title: Patient's Height and Hip Medial Offset Are the Main Determinants of the Valgus Cut Angle During Total Knee Arthroplasty.
abstract: Valgus cut angle (VCA), defined as the angle between the anatomical and the mechanical axes of femur, is an important parameter upon which a critical step of knee arthroplasty is based. Some variables have been proposed to affect the magnitude of this cut. However, little information is available regarding whether a generic value can be used, or if a patient-specific value from a long leg X-ray, or factors that can be determined preoperatively, is necessary to accurately set the VCA.
  
  
  
  Standard standing 3-joint views were used to measure a number of anatomical measurements in 358 limbs, 202 patients (116 women, 86 men). Neck-shaft angle, medial offset, femoral length (FL), distal femoral articular angle, and VCA were measured. Demographic data including gender and height were extracted from hospital charts. The correlation of VCA with each of the other factors was evaluated using linear regression and t-test and finally multivariate analysis.
  
  
  
  The average VCA was 5.76° (range 4-8). Gender and distal femoral articular angle were not related to VCA (P = .343 and .995). FL was found to be a function of height with similar effects on multivariate analysis. Only the height (or FL) and femoral offset were identified as independent factors, with a negative correlation for the former (P < .001) and a positive correlation for the latter (P < .001).
  
  
  
  Femoral offset and height are the 2 independent factors determining VCA. Other parameters are indirectly related to these 2 factors. Tall patients with a small femoral offset have smaller VCA and short patients with a large offset have larger VCA. The wide variety of VCA values does not support using a generic value for all patients during knee arthroplasty.
authors.affiliation: Department of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Michael
authors.initials: M
authors.lastname: Drexler
authors.affiliation: Department of Orthopedic Surgery, Bone and Joint Reconstruction Research Center, Shafa Hospital, IUMS, Tehran, Iran.
authors.forename: Mansour
authors.initials: M
authors.lastname: Abolghasemian
authors.affiliation: Department of Pharmacology, University of Toronto, Toronto, ON, Canada.
authors.forename: Richard
authors.initials: R
authors.lastname: Barbuto
authors.affiliation: Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Mohsen S
authors.initials: MS
authors.lastname: Naini
authors.affiliation: Department of Pediatrics, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Neda
authors.initials: N
authors.lastname: Voshmeh
authors.affiliation: Department of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Tal F
authors.initials: TF
authors.lastname: Rutenberg
authors.affiliation: Department of Orthopaedics, NYU Langone Medical Center's Hospital for Joint Diseases, White Plains, New York.
authors.forename: Ran
authors.initials: R
authors.lastname: Schwarzkopf
authors.affiliation: Division of Orthopedic Surgery, Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada.
authors.forename: David J
authors.initials: DJ
authors.lastname: Backstein
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D001827:Body Height; D005260:Female; D005269:Femur / Q000601:surgery; D006615:Hip / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D006801:Humans; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015588:Observer Variation; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014965:X-Rays
keywords: alignment; height; hip medial offset; neck-shaft angle; total knee arthroplasty; valgus cut angle