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Fixed 6° distal femoral cut consistently achieves neutral alignment for Asians, Caucasians, and Native Hawaiian/Pacific Islanders

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

Restoration of a neutral mechanical axis (MA) is important to the success of total knee arthroplasty (TKA). While known differences are present between Asians and Caucasians regarding native knee alignment, it is unknown whether such differences exist amongst Native Hawaiian/Other Pacific Islanders (NHPI) or if utilizing a fixed distal femoral cut of 6° can consistently achieve a neutral MA in these minority racial groups. This study examines the preoperative deformities presented by Asians, Caucasians, and NHPI, and the resulting knee alignment achieved following TKA when a fixed 6° distal femoral cut is targeted for all patients.

Methods

Preoperative and postoperative MA was measured from 835 Asian, 447 Caucasian, and 163 NHPI hip-to-ankle radiographs. All patients underwent TKA in which a standard distal femoral cut of 6° valgus was targeted for all patients. Data were evaluated as continuous variables and by groupings of varus (MA < − 3°), valgus (MA > 3°), and neutral (− 3° ≤ MA ≤ 3°) alignment.

Results

Preoperative deformity ranged from 38° varus to 29° valgus. The proportion of Asian and NHPI presenting with varus alignment prior to surgery was significantly greater than Caucasian patients in both males (Asians: 80.6%; Caucasians: 67.0%; NHPI: 79.0%, p = 0.001) and females (Asians: 66.1%; Caucasians: 45.7%; NHPI: 63.2%, p < 0.001). There was no difference in the proportion of patients (72–79%) achieving a neutral MA amongst all three racial groups.

Conclusion

NHPI appear to have similar preoperative deformities to Asians with both groups having significantly more varus alignment than Caucasians. Despite a wide range of preoperative deformity, application of a fixed distal femoral cut of 6° valgus successfully established a neutral MA equally in the majority of patients across all three racial groups.

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This research received no specific grant from any funding agency in the public, commercial or non-for-profit sectors.

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Authors and Affiliations

  1. John A Burns School of Medicine, 651 Ilalo Street, Honolulu, HI, 96813, USA

    Maveric Abella, Vera Ong & Tyler Thorne

  2. Department of Surgery, John A Burns School of Medicine, University of Hawai’i, 1356 Lusitana Street, Honolulu, HI, 96813, USA

    Samantha N. Andrews & Cass K. Nakasone

  3. Department of Orthopedic Surgery, Straub Medical Center, 888 South King Street, Honolulu, HI, 96818, USA

    Brent Shimoda, Samantha N. Andrews & Cass K. Nakasone

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  1. Maveric Abella
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  2. Vera Ong
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Correspondence to Cass K. Nakasone.

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Conflict of interest

Author Cass Nakasone receives royalties as a design surgeon and consulting fees from Ortho Development Corporation and is a consultant for Ortho Grid Systems. Cass Nakasone has no other relevant financial or non-financial interests to disclose. All other authors certifies that he or she has no commercial associations (e.g. consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

Ethical approval

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Hawai’i Pacific Health Research Institute (local Western Institutional Review Board) approved this study.

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This was a retrospective chart review and data collected were deidentified and presented as large scale, aggregate data. Therefore, no informed consent was obtained or required by the IRB.

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Abella, M., Ong, V., Thorne, T. et al. Fixed 6° distal femoral cut consistently achieves neutral alignment for Asians, Caucasians, and Native Hawaiian/Pacific Islanders. Arch Orthop Trauma Surg 143, 4371–4378 (2023). https://doi.org/10.1007/s00402-022-04673-1

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