Abstract\nBackground: Proper limb and component alignments as well as soft tissue balance are vital for the longevity and\noptimal long-term outcomes of total knee arthroplasty (TKA). This procedure is technically demanding in patients\nwith Ranawat type-II valgus arthritic knees with marked coronal femoral bowing. Computer-assisted surgery (CAS)\nand intra-articular bone resection with TKA are the treatments of choice for patients with ipsilateral extra-articular\ndeformity. In theory, both CAS and intra-articular bone resection are beneficial in Ranawat type-II valgus arthritic\nknees with marked coronal femoral bowing deformity, but the literature on this topic is sparse. We compared the\nbenefits of using these two techniques for TKA under this circumstance.\nMethods: Patients who had Ranawat type-II valgus arthritic knees and marked coronal femoral bowing deformity\nand had undergone TKA at our hospital between 2005 and 2013 were enrolled in this retrospective study. Patients\ntreated with CAS were assigned to the CAS-TKA group; patients treated with intra-articular bone resection were\nassigned to the Bone-Resect-TKA group. Radiographic parameters and clinical outcomes (International Knee Society\n(IKS) scores and patellar scores) in both groups were compared.\nResults: Forty-seven patients (50 knees) met the inclusion criteria: 22 knees in the CAS-TKA group and 28 knees in\nthe Bone-Resect-TKA group. Lateral retinaculum release was significantly (P = 0.008) higher in the Bone-Resect-TKA\ngroup. The joint-line was significantly properly restored in the CAS-TKA group (P = 0.011). The reconstructed\nmechanical axis was significantly (P = 0.012) closer to normal in the CAS-TKA group than in the Bone-Resect-TKA\ngroup. For component alignment, the femoral valgus and femoral flexion angles were significantly better in the\nCAS-TKA group (P = 0.002 and P = 0.006, respectively), but not the tibial valgus, tibial flexion, or patellar tilting\nangles. IKS scores and patellar scores were not significantly different between groups at a mean follow-up of\n60.2 months. Conclusions: CAS-TKA was effective for obtaining proper alignment and joint-line restoration in patients with\nRanawat type-II valgus arthritic knees and marked coronal femoral bowing deformity, but not for yielding better\nclinical outcomes. Additional large-scale prospective randomized cohort studies with long-term follow-ups are\nnecessary to make evidence-based recommendations.
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