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Current opinions about coronal plane alignment in total knee arthroplasty: A survey article.

PURPOSE
To survey an audience of international knee surgeons about their current opinions on the analysis of coronal knee alignment and their objectives for postoperative alignment in total knee arthroplasty.


METHODS
Survey of 300 surgeons from 32 different countries with an audience response system allowing three possible answers being either a positive or negative answer or an abstention.


RESULTS
Surveyed surgeons perform rarely preoperative and postoperative full leg radiographs and evaluate radiological outcomes more with short films. The main trend in this survey was towards neutral mechanical alignment, however varus alignment is acceptable in constitutional varus patients. This residual varus should be obtained through a femoral varus cut rather than a tibial varus cut. The valgus knee can remain in slight valgus but most of the correction will be performed at the femoral level. The main objective of postoperative alignment in TKA is a joint line parallel to the floor and a central load-bearing axis through the middle of the arthroplasty. Surgeons prefer unicompartmental arthroplasty more for themselves than for their patients in case of medial bone on bone arthritis.


CONCLUSIONS
Neutral mechanical axis with a joint line parallel to the floor and a centrally running load bearing axis remains the central scope of the surveyed surgeons. Because of the literature on residual varus it becomes more acceptable for the orthopaedic community to accept this type of outlier before aiming at a surgical correction.