Adequate joint line restoration and good preliminary clinical outcomes after total knee arthroplasty using the Flexion First Balancer technique

Lieshout, W. A. M. van; Duijnisveld, B.J.; Koenraadt, Koen L. M.; Elmans, L.; Kerkhoffs, Gino M. M. J.; Geenen, Rutger C. I. van

doi:10.1016/j.knee.2019.04.002

Cited by 8 publications

(21 citation statements)

References 22 publications

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“…A limitation of the current study is that it does not provide patient data to support the presumed benefits of the Flexion First Balancer method. However, another recent publication discussed PROMS and patient complication rates in a comparison of the standard MR procedure and this new technique [11]. Therefore, the main focus of this article is to provide a clear description of the technical application of the Flexion First Balancer method.…”

Section: Discussionmentioning

confidence: 99%

Flexion First Balancer: description of new technique in TKA to reproduce joint line and pre-disease mechanical alignment

et al. 2020

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A considerable proportion of patients (19%) are dissatisfied after total knee arthroplasty (TKA). Possible factors contributing to this dissatisfaction are decreased posterior condylar offset (PCO) with subsequent joint line elevation, leading to mid-flexion instability. Secondly, the pre-disease mechanical alignment is changed into a neutral alignment. The Flexion First Balancer was developed to avoid these problems. This technique aims to maintain MCL isometry by restoring medial PCO and medial joint line to its pre-disease level. Also, to reconstruct the pre-disease mechanical alignment by adjusting the distal femoral angle. In this study we provide a detailed technical overview of the Flexion First Balancer technique.

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Section: Discussionmentioning

confidence: 99%

Flexion First Balancer: description of new technique in TKA to reproduce joint line and pre-disease mechanical alignment

et al. 2020

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“…For all patients included in this study, we performed TKAs using a measured resection (MR) technique. van Lieshout et al showed that the joint line was elevated after TKA using the MR technique (22). In addition, Luyckx et al, using cadaver knees, demonstrated that despite a well-balanced knee in full extension and at 90°of exion, increased mid-exion instability was evident in knees in which the joint line was raised (23).…”

Section: Discussionmentioning

confidence: 99%

Three-Year Clinical Results of a Cruciate-Retaining Type of the Knee Prosthesis with Anatomical Geometry Developed in Japan

Nakajima¹,

Sonobe²,

Akatsu³

et al. 2020

Preprint

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Background: The FINE total knee was developed in Japan and clinical use began in 2001. It has unique design features, including an oblique 3o femorotibial joint line that reproduces anatomical geometry. Although 20 years have passed since the FINE knee was clinically used for the first time in Japan, a formal clinical evaluation including patient-reported and radiographic outcomes has not been undertaken.Methods: A total of 175 consecutive primary cruciate-retaining (CR)-FINE total knee arthroplasties (TKAs) at our hospital between February 2015 and March 2017 were included in this study. Three years postoperatively, range of motion (ROM), Knee Society Score (KSS), Knee Injury and Osteoarthritis Outcome Score (KOOS) and Forgotten Joint Score (FJS) were recorded and compared with preoperative scores. Radiographic analyses including mechanical alignment, component alignment, and incidence of radiolucent lines also were undertaken based on the radiographs three years postoperatively.Results: One-hundred twenty-two knees (70%) were available for 3-year follow-up data using KOOS, except for the sports subscale. Postoperative KOOS-symptom, -pain and -ADL were > 85 points, but KOOS-sports, -QOL and FJS were less satisfactory. ROM, KSS and all the subscales of KOOS were significantly improved compared with preoperative scores. Postoperative mean FJS was 66 and was significantly correlated with all the subscales of KOOS, but not with postoperative ROM. Radiolucent lines ≧1 mm wide were detected in five knees (4.1%). There were no major complications needing revision surgeries.Conclusions: Patient-reported outcomes (PROs) for symptoms, pain and ADL after the CR-FINE TKA were generally improved, but those for sports, QOL and FJS were improved less. The incidence of radiolucent lines was rare but detected around the femoral components. Improvements of surgical technique or innovation of the implant design with mid- to long-term follow-up will be necessary to achieve better PROs from patients receiving the FINE knee.

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“…[2][3][4][5][6] In contrast, other authors state that the constitutional PCO's alteration had no significant clinical effect on the outcomes. [7][8][9][10][11][12][13] Different factors are the reason for these differences. 7 The comparison of pre-and postoperative PCO determined in "true lateral radiographs" presents several methodological errors.…”

Section: Introductionmentioning

confidence: 99%

“…The documentation of changes on plain conventional radiographs is questionable. 10,14,15 Only a few published studies comparing pre-and postoperative PCO consider cartilage thickness. 4,10,16 As shown in Figure 2, there is a discrepancy between the pre-(bones contours) and postoperative (prosthetic shapes) measurements.…”

Section: Introductionmentioning

confidence: 99%

“…10,14,15 Only a few published studies comparing pre-and postoperative PCO consider cartilage thickness. 4,10,16 As shown in Figure 2, there is a discrepancy between the pre-(bones contours) and postoperative (prosthetic shapes) measurements. Although ignoring this discrepancy is misleading, we argue that even more important is the effect of forcing the femoral rotation to achieve the complete overlap of the medial and lateral femoral condyles (to accomplish "true lateral knee radiographs," as described by Hanratty et al 18 ).…”

Section: Introductionmentioning

confidence: 99%

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Reliability of the posterior condylar offset

León‐Muñoz

Parrinello

Galloni

et al. 2021

Journal Orthopaedic Research

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The posterior condylar offset (PCO) has been proposed as a determinant of a postoperative range of motion after total knee arthroplasty, although there is no consensus. This study aimed to demonstrate the error introduced by forcing the femoral rotation to overlap both condyles for the “true” lateral X‐ray projection for the PCO measurement. We hypothesize that the angular discrepancy between the posterior femoral cortical reference plane and the posterior condylar axis plane due to rotation invalidates the acquisition of reliable measurements on X‐rays. We have measured the PCO in 50 “true” lateral X‐rays and compared it with the medial and lateral condyles PCO's assessed on a computed tomography‐scan‐based three‐dimensional (3D) model of each knee. PCO based on the 3D imaging differed significantly between the medial (25.8 ± 3.67 mm) and lateral (16.59 ± 2.92 mm) condyle. Three‐dimensional PCO values differ significantly from those determined in the radiographic studies. Also, the mean values of the medial and lateral condyle PCO measurements differed significantly (p < 0.001) with all PCO measurements on radiographs. We have identified a difference between the posterior cortical plane and the posterior condylar axis projections, both on the axial plane with a mean value of 11.23° ± 3.64°. Our data show an interplane discrepancy angle between the posterior femoral diaphyseal cortical and the posterior condylar axis plane (due to the femur's necessary rotation to overlap both condyles) may invalidate the 2D X‐ray PCO assessment as a reliable measurement.

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Adequate joint line restoration and good preliminary clinical outcomes after total knee arthroplasty using the Flexion First Balancer technique

Cited by 8 publications

References 22 publications

Flexion First Balancer: description of new technique in TKA to reproduce joint line and pre-disease mechanical alignment

Flexion First Balancer: description of new technique in TKA to reproduce joint line and pre-disease mechanical alignment

Three-Year Clinical Results of a Cruciate-Retaining Type of the Knee Prosthesis with Anatomical Geometry Developed in Japan

Reliability of the posterior condylar offset

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