What Preoperative Radiographic Parameters Are Associated With Increased Medial Release in Total Knee Arthroplasty?
Preoperative varus deformity of the knee is a common malalignment in patients undergoing primary total knee arthroplasty (TKA). We are unaware of any studies that have correlated how various preoperative radiographic parameters can predict the amount of medial releases performed to achieve optimal coronal alignment and ligamentous balance.



A retrospective review was performed on 67 patients who required at least a medial tibial reduction osteotomy (MTRO) during primary TKA to achieve coronal balance. This patient population was matched 1:1 to another cohort of TKA patients by age, gender, and body mass index who did not require an MTRO. A radiographic evaluation was used to compare the 2 cohorts.



Preoperatively, the MTRO cohort was noted to have significantly increased varus tibiofemoral (86.12° vs 93.43°), tibial articular surface (85.79° vs 87.54°), and medial tibial articular surface angles (75.22° vs 85.34°) compared to the control cohort. The MTRO cohort had 3.13 mm of medial tibial offset and 9.06 mm of lateral joint space opening and the control cohort had 0.09 mm and 4.07 mm, respectively. The medial tibial articular surface angle and lateral joint space widening were statistically associated with the MTRO cohort. The final tibiofemoral angle in the MTRO cohort was 92.43° and was 93.40° in the control cohort.



The MTRO cohort was noted to have several preoperative radiographic parameters that were significantly different than the control cohort. However, the medial tibial articular surface angle and lateral joint space widening were the only radiographic parameters that were statistically associated with requiring an MTRO.
Colorado Joint Replacement, Porter Adventist Hospital, Denver, Colorado.
J Ryan
JR
Martin
Colorado Joint Replacement, Porter Adventist Hospital, Denver, Colorado.
Jason M
JM
Jennings
Colorado Joint Replacement, Porter Adventist Hospital, Denver, Colorado.
Daniel L
DL
Levy
Colorado Joint Replacement, Porter Adventist Hospital, Denver, Colorado.
Tyler Steven
TS
Watters
Colorado Joint Replacement, Porter Adventist Hospital, Denver, Colorado.
Todd M
TM
Miner
Colorado Joint Replacement, Porter Adventist Hospital, Denver, Colorado; Department of Biomedical Engineering, University of Tennessee, Knoxville, Tennessee; Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado.
Douglas A
DA
Dennis
D000368:Aged; D019645:Arthroplasty, Replacement, Knee; D005260:Female; D006801:Humans; D007717:Knee / Q000601:surgery; D007719:Knee Joint / Q000000981:diagnostic imaging* / Q000601:surgery; D007720:Knee Prosthesis; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000000981:diagnostic imaging* / Q000601:surgery; D010027:Osteotomy; D011859:Radiography; D012189:Retrospective Studies; D013977:Tibia / Q000601:surgery
coronal alignment; ligament balance; medial tibial reduction osteotomy; total knee arthroplasty; varus deformity