Posteromedial varus fatigue fragment (PVFF) in severe varus knee osteoarthritis phenotype: incidence, surgical implications, and management

PVFF is an underrecognized structural lesion for precision in severe varus knee OA, affecting tibial fixation, load distribution, and medial knee stability. Its presence requires careful intraoperative assessment, as fragment removal can alter gap balancing. Improved preoperative recognition and surgical planning are essential to optimize TKA outcomes in patients. Further prospective studies and biomechanical analyses are needed to better understand PVFF's long-term clinical implications and refine surgical strategies.