title: The relationship between constitutional alignment and varus osteoarthritis of the knee.
abstract: OBJECTIVE
  The role of neutral alignment in total knee arthroplasty (TKA) on short- and long-term outcomes has become controversial. Based on the concept of constitutional varus, it has been suggested that under-correction in TKA in a varus osteoarthritis (OA) population might lead to better clinical outcomes. However, it is still unknown what the relationship between constitutional varus and the development of end-stage OA is. The goal of this study was to analyse the contribution of constitutional varus in a medial OA population and to define a correlation between the constitutional alignment and end-stage varus OA.
  
  
  METHODS
  Based on full-length radiographs, corrected for the intra-articular deformity of the knee, of 315 patients with unilateral end-stage medial OA of the knee (Charnley type A), a correlation in the coronal plane was made between medial end-stage OA and the contralateral non-arthritic side.
  
  
  RESULTS
  With increasing varus alignment in the arthritic limb, the physiologic limb alignment also became more varus. The proportion of constitutional varus rose with increasing overall alignment and was found to be continuous for males. Constitutional varus was three times higher in men when the overall arthritic alignment was greater more than 6° varus.
  
  
  CONCLUSIONS
  Constitutional varus significantly contributes to varus osteoarthritis and was found to be higher than in the general population.
  
  
  METHODS
  III.
authors.affiliation: Department of Orthopaedic Surgery, London Health Sciences Centre, London, ON, Canada. pieterjanvandekerckhove@hotmail.com.|Department of Orthopaedic Surgery and Traumatology, Sint-Jan Hospital, Ruddershove 10, 8000, Brugge, Belgium. pieterjanvandekerckhove@hotmail.com.
authors.forename: Pieter-Jan T K
authors.identifier: http://orcid.org/0000-0002-0305-5280
authors.initials: PTK
authors.lastname: Vandekerckhove
authors.affiliation: Department of Orthopaedic Surgery, London Health Sciences Centre, London, ON, Canada.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Matlovich
authors.affiliation: Department of Orthopaedic Surgery, London Health Sciences Centre, London, ON, Canada.
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Teeter
authors.affiliation: Department of Orthopaedic Surgery, London Health Sciences Centre, London, ON, Canada.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: MacDonald
authors.affiliation: Department of Orthopaedic Surgery, London Health Sciences Centre, London, ON, Canada.
authors.forename: James L
authors.initials: JL
authors.lastname: Howard
authors.affiliation: Department of Orthopaedic Surgery, London Health Sciences Centre, London, ON, Canada.
authors.forename: Brent A
authors.initials: BA
authors.lastname: Lanting
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee; D017760:Bone Malalignment / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000000981:diagnostic imaging* / Q000503:physiopathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000601:surgery*; D011859:Radiography
keywords: Constitutional varus; Coronal plane alignment; Knee; Osteoarthritis; Varus
references.citation: Knee Surg Sports Traumatol Arthrosc. 2014 Mar;22(3):674-9
references.pmid: 24051507
references.citation: J Arthroplasty. 2014 Sep;29(9):1795-802
references.pmid: 24906519
references.citation: Clin Biomech (Bristol, Avon). 2002 Feb;17(2):140-6
references.pmid: 11832264
references.citation: Knee Surg Sports Traumatol Arthrosc. 2013 Oct;21(10 ):2331-7
references.pmid: 23184086
references.citation: J Arthroplasty. 2014 Feb;29(2):365-8
references.pmid: 23809707
references.citation: Knee Surg Sports Traumatol Arthrosc. 2012 Jul;20(7):1307-22
references.pmid: 21732057
references.citation: J Orthop Res. 2014 Aug;32(8):1068-74
references.pmid: 24820681
references.citation: Clin Orthop Relat Res. 2012 Jan;470(1):45-53
references.pmid: 21656315
references.citation: J Rheumatol. 2007 Sep;34(9):1796-801
references.pmid: 17787049
references.citation: Clin Orthop Relat Res. 1983 Mar;(173):178-83
references.pmid: 6825330
references.citation: Knee. 2009 Jan;16(1):42-5
references.pmid: 18790641
references.citation: Clin Orthop Relat Res. 2001 Nov;(392):232-8
references.pmid: 11716388
references.citation: Knee Surg Sports Traumatol Arthrosc. 2013 Sep;21(9):2040-7
references.pmid: 23743581
references.citation: Clin Orthop Relat Res. 2011 Dec;469(12):3443-50
references.pmid: 21789710
references.citation: Clin Orthop Relat Res. 1989 Nov;(248):135-44
references.pmid: 2805471
references.citation: Clin Orthop Relat Res. 2004 Nov;(428):26-34
references.pmid: 15534515
references.citation: J Bone Joint Surg Am. 1987 Jun;69(5):745-9
references.pmid: 3597474
references.citation: Clin Orthop Relat Res. 2001 Nov;(392):124-30
references.pmid: 11716373
references.citation: Arch Orthop Trauma Surg. 2010 Dec;130(12 ):1487-91
references.pmid: 20165859
references.citation: Clin Orthop Relat Res. 2010 Feb;468(2):542-6
references.pmid: 19760472
references.citation: Int Orthop. 2015 Nov;39(11):2117-24
references.pmid: 25823516
references.citation: J Bone Joint Surg Br. 1985 Aug;67(4):551-6
references.pmid: 4030849
references.citation: J Rheumatol. 2005 Nov;32(11):2192-9
references.pmid: 16265702
references.citation: Clin Orthop Relat Res. 2014 Jan;472(1):98-104
references.pmid: 23733590
references.citation: J Bone Joint Surg Am. 1984 Oct;66(8):1211-8
references.pmid: 6490696
references.citation: J Bone Joint Surg Am. 2010 Sep 15;92(12):2143-9
references.pmid: 20844155
references.citation: J Arthroplasty. 2009 Sep;24(6 Suppl):39-43
references.pmid: 19553073
references.citation: J Bone Joint Surg Am. 2011 Sep 7;93(17):1588-96
references.pmid: 21915573
references.citation: Orthop Clin North Am. 1994 Jul;25(3):379-86
references.pmid: 8028881
references.citation: Knee Surg Sports Traumatol Arthrosc. 2013 Oct;21(10 ):2325-30
references.pmid: 23552665
references.citation: Orthop Clin North Am. 1994 Jul;25(3):387-93
references.pmid: 8028882
references.citation: Clin Orthop Relat Res. 2009 Feb;467(2):504-9
references.pmid: 18841432
references.citation: Orthopedics. 1999 Mar;22(3):303-7
references.pmid: 10192260
references.citation: Knee. 2012 Oct;19(5):560-3
references.pmid: 22206820
references.citation: J Arthroplasty. 2002 Dec;17(8):1033-9
references.pmid: 12478515
references.citation: J Bone Joint Surg Br. 2011 Sep;93(9):1217-22
references.pmid: 21911533
references.citation: Clin Orthop Relat Res. 1990 Jun;(255 ):215-27
references.pmid: 2347155