D ecreasing proprioception of the knee is multifactorial and is a function of age and degenerative joint disease. Soft-tissue release during total knee replacement may have an influence. We have quantified soft-tissue imbalance at the time of knee replacement and attempted to eliminate it at full extension, using established methods. We studied the influence of residual soft-tissue imbalance on postoperative proprioception, assessing this in 38 patients before total knee replacement and at three and six months postoperatively. We found that proprioception improved in varus knees at three and six months after soft-tissue balancing procedures. Knees balanced in full extension and in flexion (< ±2°) showed a significant improvement in proprioception (p < 0.0005) whereas those which were not balanced in flexion but fully balanced in extension had no significant improvement. We conclude that soft-tissue balance in both flexion and extension is important to allow satisfactory postoperative proprioception of the knee.

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Due to the increase in prescription of insoles to relieve symptoms due to skeletal shocks at heel strike a pilot study was initiated to look at some materials used for this purpose. Five materials were examined (Plastazote, Spenco, Sorbothane, Poron (PPT) and Viscolas) by two methods. The first method used an accelerometer mounted between the teeth of one of the authors (PR) to record skeletal shock. The second method used a force plate to record the shock produced by dropping a ball-bearing onto the insoles from a standard height. The results showed that Plastazote is poor at absorbing shock with Spenco and Sorbothane being quite good. The best insole materials tested were Poron (PPT) and Viscolas with the latter being marginally superior. No account was taken of degradation of the materials in use except that Plastazote worn for 72 hours was also used in the study, this producing the worst results.

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