Local soft tissue thickness is a superior predictor of accuracy of implant alignment compared to body mass index in total knee arthroplasty

PSF is a significant risk factor for component malalignment in both coronal and sagittal planes and provides a simple, radiograph-based measure that outperforms BMI in predicting alignment accuracy in conventional TKA. A PSF threshold of approximately 11 mm may help preoperatively identify patients at risk for malalignment, in whom navigation, robotics, or patient-specific instrumentation may be considered. Further prospective studies with larger cohorts and clinical outcomes are warranted to validate these findings. Video Abstract.