Characterizing the Magnitude of and Risk Factors for Functional Limb Lengthening in Patients Undergoing Primary Total Knee Arthroplasty

Background: There is little data on the magnitude and factors for functional leg lengthening after primary total knee arthroplasty (TKA). Questions/Purpose: We sought to determine the incidence of and risk factors for functional leg lengthening after primary TKA. Methods: We retrospectively reviewed consecutive unilateral primary TKAs at a single institution from 2015 to 2018. Of the 782 TKAs included, 430 (55%) were performed in women; the mean age was 66 years, and the mean body mass index was 29 kg/m2. Preoperatively, 541 (69%) knees were varus deformities and 223 (29%) were valgus deformities. Hip to ankle biplanar radiographs were obtained preoperatively and 6 weeks postoperatively for all patients. Two independent researchers measured leg length, coronal plane deformity, lateral knee flexion angle, and overall mechanical alignment on all preoperative and postoperative radiographs. Results: The mean overall ipsilateral functional leg lengthening was 7.0 mm. Seven hundred knees (90%) were overall functionally lengthened, including 462 (59%) knees lengthened >5 mm and 250 (31%) knees lengthened 10 mm or more. A valgus deformity and coronal plane deformity of 10° or more were significant risk factors for increased functional lengthening. Patients with severe valgus deformities (>10°) had the largest amount of functional lengthening, at a mean of 13.5 mm. Conclusion: After primary TKA, 90% of limbs are functionally lengthened, including roughly one-third over a centimeter. Valgus knee deformities and severe deformities (>10°) were significant risk factors for increased limb lengthening.