Pitfalls in assessing limb alignment affected by rotation and flexion of the knee after total knee arthroplasty: Analysis using sagittal and coronal whole-body EOS radiography

Inappropriate posture during radiographic assessment may lead to misunderstanding of postoperative alignment after total knee arthroplasty (TKA). The EOS system assesses coronal and sagittal alignment simultaneously. This study aimed to evaluate the effect of flexion and/or rotation on alignment, and identify the patterns of knee posture with serial follow-up using the EOS system. One-hundred and fifteen patients of TKA and serial whole-body EOS were included. The hip–knee–ankle (HKA) angle in the coronal and sagittal planes, femoral component rotation ratio (FCR), tibial component rotation ratio (TCR), and fibular overlap ratio (FO) were measured immediately and at six months and one year postoperatively. Total and partial correlation, using flexion and rotation as a control variable was performed. The mean HKA values and flexion immediately post-operation were different compared with the values noted at six months and one year postoperatively (for all, P