Fixed Distal Femoral Cut of 6° Valgus in Total Knee Arthroplasty: A Radiographic Review of 788 Consecutive Cases

Background: In place of the mechanical axis (MA), the use of the variable tibiofemoral angle is frequently used to plan measured resection bony cuts during total knee arthroplasty (TKA). This angle, coupled with operator-dependent variability of intramedullary distal femoral cutting guides, has the potential for catastrophic outcomes. Therefore, a simpler, fixed femoral cut of 6 degrees valgus may be more appropriate when direct measurement of the MA is not possible. Methods: This was a retrospective study of 788 consecutive TKAs, in which the distal femoral cut was set to 6 degrees valgus. The preoperative and 6-week postoperative MA were measured on hip-to-ankle radiographs. Data were evaluated as a group as well as grouped by preoperative deformity (MA < -3 degrees, -3 degrees < MA < 3 degrees, 3 degrees < MA). Results: Following TKA, MA alignment for all patients was 0.0 degrees +/- 2.3 degrees (range, -7.0 degrees to 8.0 degrees). When grouped by pre-TKA alignment, 548 patients were considered varus (MA < -3 degrees), 137 were neutral (-3 degrees < MA < 3 degrees), and 103 patients were valgus (3 degrees < MA). When evaluating the post-TKA alignment achieved in the 3 groups, neutral alignment (-3 degrees < MA < 3 degrees) was established in 86.5% of varus patients, 86.1% of neutral patients, and 82.5% of valgus patients. Conclusion: A standard distal femoral cut of 6 degrees resulted in a neutral MA in 86% of patients. While no single technique will be correct for all deformities, in the absence of sophisticated preoperative planning aids, this simple technique could provide a more reliable surgical technique than the measured tibiofemoral angle. (C) 2018 Elsevier Inc. All rights reserved.