• Vikram Arun Mhaskar, Rachit Saggar, Satyabrat Karan, and Jitendra Maheshwari.
• Sitaram Bhartia Institute of Science and Research, New Delhi, India. drvikrammhaskar@gmail.com.
• Arch Orthop Trauma Surg. 2024 Dec 28; 145 (1): 102102.

PurposeAchieving precise postoperative alignment is critical for the long-term success of total knee arthroplasty (TKA). Long-leg standing radiograph (LLR) at 6 weeks post-op is the gold standard for assessing alignment, but its reliance on weight-bearing and positioning makes it less practical in the early postoperative period. Supine computed tomography scanogram (CTS) offers a potential alternative. This study compares CTS and LLR in patients undergoing TKA with patient-specific valgus correction angles (VCA).MethodsA prospective study of 108 knees from 57 patients undergoing primary TKA was conducted. CTS was performed on postoperative day three in a supine non-weight-bearing position, and LLR at six weeks in an upright standing position. Coronal alignment was assessed using hip-knee-ankle angle (HKA) and compared using Bland-Altman plots, paired-samples t-tests, and Cohen's d.ResultsCTS showed 57% of knees were within 3° of neutral alignment, while LLR showed 61%. The mean difference between modalities was 0.52° (SD, 3.56°; p = 0.07). Inter-observer reliability was excellent for both CTS and LLR (all ICCs > 0.9).ConclusionWhile CTS provides a useful alternative for early postoperative alignment assessment-particularly in situations where a standing LLR is not feasible-the observed variability suggests that LLR remains the more reliable modality when precise alignment is critical. Surgeons should therefore consider CTS as an adjunct tool for early decision-making or non-ambulatory patients in the immediate postoperative setting.Level Of EvidenceLevel II, Prospective Comparative Study.© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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