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Sappey-Marinier E, Fernandez A, Shatrov J, Batailler C, Servien E, Huten D, Lustig S. Management of fixed flexion contracture in primary total knee arthroplasty: recent systematic review. SICOT J 2024; 10:11. [PMID: 38530205 DOI: 10.1051/sicotj/2024007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 02/12/2024] [Indexed: 03/27/2024] Open
Abstract
INTRODUCTION This study aimed to systematically review the literature and identify the surgical management strategy for fixed flexion contracture in primary total knee arthroplasty (TKA) surgery, pre-, intra-, and post-operatively. Secondary endpoints were etiologies and factors favoring flexion contracture. MATERIALS AND METHODS Searches were carried out in November 2023 in several databases (Pubmed, Scopus, Cochrane, and Google Scholar) using the following keywords: "flexion contracture AND TKA", "fixed flexion deformity AND TKA", "posterior capsular release AND TKA", "posterior capsulotomy in TKA", "distal femoral resection AND TKA". Study quality was assessed using the STROBE checklist and the Downs and Black score. Data concerning factors or strategies leading to the development or prevention of flexion contracture after TKA were extracted from the text, figures, and tables of the included references. The effect of each predictive factor on flexion contracture after TKA was recorded. RESULTS Thirty-one studies were identified to meet the inclusion and exclusion criteria. These studies described a variety of preoperative and intraoperative factors that contribute to the development or correction of postoperative flexion contracture. The only clearly identified predictor of postoperative flexion contracture was preoperative flexion contracture. Intraoperative steps described to correct flexion contracture were: soft-tissue balancing (in posterior and medial compartments), distal femoral resection, flexion of the femoral component, and posterior condylar resection. However, no study has investigated these factors in a global model. DISCUSSION This review identified various pre-, intra-, and post-operative factors predictive of post-operative flexion contracture. In practice, these factors are likely to interact, and it is therefore crucial to further investigate them in a comprehensive model to develop an algorithm for the management of flexion contracture. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Elliot Sappey-Marinier
- Département de chirurgie orthopédique et de médecine du sport, FIFA medical center of excellence, Hôpital de la Croix-Rousse, Centre Hospitalier Universitaire de Lyon, Lyon, France - Univ Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406, Lyon, France
| | - Andréa Fernandez
- Service de chirurgie Orthopédique, Centre chirurgical Emile Gallé, Centre Hospitalier Universitaire de Nancy, Nancy, France
| | - Jobe Shatrov
- Département de chirurgie orthopédique et de médecine du sport, FIFA medical center of excellence, Hôpital de la Croix-Rousse, Centre Hospitalier Universitaire de Lyon, Lyon, France
| | - Cécile Batailler
- Département de chirurgie orthopédique et de médecine du sport, FIFA medical center of excellence, Hôpital de la Croix-Rousse, Centre Hospitalier Universitaire de Lyon, Lyon, France - Univ Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406, Lyon, France
| | - Elvire Servien
- Département de chirurgie orthopédique et de médecine du sport, FIFA medical center of excellence, Hôpital de la Croix-Rousse, Centre Hospitalier Universitaire de Lyon, Lyon, France - LIBM - EA 7424, Interuniversity Laboratory of Biology of Mobility, Université Claude Bernard Lyon 1, Lyon, France
| | - Denis Huten
- Chirurgie Orthopédique, Réparatrice et Traumatologique, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Sébastien Lustig
- Département de chirurgie orthopédique et de médecine du sport, FIFA medical center of excellence, Hôpital de la Croix-Rousse, Centre Hospitalier Universitaire de Lyon, Lyon, France - Univ Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406, Lyon, France
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Lee SS, Lee J, Alharthi H, Moon YW. Effect of mediolateral gap difference on postoperative outcomes in navigation-assisted total knee arthroplasty using an ultracongruent insert and the medial stabilising technique. Knee Surg Sports Traumatol Arthrosc 2023; 31:3745-3754. [PMID: 36708379 DOI: 10.1007/s00167-023-07324-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 01/16/2023] [Indexed: 01/29/2023]
Abstract
PURPOSE This study was aimed to compare the clinical, functional, and radiographic outcomes between symmetric and asymmetric extension and mediolateral gap balance after navigation-assisted (NA) total knee arthroplasty (TKA) using ultracongruent (UC) insets and the medial stabilising technique (MST). METHODS In all, 363 knees of 275 patients who underwent mechanical alignment-target NA TKA with MST between January 2015 and December 2017 were analysed. Patients were divided into balanced (extension mediolateral gap difference ≤ 2 mm) and tight medial (difference ≥ 3 mm) groups. Pre- and postoperative clinical, functional (range of motion, Western Ontario and McMaster University Osteoarthritis [WOMAC] index, Knee Society Knee Score [KSKS], and Knee Society Function Score [KSFS]) and radiographic (hip-knee-ankle [HKA] angle, femoral condylar offset, extension angle [a minus indicates hyperextension], and joint line distance) outcomes were compared between the groups. Student's t- or Chi-squared test was used to compare the outcomes. RESULTS Among the 363 knees analysed, 279 (77%) were assigned to the balanced group and 84 (23%) to the tight medial group. The preoperative HKA angle was significantly greater in the tight medial group than in the balanced group (9.7° ± 4.1° vs 14.3° ± 4.7°, P < 0.001). The postoperative WOMAC index, KSKS, and KSFS were similar between the groups. The change in the joint line distance was not significantly different (1.5 ± 3.7 vs 2.0 ± 3.3; n.s). CONCLUSION The clinical, functional, and radiographic outcomes, including joint line distance, were comparable between the tight medial and balanced group after mechanical alignment-targeted UC TKA with MST. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Sung-Sahn Lee
- Department of Orthopaedic Surgery, Ilsan Paik Hospital, Inje University School of Medicine, Goyangsi, Gyeonggido, Korea
| | - Jeounghun Lee
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon Street, Gangnam-Gu, Seoul, 06351, Korea
| | - Hail Alharthi
- Arthroplasty Division, Taif University, Taif, Saudi Arabia
| | - Young-Wan Moon
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon Street, Gangnam-Gu, Seoul, 06351, Korea.
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Inoue A, Arai Y, Nakagawa S, Yoshihara Y, Kobayashi M, Takahashi K. The clinical results of bi-cruciate vs posterior stabilized total knee arthroplasty for flexion contracture in osteoarthritic knee. J Orthop Surg (Hong Kong) 2023; 31:10225536231190524. [PMID: 37817454 DOI: 10.1177/10225536231190524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND The improvement of flexion contracture is important in knee arthroplasty since residual flexion contracture postoperatively is associated with decreased quality of life and patient satisfaction. In this study, we investigated the effect of bi-cruciate stabilized (BCS)-type total knee arthroplasty (TKA) as compared to posterior stabilized (PS)-type TKA on osteoarthritic primary knees with flexion contractures. METHODS 59 TKAs from January 2014 to December 2020, of which 30 were PS-type TKAs (NexGen LPS-flexⓇ; 76.3 years, BMI 27.5) and 29 BCS-type TKAs (Journey IIⓇ; 72.5 years, BMI 28.6), were performed for knee osteoarthritis with preoperative flexion contracture of 15° or greater. Full extension was obtained intraoperatively during all TKAs. Clinical outcomes, radiological evaluations, and the amount of additional distal femoral osteotomy during TKA were evaluated in a retrospective study design. RESULTS The range of motion improved in the both groups. Postoperative flexion contracture was significantly improved in the BCS group. Knee Society Score improved significantly in both groups, with no difference between the two groups. The amount of additional distal femoral osteotomy was 2.5 ± 1.3 mm for the PS group, and 1.8 ± 1.5 mm for the BCS group, showing a significant difference (p = 0.04). DISCUSSION The BCS-type TKA significantly improved preoperative flexion contracture and reduced the amount of additional distal femoral osteotomy compared to PS-type TKA. This is attributed to the anterior cam in the BCS-type TKA, which leads to a smaller amount of protrusion of the posterior femoral condyle from the posterior margin of the tibial component in the BCS-type in knee extension, as compared to the PS-type.
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Affiliation(s)
- Atsuo Inoue
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Orthopaedic Surgery, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Yuji Arai
- Department of Sports and Para-Sports Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shuji Nakagawa
- Department of Sports and Para-Sports Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yasushi Yoshihara
- Department of Orthopaedic Surgery, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Masashi Kobayashi
- Department of Orthopaedic Surgery, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
- Kobayashi Orthopaedic Clinic, Kyoto, Japan
| | - Kenji Takahashi
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Okayoshi T, Okamoto Y, Wakama H, Otsuki S, Neo M. The flexion-extension gap is predictive of patient-reported outcome measures after cruciate-retaining total knee arthroplasty. Knee 2023; 41:150-160. [PMID: 36702049 DOI: 10.1016/j.knee.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 11/13/2022] [Accepted: 12/21/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND We aimed to evaluate the association between the flexion-extension gap difference and patient-reported outcome measures after total knee arthroplasty (TKA). METHODS This was a retrospective case-control study of 60 cruciate-retaining single-radius TKAs. Soft tissue balancing was measured using an offset seesaw tensioner and centre-type digital knee balancer under joint distraction forces of 20-50 lbf and 1.5 times body mass index (1.5 BMI). At the last follow up of 2.0-6.5 (mean, 4.5) years postoperatively, patients were asked if they perceived their knee joint as 'natural' (26 knees) or 'artificial' (34 knees). Age, sex, and the flexion-extension gap were compared between the two groups. A receiver operating characteristic curve was used to determine cut-off values of variables predictive of a natural joint perception. RESULTS Natural joint perception was associated with a greater flexion-extension gap difference under a distraction force of 1.5 BMI (P = 0.016), higher knee function (Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, P = 0.019), and quality of life (EuroQol 5-Dimension, P = 0.029). A gap difference of 0.95 mm under 1.5 BMI distraction predicted a natural joint perception post-TKA (sensitivity, 97.1%; specificity, 88.5%). Using a gap threshold of 1.0 mm under a 1.5 BMI distraction force yielded significant between-group differences in postoperative flexion (P = 0.040), satisfaction (P = 0.043), knee joint function (P < 0.001), quality of life (P = 0.032), and posterior femoral condylar offset (P = 0.037) CONCLUSION: A flexion-extension gap difference ≥1.0 mm under a distraction force of 1.5 BMI predicted superior outcomes, including patient satisfaction, after cruciate-retaining TKA. It was suggested that posterior femoral condylar offset could influence this finding.
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Affiliation(s)
- Tomohiro Okayoshi
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki 569-8686, Japan
| | - Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki 569-8686, Japan.
| | - Hitoshi Wakama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki 569-8686, Japan
| | - Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki 569-8686, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki 569-8686, Japan
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Additional Distal Femoral Resection Minimally Improves Terminal Knee Extension: A Systematic Review and Meta-Regression Challenging the Dogma. Arthroplast Today 2023; 19:101083. [PMID: 36845290 PMCID: PMC9947997 DOI: 10.1016/j.artd.2022.101083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/30/2022] [Accepted: 12/11/2022] [Indexed: 01/13/2023] Open
Abstract
Background Additional distal femoral resection is a common technique to address a flexion contracture during primary total knee arthroplasty (TKA) but can lead to midflexion instability and patella baja. Prior reports regarding the magnitude of knee extension obtained with additional femoral resection have varied. This study sought to systematically review research describing the effect of femoral resection on knee extension and to perform meta-regression to estimate this relationship. Methods A systematic review was conducted using MEDLINE, PubMed, and Cochrane databases by combining the terms ("flexion contracture" OR "flexion deformity") AND ("knee arthroplasty" OR "knee replacement") to identify 481 abstracts. In total, 7 articles reporting change in knee extension after additional femoral resection or augmentation across 184 knees were included. The mean value for knee extension, its standard deviation, and the number of knees tested were recorded for each level. Meta-regression was performed using weighted mixed-effects linear regression. Results Meta-regression estimated that each 1mm resected from the joint line produced a 2.5° gain of extension (95% confidence interval, 1.7 to 3.2). Sensitivity analyses excluding outlying observations estimated each 1mm resected from the joint line produced a 2.0° gain of extension (95% confidence interval, 1.9 to 2.2). Conclusions Each millimeter of additional femoral resection is likely to produce only a 2° improvement in knee extension. Thus, an additional resection of 2 mm is likely to improve knee extension by less than 5°. Alternative techniques, including posterior capsular release and posterior osteophyte resection, should be considered in correcting a flexion contracture during TKA.
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Okamoto Y, Wakama H, Matsuyama J, Nakamura K, Otsuki S, Neo M. The significance of the pelvic incidence measurement as a possible predictor of TKA outcome. Knee Surg Sports Traumatol Arthrosc 2022:10.1007/s00167-022-07224-8. [PMID: 36352242 DOI: 10.1007/s00167-022-07224-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/03/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate the association between the sagittal alignment of the pelvis and residual knee flexion contracture after total knee arthroplasty (TKA). This is important as a flexion contraction can be associated with the risk of poor outcomes and patient satisfaction after TKA. METHODS This was a retrospective, case-control, study of 200 osteoarthritic knees, contributed by 200 patients, over a mean follow-up of 2.4 years. The following factors were compared between patients 'with' (46 knees) and 'without' (154 knees) a residual flexion contracture ≥ 10° after TKA: age, sex, pelvic incidence (PI), anterior femoral bowing, femoral component flexion angle (FFA), and patient-reported outcomes. Logistic regression and receiver operating characteristic curve analyses were used to identify predictive factors. RESULTS The following factors were predictive of a residual flexion contracture ≥ 10°: a pelvic incidence ≥ 55° (odds ratio, 1.29; 95% confidence interval, 1.05-1.59; P = 0.031) and the FFA (odds ratio, 1.08; 95% confidence interval, 1.03-1.14; P = 0.044). A pelvic incidence cutoff of 55° yielded a significant between-group difference, with a sensitivity of 78.4% and specificity of 89.9% to differentiate a residual knee flexion contracture ≥ 10° (P = 0.001), patient satisfaction (P = 0.029), EuroQol 5-Dimension score (P = 0.028), anterior femoral curvature (P = 0.031), and Knee Injury and Osteoarthritis Outcome Score-Joint Replacement score (P = 0.046). CONCLUSION A pelvic incidence > 55° is associated with a residual knee flexion contracture ≥ 10° after TKA. The significance of the pelvic incidence measurement as a possible predictor of TKA outcome was highlighted, including its impact on patient satisfaction. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki, 569-8686, Japan.
| | - Hitoshi Wakama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki, 569-8686, Japan
| | - Junya Matsuyama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki, 569-8686, Japan
| | - Kaito Nakamura
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki, 569-8686, Japan
| | - Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki, 569-8686, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki, 569-8686, Japan
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Posteromedial vertical capsulotomy selectively expands the intraoperative extension gap in cruciate-retaining total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2022; 31:1347-1353. [PMID: 35648178 DOI: 10.1007/s00167-022-07015-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 05/11/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Effective soft-tissue balancing procedures for expanding the extension gap (EG) are needed in cases of gap mismatch in total knee arthroplasty (TKA). A posteromedial vertical capsulotomy (PMVC) is performed to restore mobility in a knee with a flexion contracture. The purpose of this study was to evaluate the effectiveness and safety of PMVC for intraoperative gap adjustment in cruciate-retaining TKA. METHODS A total of 120 consecutive knees undergoing cruciate-retaining TKA for varus osteoarthritis were examined. The EG and flexion gap (FG) with a trial femoral component were measured using spacer blocks before and after PMVC. PMVC was performed when the first FG was larger than the first EG by > 2 mm. RESULTS Sixty-five knees underwent PMVC, and the mean EG significantly increased by 2.4 mm (p < 0.001). This increase was significantly larger than that of the FG by 2.0 mm (p < 0.001). The preoperative extension range of motion (ROM) was negatively correlated with the EG change after PMVC (r = - 0.39, p = 0.001). A receiver operating characteristic (ROC) curve indicated a preoperative extension ROM cut-off of -10° for predicting PMVC (sensitivity 72.3%, specificity 56.4%). No associated complications were observed during a minimum 2-year follow-up period, and there was no difference in the postoperative Knee Society Score between the PMVC and non-PMVC groups. CONCLUSION PMVC may be a useful soft-tissue treatment for gap adjustment with a selective EG expansion in TKA, especially in cases of a limited preoperative extension of - 10° or less. LEVEL OF EVIDENCE Therapeutic study, level III.
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Shin KH, Jang KM, Han SB. Component gap measurement reflects the planned gap balance during total knee arthroplasty more accurately and reliably than bone surface gap measurement. Knee Surg Sports Traumatol Arthrosc 2022; 30:584-592. [PMID: 33068127 DOI: 10.1007/s00167-020-06324-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 10/06/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE This study aimed to compare the reliability of two gap assessment methods (component and bone surface gap measurement vs. planned gap balance) and identify the contributors to component gaps other than planned gaps. METHODS The prospectively collected data for 122 consecutive primary total knee arthroplasties (TKAs; 114 patients). After femoral planning for gap balancing, the medial and lateral planned gaps were calculated (planned gap). The established medial extension and flexion gaps (MEG and MFG, respectively) and lateral extension and flexion gaps (LEG and LFG, respectively) were measured with and without the TKA components (bone surface and component gaps) at 0° and 90° flexion. The intraclass and Pearson correlation coefficients for each gap measurement method were assessed using planned gap values, and multiple linear regression analyses were performed to identify the contributors to component gaps. RESULTS Compared with the bone surface gap measurement, the component gap measurement showed higher reliability and stronger correlation with the planned gap balance for each gap. The changes in the medial posterior femoral offset contributed to the MEG and LEG, whereas those in the joint line height contributed to the LEG. The changes in the hip-knee-ankle angle and lateral posterior femoral offset contributed to the LFG. CONCLUSION Component gap measurements of the established gap more accurately and reliably reflect the planned gap balance than do bone surface gap measurements. The established gaps are affected by several factors other than femoral planning.
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Affiliation(s)
- Kyun-Ho Shin
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, 73 Inchon-ro, Sungbuk-gu, Seoul, 02841, South Korea
| | - Ki-Mo Jang
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, 73 Inchon-ro, Sungbuk-gu, Seoul, 02841, South Korea
| | - Seung-Beom Han
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, 73 Inchon-ro, Sungbuk-gu, Seoul, 02841, South Korea.
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Okamoto Y, Wakama H, Okayoshi T, Matsuyama J, Otsuki S, Neo M. Spinopelvic mismatch is associated with patient-reported outcome measures after total knee arthroplasty at a mean follow-up of 15 years. Knee 2022; 34:156-166. [PMID: 34923348 DOI: 10.1016/j.knee.2021.11.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/02/2021] [Accepted: 11/25/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Total knee arthroplasty (TKA) is widely performed; yet, up to 25% of patients are dissatisfied with outcomes. Our aim was to evaluate the association between a spinopelvic mismatch and patient-reported outcomes after TKA. METHODS This was a retrospective study of 101 TKAs performed for osteoarthritis, at a mean 14.6 (range, 10.0-18.0) years post-surgery. Postoperative knee joint perception was evaluated as 'artificial', with or without restrictions, or 'natural'. Age, sex and the spinopelvic mismatch were compared between the 'artificial' (n = 54) and 'natural' (n = 47) perception groups. Multiple logistic regression analysis was used to identify predictive factors of an artificial perception, with a receiver operating characteristic curve to identify cut-off values for significant factors. RESULTS A spinopelvic mismatch, defined as a pelvic incidence minus lumbar lordosis (PI-LL) ≥ 10°, was associated with an artificial perception (odds ratio, 1.57; 95% confidence interval, 1.29-3.22; P = 0.023). An artificial joint perception was related to lower Knee Injury and Osteoarthritis Outcome Score-Joint Replacement (KOOS-JR, P = 0.021) and EuroQol 5-Dimension (EQ-5D, P = 0.025) scores. The cut-off PI-LL of 11° differentiated the groups with a sensitivity of 87.0% and specificity of 91.9%. Postoperative KOOS-JR (P < 0.001), EQ-5D (P = 0.014), satisfaction (P = 0.015), knee extension angle (P = 0.024), and perception (P = 0.032) differed between the groups when the PI-LL threshold was set at 10°. CONCLUSION A spinopelvic mismatch (PI-LL ≥ 10°) is associated with a risk of artificial perception of function after TKA. Measurement of the PI-LL could assist patients and surgeons to predict TKA outcomes.
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Affiliation(s)
- Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki 569-8686, Japan.
| | - Hitoshi Wakama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki 569-8686, Japan.
| | - Tomohiro Okayoshi
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki 569-8686, Japan.
| | - Junya Matsuyama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki 569-8686, Japan.
| | - Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki 569-8686, Japan.
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki 569-8686, Japan.
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Kinoshita T, Hino K, Kutsuna T, Watamori K, Tsuda T, Miura H. Efficacy of posterior capsular release for flexion contracture in posterior-stabilized total knee arthroplasty. J Exp Orthop 2021; 8:102. [PMID: 34735661 PMCID: PMC8568746 DOI: 10.1186/s40634-021-00422-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 10/22/2021] [Indexed: 11/15/2022] Open
Abstract
Purpose Posterior capsular contracture causes stiffness during knee extension in knee osteoarthritis. Furthermore, in posterior-stabilized total knee arthroplasty (PS-TKA), a unique design such as the cam mechanism could conflict with the posterior capsule (PC) causing flexion contracture (FC). However, few studies have focused on the anatomical aspects of the PC. This study aimed to investigate the anatomical site and forms of posterior capsular attachment to the femoral cortex, and to evaluate the efficacy of posterior capsular release for FC by assessing changes in knee extension angles using a navigation system. Methods Attachment sites of the PC were investigated in 10 cadaveric knees using computed tomography. PS-TKA was performed in six cadaveric knees using a navigation system to evaluate the efficacy of posterior capsular release for FC. Posterior capsular release was performed stepwise at each part of the femoral condyle. Results The gastrocnemius tendon and PC were integrally attached to the femoral cortex at the medial and lateral condyles, whereas the PC at the intercondylar fossa was independently attached directly to the femoral cortex. Moreover, the PC at the intercondylar fossa was attached most distally among each femoral condyle. Posterior capsular release at the intercondylar fossa allowed 11.4° ± 2.8° improvement in knee extension. This angle was further improved by 5.5° ± 1.3°, after subsequent capsular release at the medial and lateral condyles. Conclusion The forms and sites of posterior capsular attachment differed based on the part of the femoral condyle. Stepwise posterior capsular release was effective for FC in PS-TKA. Level of evidence III.
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Affiliation(s)
- Tomofumi Kinoshita
- Department of Orthopedic Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Kazunori Hino
- Department of Orthopedic Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan.
| | - Tatsuhiko Kutsuna
- Department of Orthopedic Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Kunihiko Watamori
- Department of Orthopedic Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Takashi Tsuda
- Department of Orthopedic Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Hiromasa Miura
- Department of Orthopedic Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
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Kawasaki M, Kaneyama R, Suzuki H, Fujitani T, Tsukamoto M, Sabanai K, Yoshioka T, Okimoto N, Nagamine R, Sakai A. Component gap control during posterior-stabilised total knee arthroplasty using the posterior condylar pre-cut technique. J Exp Orthop 2021; 8:77. [PMID: 34524551 PMCID: PMC8443714 DOI: 10.1186/s40634-021-00398-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/27/2021] [Indexed: 11/10/2022] Open
Abstract
Purpose Adjusting the gap lengths to ensure equal lengths in both extension and flexion during total knee arthroplasty (TKA) is important for achieving successful outcomes. We designed a new pre-cut trial component (PCT) for posterior-stabilised (PS) TKA and aimed to determine whether the pre-cut technique is useful for component gap (CG) control in PS TKA. Methods A total of 70 knees were included. The PS PCT for PS TKA is composed of a 9-mm-thick distal part and 5-mm-thick posterior part with a cam structure. First, the distal femur and proximal tibia were cut to create an extension gap. Next, a 4-mm pre-cut was made from the posterior femoral condylar line; then, the PS PCT was attached, and the CGs were checked and compared at 0° and 90° knee flexion. Final CGs with the trial femoral components were compared with gaps in PS PCT at 0° and 90° knee flexion. Results CGs using PS PCTs were 10.2 mm at 0° and 13.6 mm at 90° knee flexion. According to the release of the posterior capsule at intercondylar notch and the adjustment of the cutting level of posterior femoral condyle, the final CG on knee extension was 11.3 mm; it did not significantly differ from CGs with PS PCT. The final CG at 90° knee flexion was 12.7 mm; it did not significantly differ from the estimated gap (12.4 mm) in PS PCT after flexion gap control. Conclusion CG control using PS PCT is a useful technique during PS TKA. Level of evidence Level IV: Case series.
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Affiliation(s)
- Makoto Kawasaki
- Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka Yahatanishi-ku, Kitakyushu City, Fukuoka, 807-8555, Japan.
| | - Ryutaku Kaneyama
- Knee Joint Reconstruction Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura City, Kanagawa, 247-8533, Japan
| | - Hitoshi Suzuki
- Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka Yahatanishi-ku, Kitakyushu City, Fukuoka, 807-8555, Japan
| | - Teruaki Fujitani
- Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka Yahatanishi-ku, Kitakyushu City, Fukuoka, 807-8555, Japan
| | - Manabu Tsukamoto
- Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka Yahatanishi-ku, Kitakyushu City, Fukuoka, 807-8555, Japan
| | - Ken Sabanai
- Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka Yahatanishi-ku, Kitakyushu City, Fukuoka, 807-8555, Japan
| | - Toru Yoshioka
- Department of Orthopaedics, Shimura Hospital, 3-13 Funairimachi Naka-ku, Hiroshima, 730-0841, Japan
| | - Nobukazu Okimoto
- Okimoto Clinic, 185-4 Yutakamachikubi, Kure City, Hiroshima, 734-0304, Japan
| | - Ryuji Nagamine
- Center of Artificial Joint and Rheumatism, Fukuoka Tokushukai Medical Center, 4-5 Sugukita, Kasuga City, Fukuoka, 816-0864, Japan
| | - Akinori Sakai
- Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka Yahatanishi-ku, Kitakyushu City, Fukuoka, 807-8555, Japan
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12
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Shin KH, Kim SB, Jang KM, Lee CS, Han SB. Posterior tibial slope is a modifiable predictor of relatively large extension gaps in total knee arthroplasty for degenerative osteoarthritis. J Orthop Surg (Hong Kong) 2021; 29:23094990211002004. [PMID: 33779412 DOI: 10.1177/23094990211002004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND During total knee arthroplasty (TKA) for osteoarthritis, the sagittal gap imbalance (SGI) with a relatively large extension gap is an important surgical challenge. We determined the predictors of SGI with a relatively large extension gap and evaluated the surgical outcomes of knees with SGI. METHODS 551 consecutive cases of primary TKA for osteoarthritis were retrospectively reviewed. The cohort was divided into two groups according to the SGI and statistically matched according to baseline characteristics via the inverse probability of treatment weighting method. Multiple linear and logistic regression analyses were performed to determine the predictors of sagittal gap difference (SGD) and SGI. Intergroup differences in clinical and radiological outcomes were analyzed. RESULTS Of all the knees included, 8.5% (n = 45) presented with SGI with a relatively large extension gap and required femoral sagittal balancing to manage SGI. The hyperextension angle (HA), preoperative joint line convergence angle (JLCA), and the change in posterior tibial slope (PTS) significantly correlated to SGD and predicted SGI with a relatively large extension gap. SGI group showed significant changes in femoral posterior condylar offset and joint line height compared to those without SGI (1.48 vs -0.45, 1.37 vs -0.51, respectively). Postoperative ROM and knee society knee scores were lower in SGI group. CONCLUSION Knees requiring sagittal balancing to manage SGI with a relatively large extension gap is not uncommon in TKA for osteoarthritic knees. The change in PTS is an independent and modifiable predictor of SGI.
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Affiliation(s)
- Kyun-Ho Shin
- Joint Center, 37997Inbone Hospital, Paju-si, Gyeonggi-do, South Korea
| | - Sang-Bum Kim
- Joint Center, 37997Inbone Hospital, Paju-si, Gyeonggi-do, South Korea
| | - Ki-Mo Jang
- Department of Orthopaedic Surgery, Anam Hospital, 37997Korea University College of Medicine, Seoul, South Korea
| | - Chul-Soo Lee
- Department of Orthopaedic Surgery, Anam Hospital, 37997Korea University College of Medicine, Seoul, South Korea
| | - Seung-Beom Han
- Department of Orthopaedic Surgery, Anam Hospital, 37997Korea University College of Medicine, Seoul, South Korea
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13
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Elmasry SS, Chalmers BP, Kahlenberg CA, Mayman DJ, Wright TM, Westrich GH, Cross MB, Sculco PK, Imhauser CW. Simulation of preoperative flexion contracture in a computational model of total knee arthroplasty: Development and evaluation. J Biomech 2021; 120:110367. [PMID: 33887615 PMCID: PMC8183383 DOI: 10.1016/j.jbiomech.2021.110367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 01/29/2021] [Accepted: 03/01/2021] [Indexed: 02/07/2023]
Abstract
Preoperative flexion contracture is a risk factor for patient dissatisfaction following primary total knee arthroplasty (TKA). Previous studies utilizing surgical navigation technology and cadaveric models attempted to identify operative techniques to correct knees with flexion contracture and minimize undesirable outcomes such as knee instability. However, no consensus has emerged on a surgical strategy to treat this clinical condition. Therefore, the purpose of this study was to develop and evaluate a computational model of TKA with flexion contracture that can be used to devise surgical strategies that restore knee extension and to understand factors that cause negative outcomes. We developed six computational models of knees implanted with a posteriorly stabilized TKA using a measured resection technique. We incorporated tensions in the collateral ligaments representative of those achieved in TKA using reference data from a cadaveric experiment and determined tensions in the posterior capsule elements in knees with flexion contracture by simulating a passive extension exam. Subject-specific extension moments were calculated and used to evaluate the amount of knee extension that would be restored after incrementally resecting the distal femur. Model predictions of the extension angle after resecting the distal femur by 2 and 4 mm were within 1.2° (p ≥ 0.32) and 1.6° (p ≥ 0.25), respectively, of previous studies. Accordingly, the presented computational method could be a credible surrogate to study the mechanical impact of flexion contracture in TKA and to evaluate its surgical treatment.
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Affiliation(s)
- Shady S Elmasry
- Department of Biomechanics, Hospital for Special Surgery, Weill Cornell Medicine of Cornell University, New York, NY, USA; Department of Mechanical Design and Production, Faculty of Engineering, Cairo University, Egypt.
| | - Brian P Chalmers
- Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine of Cornell University, New York, NY, USA
| | - Cynthia A Kahlenberg
- Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine of Cornell University, New York, NY, USA
| | - David J Mayman
- Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine of Cornell University, New York, NY, USA
| | - Timothy M Wright
- Department of Biomechanics, Hospital for Special Surgery, Weill Cornell Medicine of Cornell University, New York, NY, USA
| | - Geoffrey H Westrich
- Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine of Cornell University, New York, NY, USA
| | - Michael B Cross
- Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine of Cornell University, New York, NY, USA
| | - Peter K Sculco
- Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine of Cornell University, New York, NY, USA
| | - Carl W Imhauser
- Department of Biomechanics, Hospital for Special Surgery, Weill Cornell Medicine of Cornell University, New York, NY, USA
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14
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Wakama H, Okamoto Y, Otsuki S, Nakagawa K, Okuno N, Neo M. Preoperative factors associated with extension gap in cruciate-retaining total knee arthroplasty: A retrospective study on continuous determination of distraction force. J Orthop Sci 2020; 25:1035-1039. [PMID: 31902557 DOI: 10.1016/j.jos.2019.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 11/07/2019] [Accepted: 12/04/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim of this retrospective study was to identify the preoperative patient-related factors affecting the soft tissue balancing in cruciate-retaining total knee arthroplasty. This is an important clinical issue, as the acquisition of adequate soft tissue balancing is essential for successful outcomes. METHODS The study group included 59 knees treated for medial compartment osteoarthritis. The extension gap was measured using the newly electric tensor that enables continuous quantification of a distraction force ranging from 0 to 40 lbf. We performed regression analyses to identify the relationship between preoperative factors and the extension gap. RESULTS Patient height, weight, and percent mechanical axis showed univariate correlation with the extension gap of either 30 lbf or 40 lbf. In the multivariate regression analysis without encountering multicollinearity, percent mechanical axis was inversely associated with the extension gap (t-value = -2.31, p = 0.02 for 30 lbf; and t-value = -2.39; p = 0.02 for 40lbf) as a significant independent factor. CONCLUSIONS We revealed the significant influence of several factors on the absolute value of the extension gap. Particularly, the severity of preoperative coronal alignment was a statistically independent explanatory variable, and the extension gap was overvalued in knees with severe varus deformity. This influence should be considered when comparing different individual cases longitudinally. Our feasible strategies could lead to a better understanding about the soft tissue balancing in total knee arthroplasty.
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Affiliation(s)
- Hitoshi Wakama
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka, 5698686, Japan
| | - Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka, 5698686, Japan.
| | - Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka, 5698686, Japan
| | - Kosuke Nakagawa
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka, 5698686, Japan
| | - Nobuhiro Okuno
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka, 5698686, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka, 5698686, Japan
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15
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Lee SS, Kim JH, Heo JW, Moon YW. Gradual change in knee extension following total knee arthroplasty using ultracongruent inserts. Knee 2019; 26:905-913. [PMID: 31229289 DOI: 10.1016/j.knee.2019.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 02/07/2019] [Accepted: 06/01/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Total knee arthroplasty (TKA) using an ultracongruent (UC) insert is widely performed. Lack of the posterior cruciate ligament or post-cam mechanism is a concern in terms of range of motion. The flexion angle of UC TKA had been well investigated; however, natural history and correlation factors of the postoperative extension angle have not been well documented. This study aimed to investigate time-dependent changes in extension after TKA using UC inserts, and to evaluate factors that correlated with the postoperative extension angle. METHODS This study reviewed 388 gap-balanced UC TKAs (331 patients) without hyperextension at navigation and performed between November 2010 and December 2014. The extension angle (a positive number indicates hyperextension) was measured on full-extension lateral radiographs. The extension angles from five days post-operation to final follow-up were investigated. Factors correlated with the postoperative extension angle were evaluated using multiple regression analysis. RESULTS Mean follow-up duration was 46.2 months. Until two years, the extension angle gradually increased; mean angles at five days/six months/one year/two years/and final follow-up were: -9.2°/-2.6°/0.6°/1.0°/1.0°, respectively. Female sex (β = -0.15, P = 0.002) and pre-operative hyperextension (β = 0.31, P < 0.001) were associated with postoperative hyperextension deformity. CONCLUSIONS Following UC TKA, knees became gradually more extended until two years post-operation. Sex and pre-operative extension angle were predictive factors for the postoperative extension angle following UC TKA. LEVEL OF EVIDENCE Level 4, Case series.
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Affiliation(s)
- Sung-Sahn Lee
- Department of Orthopedic Surgery, Ilsan Paik Hospital, Inje University School of Medicine, Goyangsi, Gyeonggido, South Korea
| | - Joo Hwan Kim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jae-Won Heo
- Department of Orthopedic Surgery, Bareunsesang Hospital, Seongnamsi, Gyeonggido, South Korea
| | - Young-Wan Moon
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
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16
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Okamoto Y, Otsuki S, Nakajima M, Jotoku T, Wakama H, Neo M. Sagittal Alignment of the Femoral Component and Patient Height Are Associated With Persisting Flexion Contracture After Primary Total Knee Arthroplasty. J Arthroplasty 2019; 34:1476-1482. [PMID: 30905642 DOI: 10.1016/j.arth.2019.02.051] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/10/2019] [Accepted: 02/22/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The aim of our retrospective case-control study is to identify risk factors associated with a persisting flexion contracture after total knee arthroplasty (TKA). This is an important clinical issue as a flexion contraction can lead to poor long-term clinical outcomes and patient satisfaction after TKA. METHODS The study group included 120 knees treated for a varus osteoarthritic deformity of the knee using a posterior cruciate-retaining TKA. We evaluated the association between a flexion contracture >10°, 2 years after surgery, and the following potential risk factors, using logistic regression analysis: age, body height, body mass index, preoperative knee extension and hip-knee-ankle angle, and radiological parameters of component alignment, namely the femoral component medial angle, the femoral component flexion angle (FFA), the tibial component medial angle, and the posterior tibial slope. RESULTS Of the 120 knees, a persisting flexion contracture >10° was identified in 33 (28%). The mean FFA in these cases was 7.3° (standard deviation, 1.4) compared to 4.2° (standard deviation, 1.2) for cases with a contracture of ≤10° (P = .034). On multivariate analysis, the FFA (odds ratio, 3.73; 95% confidence interval, 1.16-17.81; P = .034) and body height (odds ratio, 0.43; 95% confidence interval, 0.29-0.57; P = .041) were independent predictive risk factors for a residual flexion contracture >10°. CONCLUSION Clinicians should be aware that flexed position of the femoral component, particularly in patients of short stature, is associated with increased occurrence of persistent flexion contracture.
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Affiliation(s)
- Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Mikio Nakajima
- Department of Orthopaedic Surgery, Katsuragi Hospital, Kishiwada, Japan
| | - Tsuyoshi Jotoku
- Department of Orthopaedic Surgery, Katsuragi Hospital, Kishiwada, Japan
| | - Hitoshi Wakama
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
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17
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Pinter Z, Staggers R, Lee S, Bergstresser S, Shah A, Naranje S. Open posterior capsular release with an osteotome in total knee arthroplasty does not place important neurovascular structures at risk. Knee Surg Sports Traumatol Arthrosc 2019; 27:2120-2123. [PMID: 30767066 DOI: 10.1007/s00167-019-05399-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 02/06/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Posterior capsular contracture is a potential consequence of osteoarthritis, post-traumatic arthritis, and surgical procedures of the knee. Many patients who undergo TKA will be found to have some degree of flexion contracture intraoperatively, which necessitates posterior capsular release. There is no information in the literature about the safety of posterior capsular release done during TKA. The present cadaveric study investigates the safety of posterior capsular release during TKA. METHODS This study involved ten fresh-frozen cadaver specimens, each of which underwent three successive releases of the posterior capsule medially, laterally, and in the midline. One senior joint surgeon performed this procedure with a 1.27 cm curved osteotome, hugging the bone posteriorly on the distal aspect of the femur until the osteotome moved freely behind the bone without resistance. The distance from the distal aspect of the femur to the tip of the osteotome was then measured. Finally, the popliteal fossa was dissected, and the course of the neurovascular bundle was followed to assess for any macroscopic injury. RESULTS The capsule was penetrated at a median depth of 13.6 cm (range 10.3-17.6). Even at this depth, no injuries to the popliteal artery, tibial nerve, or popliteal vein occurred in any of the 30 penetrating events. CONCLUSION This study suggests that posterior capsular release can be performed safely with this technique.
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Affiliation(s)
- Zachariah Pinter
- University of Alabama at Birmingham, 1201 11th Avenue South, Suite 200, Birmingham, AL, 35205, USA
| | - Rucker Staggers
- University of Alabama at Birmingham, 1201 11th Avenue South, Suite 200, Birmingham, AL, 35205, USA
| | - Sung Lee
- University of Alabama at Birmingham, 1201 11th Avenue South, Suite 200, Birmingham, AL, 35205, USA
| | - Shelby Bergstresser
- University of Alabama at Birmingham, 1201 11th Avenue South, Suite 200, Birmingham, AL, 35205, USA
| | - Ashish Shah
- University of Alabama at Birmingham, 1201 11th Avenue South, Suite 200, Birmingham, AL, 35205, USA
| | - Sameer Naranje
- University of Alabama at Birmingham, 1201 11th Avenue South, Suite 200, Birmingham, AL, 35205, USA.
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18
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Seo SS, Kim CW, Seo JH, Kim DH, Kim OG, Lee CR. Effects of Resection of Posterior Condyles of Femur on Extension Gap of Knee Joint in Total Knee Arthroplasty. J Arthroplasty 2017; 32:1819-1823. [PMID: 28236549 DOI: 10.1016/j.arth.2017.01.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 12/22/2016] [Accepted: 01/23/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND When evaluating the effects of the preparation of the flexion gap on the extension gap in total knee arthroplasty (TKA), the effects of posterior condylar resection and osteophyte removal on the extension gap should be differentiated. Although the amount of osteophytes differs between patients, posterior condylar resection is a procedure that is routinely implemented in TKA. The aim of this study was to assess the effects of the resection of the posterior condyle of the femur on the extension gap in posterior-stabilized (PS) TKA. METHODS We enrolled 40 knees that underwent PS TKA between July 2010 and February 2011 with no or minimal osteophytes in the posterior compartment and a varus deformity of <15°. We measured the extension gap before and after the resection of the posterior condyle of the femur using a tensor under 20 and 40 lb of distraction force. RESULTS Under 20 lb of distraction force, the average extension gap was 13.3 mm (standard deviation [SD], 1.6) before and 13.8 mm (SD, 1.6) after posterior condylar resection. Under 40 lb of distraction force, the average extension gap was 15.1 mm (SD, 1.5) before and 16.1 mm (SD, 1.7) after posterior condylar resection. CONCLUSION The resection of the posterior condyle of the femur in PS TKA increased the extension gap. However, this increase was only by approximately 1 mm. In conclusion, posterior condylar resection does increase the extension gap by approximately 1 mm. However, in most case, this change in unlikely to be clinically important.
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Affiliation(s)
- Seung-Suk Seo
- Department of Orthopedic Surgery, Bumin Hospital, Buk-gu, Busan, Republic of Korea
| | - Chang-Wan Kim
- Department of Orthopedic Surgery, Busan Paik Hospital, College of Medicine, Inje University, Busanjin-gu, Busan, Republic of Korea
| | - Jin-Hyuk Seo
- Department of Orthopedic Surgery, Bumin Hospital, Buk-gu, Busan, Republic of Korea
| | - Do-Hun Kim
- Department of Orthopedic Surgery, Bumin Hospital, Buk-gu, Busan, Republic of Korea
| | - Ok-Gul Kim
- Department of Orthopedic Surgery, Bumin Hospital, Buk-gu, Busan, Republic of Korea
| | - Chang-Rack Lee
- Department of Orthopedic Surgery, Busan Paik Hospital, College of Medicine, Inje University, Busanjin-gu, Busan, Republic of Korea
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