Objective:To explore the short-term clinical efficacy of primary total knee arthroplasty(TKA)under the Enhanced Recovery After Surgery(ERAS)protocol in patients with varying degrees of knee varus deformity.Methods:A total of 120 patients who underwent TKA for knee osteoarthritis with varus deformity were selected.Perioperative management was based on the ERAS protocol.Based on the preoperative hip-knee-ankle angle(HKA),the patients were divided into three groups:Group A(varus angle≤10°),Group B(10°＜varus angle≤15°),and Group C(15°＜varus angle ≤ 20°),with 40 patients in each group.The clinical scores and lower limb alignment were compared among the three groups.Results:All 120 patients were followed up for 6～9 months,with a mean duration of(7.54±0.92)months.Significant intergroup differences were observed in the surgical duration among the three groups(P＜0.05),while no significant differences were found in other perioperative indicators across the groups(P＞0.05).Postop-eratively,all three groups showed significant improvements in VAS scores,HSS scores,range of motion(ROM)of the knee,the Knee Society Knee and Function Score compared to preoperative levels(P＜0.05).At both the preoperative and 30-day postoperative follow-up,statistically significant differences in VAS scores were observed among the three groups,with Group A was lower than Groups B and C(P＜0.05),and Group B was lower than Group C(P＜0.05).ROM,the Knee Society Knee and Function Score in Group A were better than those in Groups B and C(P＜0.05),and Group B was better than Group C(P＜0.05).However,at the 6-month postoper-ative follow-up,no statistically significant differences were found in these score metrics among the three groups(P＞0.05).In terms of imaging,all three groups demonstrated significant improvements in the HKA angle and femorotibial angle(FTA)postoperatively com-pared to preoperative levels(P＜0.05).At both the preoperative and 30-day postoperative follow-up,statistically significant differences in the HKA angles were observed among the three groups(P＜0 05),with Group A was better than Groups B and C(P＜0.05),and Group B was better than Group C(P＜0.05).FT A angles in Group A was less than that in Groups B and C,and Group B was less than Group C(P＜0.05).No statistically significant differences were found in the overall complication rates among the groups(P＞0.05).Conclusion:Based on short-term follow-up results,TKA under the ERAS concept demonstrates favorable outcomes for patients with knee osteoarthritis and varus deformity of varying severity.The severity of preoperative varus deformity significantly impacts both preop-erative knee function and postoperative lower limb alignment after TKA,but has a relatively minor effect on postoperative knee pain,function,and range of motion.