Slight under-correction using individualized intentional varus femoral cutting leads to favorable outcomes in patients with lateral femoral bowing and varus knee

Restoration of neutral alignment is considered key in total knee arthroplasty (TKA). However, this may be undesirable and can result in medial soft-tissue over-release in patients with varus knee and lateral femoral bowing. This study aimed to determine whether individualized intentional varus distal femoral cutting yielded satisfactory clinical and radiological outcomes. A total of 77 patients (91 knees) with varus knee (hip–knee–ankle axis ≥ 10°) and lateral femoral bowing > 5° underwent navigation-assisted primary TKA using individualized intentional varus distal femoral cutting. Knee Society scores, Western Ontario and McMaster Universities scores, and radiographs for limb alignment, implant alignment, and aseptic loosening were evaluated. Subgroup analyses were performed according to the limb alignment and coronal femoral component alignment (0° ± 3° vs. varus of > 3°). All clinical outcomes significantly improved at the final follow-up (p