Clinical outcome of increased flexion gap after total knee arthroplasty. Can controlled gap imbalance improve knee flexion?

Ismailidis, Petros; Kuster, Markus S.; Jost, Bernhard; Giesinger, Karlmeinrad; Behrend, Henrik

doi:10.1007/s00167-016-4009-1

Cited by 16 publications

(11 citation statements)

References 27 publications

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“…These findings are supported by a recent study by Ismailidis et al. ( 2017 ) that found a positive effect on postoperative flexion and patient satisfaction in knees where the flexion gap exceeded the extension gap by 2.5 mm. Furthermore, Tsukiyama et al.…”

Section: Discussionsupporting

confidence: 83%

No detrimental effect of ligament balancing on functional outcome after total knee arthroplasty: a prospective cohort study on 129 mechanically aligned knees with 3 years’ follow-up

Aunan

Röhrl

2018

Acta Orthopaedica

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Background and purpose — In the classical mechanical alignment technique, ligament balancing is considered a prerequisite for good function and endurance in total knee arthroplasty (TKA). However, it has been argued that ligament balancing may have a negative effect on knee function, and some authors advocate anatomic or kinematic alignment in order to reduce the extent of ligament releases. The effect of the trauma induced by ligament balancing on functional outcome is unknown; therefore, the aim of this study was to investigate this effect.Patients and methods — 129 knees (73 women) were investigated. Mean age was 69 years (42–82), and mean BMI was 29 (20–43). Preoperatively 103 knees had a varus deformity, 21 knees had valgus deformity, and 5 knees were neutral. The primary outcome measure was the Knee injury and Osteoarthritis Outcome Score (KOOS). Secondary outcome measures were the Oxford Knee Score (OKS) and patient satisfaction (VAS). All ligament releases were registered intraoperatively and outcome at 3 years’ follow-up in knees with and without ligament balancing was comparedResults — 86 knees were ligament balanced and 43 knees were not. Ligament-balanced varus knees had more preoperative deformity than varus knees without ligament balancing (p = 0.01). There were no statistically significant differences in outcomes between ligament-balanced and non-ligament-balanced knees at 3 years’ follow-up. No correlation was found between increasing numbers of soft tissue structures released and outcome.Interpretation — We did not find any negative effect of the trauma induced by ligament balancing on knee function after 3 years.

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Section: Discussionsupporting

confidence: 83%

No detrimental effect of ligament balancing on functional outcome after total knee arthroplasty: a prospective cohort study on 129 mechanically aligned knees with 3 years’ follow-up

Aunan

Röhrl

2018

Acta Orthopaedica

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“…Some previous studies reported AP translation of 5–10 mm was related to similar or better patients’ clinical outcomes. 15,33 However, in an outpatient clinic, some patients with no excessive AP translation less than 10 mm complain about ascending or descending stairs and walking downhill. Mochizuki et al 22 demonstrated that more than 7 mm of mid-flexion AP laxity can cause feeling of instability.…”

Section: Discussionmentioning

confidence: 99%

Similar outcomes between ultracongruent and posterior-stabilized insert in total knee arthroplasty: A propensity score-matched analysis

Lee

Yeom

Lee

et al. 2019

J Orthop Surg (Hong Kong)

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Purpose: (1) To compare postoperative range of motion (ROM), stability, and clinical outcomes between fixed-bearing posterior-stabilized (PS) and ultracongruent (UC). (2) The effect of postoperative stability on ROM and clinical outcomes was also evaluated in both designs. Materials and methods: Propensity score matching was conducted for age, gender, body mass index, preoperative ROM, Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index, Knee Society (KS) scores, hip–knee–ankle (HKA) alignment, and follow-up period. Two hundred patients (100 PS and 100 UC) were enrolled. Preoperative and final follow-up outcomes including postoperative ROM, anteroposterior (AP) stability (good, fair, and poor), WOMAC index, and KS scores were compared. Then, postoperative outcomes compared between the PS and UC. We also analyzed if AP stability was associated with the postoperative outcomes in both implant designs. Results: In both groups, ROM and clinical outcomes of final follow-up showed improvement than preoperation. Statistical significance was not determined between the PS and UC groups in terms of postoperative ROM (PS vs. UC, 134.6° vs. 133.4°, p = 0.13), stability (good/fair/poor, 91/9/0 vs. 84/14/0, p = 0.376), WOMAC index, KS scores, and outliers of HKA alignment (15% vs. 10%, p = 0.393). “Fair” stability showed inferior KS scores but greater ROM than “good” stability in both designs. Conclusion: TKA with UC insert provided similar ROM, AP stability, and clinical outcomes when compared to PS insert. In both designs, greater postoperative ROM was found but inferior clinical outcomes were found when TKA resulted in fair stability instead of good stability. Level of evidence III: Retrospective comparative study.

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“…As flexion gap increases by cutting PCL, surgeons have been concerned about the flexion gap growing too large in PS-TKA [4]. Flexion gap has been reported to affect postoperative range of motion and clinical outcomes [13][14][15]. Therefore, adjusting the flexion gap is a crucial component of PS-TKA [16].…”

Section: Resultsmentioning

confidence: 99%

Evaluation of the flexion gap with a distal femoral trial component in posterior-stabilized total knee arthroplasty

Kamei

Ishibashi

Yoshioka

et al. 2022

Knee Surg & Relat Res

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Purpose A distal femoral trial component was manufactured, and flexion gap size and inclination were evaluated with or without the distal femoral trial component in total knee arthroplasty (TKA). This study aimed to evaluate the effect of the distal femoral trial component on flexion gap size and joint inclination in posterior-stabilized (PS)-TKA. Materials and methods A total of 84 patients with medial osteoarthritis who underwent mobile-bearing PS-TKA using modified gap techniques were included in this retrospective study. The flexion gap size and inclination before and after setting the distal femoral trial component were evaluated and compared with the final gap size and inclination. Results The joint gap size and inclination were significantly lower in those with than in those without the distal femoral trial component (P = 0.005, P < 0.001). The final gap size and inclination were similar to the gap size and inclination with the distal trial component (P = 0.468, P = 0.158). Conclusions The joint gap size and medial tension in PS-TKA were significantly reduced after setting the distal femoral trial component. The flexion gap measured using the distal femoral trial component was similar to that when the final trial component was set. To more accurately perform the gap technique TKA, the flexion gap should be measured using the distal femoral trial component.

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Clinical outcome of increased flexion gap after total knee arthroplasty. Can controlled gap imbalance improve knee flexion?

Abstract: III.

Cited by 16 publications

References 27 publications

No detrimental effect of ligament balancing on functional outcome after total knee arthroplasty: a prospective cohort study on 129 mechanically aligned knees with 3 years’ follow-up

No detrimental effect of ligament balancing on functional outcome after total knee arthroplasty: a prospective cohort study on 129 mechanically aligned knees with 3 years’ follow-up

Similar outcomes between ultracongruent and posterior-stabilized insert in total knee arthroplasty: A propensity score-matched analysis

Evaluation of the flexion gap with a distal femoral trial component in posterior-stabilized total knee arthroplasty

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