Change in mechanical axis alignment highly correlates with increased limb loading after total knee arthroplasty

AIMS AND OBJECTIVES: Mechanical axis of the lower limb assessed in standing long-leg radiographs was demonstrated to change within the first three postoperative months after total knee arthroplasty (TKA). The underlying mechanism including the influence of limb loading for the change in mechanical axis alignment after TKA has not been evaluated so far. MATERIALS AND METHODS: Mechanical axis of the lower limb and limb loading were evaluated in 115 patients 10 days and 12 weeks after TKA. Mechanical axis was measured in standing long-leg radiographs while limb loading was simultaneously assessed using a scale. Absolute and relative limb loading with their correlation to the mechanical axis were calculated. RESULTS: Mechanical axis in patients with postoperative complete extension (n = 100) changed from an initial -0.82° ± 1.9° valgus alignment to a varus axis of +0.6° ± 1.5 (p < 0.01). This change in alignment was accompanied by an increased limb loading from 89.9% 10.7% to 93.0% 7.0% (p < 0.01). The mechanical axis highly/significantly correlated with relative limb loading in both measurements (r = 0.804, p < 0.001 respectively r = 0.562, p < 0.001). These alterations and distinctions were much more pronounced in patients with postoperative incomplete extension. CONCLUSION: Mechanical axis of the leg significantly changes while limb loading increases within the first three postoperative months after TKA. The postoperative alignment highly correlates with the loading of the lower limb. Therefore, the actual mechanical axis can only be assessed at physiological limb loading in long-leg radiographs at complete extension with full weight bearing.