PURPOSE Restoration of neutral alignment is considered key in total knee arthroplasty (TKA). However, this may be undesirable and can result in medial soft-tissue over-release in patients with varus knee and lateral femoral bowing. This study aimed to determine whether individualized intentional varus distal femoral cutting yielded satisfactory clinical and radiological outcomes. METHODS A total of 77 patients (91 knees) with varus knee (hip-knee-ankle axis ≥ 10°) and lateral femoral bowing > 5° underwent navigation-assisted primary TKA using individualized intentional varus distal femoral cutting. Knee Society scores, Western Ontario and McMaster Universities scores, and radiographs for limb alignment, implant alignment, and aseptic loosening were evaluated. Subgroup analyses were performed according to the limb alignment and coronal femoral component alignment (0° ± 3° vs. varus of > 3°). RESULTS All clinical outcomes significantly improved at the final follow-up (p < 0.05 in all). The mechanical axis angle changed from 13.1° ± 2.7° to 2.8° ± 1.5°. The coronal femoral component angle at the final follow-up was 2.8° ± 1.3°. Radiolucent lines were observed in 6 cases (6.6%) and were less than 2 mm in all cases without progression. In subgroup analyses, no significant differences were observed in clinical outcomes (n.s. in all) and in the incidence of radiolucent lines (n.s. in limb alignment, n.s. in coronal femoral component alignment). CONCLUSIONS Individualized intentional varus distal femoral cutting yielded favorable clinical outcomes without complications at 5-year follow-up. Slight under-correction using intentional varus distal femoral cutting could be a viable option in patients with varus knee and lateral femoral bowing during navigation-assisted TKA. LEVEL OF EVIDENCE IV.

中文翻译：

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使用个性化的内翻股骨切开术进行轻微矫正会导致外侧股弓和膝内翻患者获得良好的预后。

目的中性对齐的恢复被认为是全膝关节置换术（TKA）的关键。然而，这可能是不希望的，并且可能导致膝内翻和股外侧弓患者的内侧软组织过度释放。这项研究旨在确定个性化的股骨远端远端内翻切开术是否能产生令人满意的临床和放射学结果。方法对77例（91膝）内翻膝（髋-膝-踝轴≥10°）且股弓外侧弯曲> 5°的患者行导航辅助性原发性TKA，采用个体化的内翻股骨远端股骨切开术。评估了膝关节协会评分，西安大略大学和麦克马斯特大学评分以及四肢对准，植入物对准和无菌性松动的X光照片。根据肢体排列和冠状股骨成分排列（0°±3°vs内翻> 3°）进行亚组分析。结果在最后的随访中所有临床结局均显着改善（全部p <0.05）。机械轴角从13.1°±2.7°更改为2.8°±1.5°。最后一次随访时的冠状股分角为2.8°±1.3°。在6例（6.6％）的病例中观察到射线可透线，在所有情况下均未超过2 mm。在亚组分析中，在临床结果（全部为ns）和射线可透线的发生率（肢体对齐为ns，冠状股骨组件对齐为ns）中均未观察到显着差异。结论在5年的随访中，个性化的股骨远端股骨远端内切术取得了良好的临床效果，而没有并发症。对于在导航辅助的TKA期间内翻膝关节和股外侧弓的患者，使用特有的内翻股骨远端股骨切除术进行轻微矫正可能是可行的选择。证据级别IV。