![]() ![]() Triple films of 1531 subjects with radiographic hip or knee osteoarthritis or subjective complaint of hip or knee pain, 352 subjects with a history of lower limb fractures, and 62 subjects with previous other lower limb surgeries (knee cruciate ligament reconstruction or other foot and ankle surgeries) were excluded, as well as 71 triple films with poor image quality. All triple films were reviewed by two orthopedic research residents (the first and the second authors). ![]() Unsuitable triple films were excluded according to the following criteria: previous complaint of knee or hip pain mentioned in the chart, osteoarthritis of the knee or hip on plain film (Kellgren–Lawrence classification grade 1 or above), lower limb trauma, deformity or surgery history, and rotation or poor image quality. From these, healthy subjects were selected and included in this study. In total, 2230 subjects aged 20–70 years were initially included for review. This retrospective, institutional review board-approved study was conducted by reviewing weight-bearing radiographs of the entire lower extremities (triple film) in our hospital that were taken in the outpatient department from January 2000 to December 2015 for any reason. The purposes of this study were (1) to analyze the lower limb coronal alignment of a healthy population, (2) to classify the alignment of the lower limbs according to the mechanical alignment of the femur and tibia, and (3) to discuss potential problems that could be encountered during TKA due to the mismatch of femoral and tibial coronal alignment for each type of lower limb, with the aim of improving outcomes of TKA. This study aimed to investigate and categorize the alignment of the knees in a healthy population according to natural femur and tibia mechanical alignments with a view to improving outcomes of TKA. However, this classification does not describe the mismatch in the alignment of the tibia and femur. In the aforementioned studies, lower limb coronal alignment was classified into varus, neutral, or valgus based on the hip–knee–ankle angle (HKAA). The imbalance could not always be corrected successfully by a soft tissue release technique unless comprehensive analysis of femoral and tibial coronal alignment was performed during preoperative planning. These problems frequently occurred during TKA on patients with a mismatch between femoral and tibial coronal alignment in the knee joint or with an extremely varus or valgus alignment. Unequal flexion or extension gap, soft tissue imbalance, and patella maltracking might be the main reasons of dissatisfaction. However, up to one-fifth of patients who underwent TKA are were dissatisfied. It is also considered to be an important parameter for predicting long-term aseptic wearing or loosening, according to previous literature. ![]() Restoration of neutral coronal alignment during total knee arthroplasty (TKA) plays a crucial role for the durability of the prosthesis. ![]()
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