BEYOND THE CORONAL PLANE: THE ROLE OF PRE- AND POSTOPERATIVE 3D ALIGNMENT IN PREDICTING TOTAL KNEE ARTHROPLASTY OUTCOMES

Abstract This study explores the impact of three-dimensional (3D) alignment on the functional outcomes of total knee arthroplasty (TKA). While most existing studies have primarily focused on coronal alignment, debating whether it should be mechanical, kinematic, or functional, there has been relatively little emphasis on the role of 3D alignment, including sagittal and axial planes, as well as patellar alignment. Method In this research, we aim to address the existing gap by analyzing three-dimensional alignment parameters—coronal, sagittal, and axial—both preoperatively and postoperatively, using comprehensive CT imaging. We will assess their correlation with one-year functional outcomes. Our cohort comprises more than 200 TKR cases using the same implant and surgical technique performed between 2020 and 2024, each with at least one year of follow-up data assessed via the KOOS scoring system, providing a robust foundation for meaningful analysis. All variables will be measured both preoperatively and postoperatively, including: Mechanical alignment and kinematic alignment Lateral distal femoral angle (LDFA) Medial proximal tibial angle (MPTA) Femoral rotation (native and femoral component) Tibial rotation (native and tibial component) Patellar tilt angle (or resection angle if replaced) Femoral component flexion angle (postoperative) Results The results will be presented at the meeting and will allow the discussion on alignment to extend beyond the coronal plane which considered on its own may underestimate the complex nature of knee joint mechanics. By evaluating all three planes and patellar alignment, we hope to provide a more comprehensive understanding of how 3D alignment influences TKA outcomes.