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Purpose Osteoarthritis of knees with varus deformity is associated with a compensatory valgus deformity of the hindfoot and a lateral loading foot pressure pattern. However, whether this abnormal loading pattern is corrected in total knee arthroplasty (TKA) is unclear. Methods The alignment and loading pattern of 91 consecutive patients (121 knees) undergoing TKA with pre-operative varus more than 10° were evaluated prospectively with functional outcome scores, static conventional radiography and dynamic pedobarogaphy pre-operatively and 1-year post-operatively. Outcomes assessed were Oxford Knee Scores, American Orthopaedic Foot and Ankle Scores, femorotibial mechanical angle, tibia–hindfoot angle, hindfoot valgus/varus index (VVI), foot line of pressure (LOP) laterality and peak pressure (PP) at both time points. Results Of 121 knees, 98 (81%) regained normal alignment of the knee and 114 (92%) of the hindfoot. Similarly, PP (p Conclusion The present study shows, following the correction of knee varus with TKA, hindfoot alignment and foot loading pattern are both restored in the majority of patients. TKA offers both static and dynamic correction as seen in the hindfoot and loading pattern, respectively. Level of evidence Level III: prospective case–control study.

Purpose of the study To document and compare the functional outcome of neutral alignment and under-correction after total knee arthroplasty (TKA) in severe varus knees of more than 15° at three and 12 months post-surgery. Materials and methods One hundred twenty-four consecutive patients (163 TKAs) of an average age of 61.9 years (52–79) with a pre-operative varus more than 15° were managed with jig-based TKA. Based on the post-operative mechanical femorotibial alignment (FTMA), they were categorised into three groups, namely neutral (180 + 3°), mild varus (173° to 176°) and severe varus (172° and below). The outcomes of these three groups were assessed at three and 12 months by the Oxford knee score and the WOMAC score were calculated and co-related to the extent of correction. Results At three months, knees in the mild varus group (n = 88) had the best results with an Oxford knee score of 41.76 + 1.44 and a WOMAC score of 19.29 + 2.93 compared to the severe varus group and the neutral alignment group which had Oxford knee scores (OKS) of 37.43 + 2.51 and 31.91 + 3.51 and WOMAC scores of 22.57 + 1.51 and 24.46 + 4.15 respectively. However at 12 months, knees in all the groups (neutral, mild varus, severe varus) had similar good functional outcomes with OKS of 39.08 + 1.68, 39.24 + 1.88, 39.29 + 1.11 and WOMAC scores of 17.42 + 2.15, 16.48 + 2.11, 16.14 + 1.21 respectively. A scatter plot done for post-operative FTMA and the functional outcome score for both scores showed a bell curve with the best outcome corresponding to a FTMA of 175° at 3 months and equal distribution for both scores at 12 months. Conclusion The results of our study showed that minimal under-correction gave superior functional outcomes at three months. But this advantage was temporary and both, under-correction and neutral alignment achieved equally good outcomes at one year. Considering the increased prosthesis longevity associated with neutral alignment, we propose that neutral alignment must be aimed for during TKA for knees with severe varus. Study Design Prospective study