Patient’s height and hip medial offset are the main determinants of the valgus cut angle during total knee arthroplasty

Abstract Background Valgus cut angle (VCA) defined as the angle between the anatomical and the mechanical axes of femur, is an important parameter upon which a critical step of knee arthroplasty is based. Some variables have been proposed to affect the magnitude of this cut. However, little information is available regarding whether a generic value can be used, or if a patient specific value from a long leg x-ray, or factors that can be determined pre-operatively, is necessary to accurately set the VCA. Methods Standard standing 3-joint views were used to measure a number of anatomical measurements in 358 limbs, 202 patients (116 females, 86 males). Neck-shaft angle (NSA), medial offset (MO), femoral length (FL), distal femoral articular angle (DFAA) and VCA were measured. Demographic data including gender and height were extracted from hospital charts. The correlation of VCA with each of the other factors was evaluated using linear regression and t test and finally multivariate analysis. Results The average VCA was 5.76˚ (range, 4-8). Gender and DFAA were not related to the VCA (P values, 0.343 and 0.995, respectively). FL was found to be a function of the height with similar effects on multivariate analysis. Only the height (or FL) and femoral offset were identified as independent factors, with a negative correlation for the former (P value< 0.001) and a positive correlation for the latter (P value< 0.001). Conclusion Femoral offset and the height are the two independent factors determining the VCA, Other parameters are indirectly related to these two factors. Tall patients with a small femoral offset have smaller VCA and short patients with a large offset have larger VCA. The wide variety of VCA values does not support using a generic value for all patients during knee arthroplasty.