthroplasty.

MeSH terms

  • Aged
  • Arthroplasty, Replacement, Knee / methods*
  • Female
  • Femur / diagnostic imaging
  • Femur / surgery*
  • Humans
  • Knee Joint / diagnostic imaging
  • Knee Joint / surgery*
  • Male
  • Osteoarthritis, Knee / diagnosis
  • Osteoarthritis, Knee / surgery*
  • Postoperative Period
  • Retrospective Studies
  • Surgery, Computer-Assisted / methods*
  • Tomography, X-Ray Computed / methods*