Differences in knee joint kinematics and forces after posterior cruciate retaining and stabilized total knee arthroplasty

Wünschel, Markus; Leasure, Jeremi; Dalheimer, Philipp; Kraft, Nicole; Wülker, Nikolaus; Müller, Otto

doi:10.1016/j.knee.2013.03.005

Cited by 45 publications

(49 citation statements)

References 44 publications

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“…Traditionally, it is recognised that the PS prosthesis and procedure will result in a different knee condition, including postoperative kinematics and outcomes, compared with CR [22][23][24][25]. In our study, joint-component gap at flexion was significantly larger than at extension in PS using the measured-resection technique.…”

Section: Discussionmentioning

confidence: 48%

Soft-tissue balancing in total knee arthroplasty: cruciate-retaining versus posterior-stabilised, and measured-resection versus gap technique

Matsumoto

Muratsu

Kawakami

et al. 2013

International Orthopaedics (SICOT)

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Purpose The purpose of this study was to prove the hypothesis that soft tissues are well balanced using the gap technique with a navigation system in cruciate-retaining (CR) and posterior-stabilised (PS) total knee arthroplasty (TKA), leading to better clinical outcomes compared with the measuredresection technique. Methods One hundred and thirty-five TKAs (90 CR and 45 PS) were performed in patients with varus-type osteoarthritis using the gap technique guided by the offset-type tensor and a navigation system. Soft-tissue balance (joint-component gap and ligament balance) were intraoperatively assessed with the tensor under 40 lb of joint-distraction force. The achievement in the equalised rectangular gap at extension and flexion was assessed and retrospectively compared with the previous series in which the measured-resection technique was used (20 CR and 100 PS TKAs). In addition, clinical outcomes, including range of motion and Knee Society Score were assessed at a minimum two year follow-up. Results In achieving equalised rectangular gaps at extension and flexion, CR TKAs met criteria in more cases [66.7 % (64/90) vs.

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Section: Discussionmentioning

confidence: 48%

Soft-tissue balancing in total knee arthroplasty: cruciate-retaining versus posterior-stabilised, and measured-resection versus gap technique

Matsumoto

Muratsu

Kawakami

et al. 2013

International Orthopaedics (SICOT)

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show abstract

“…Numerous studies have reported on the kinematics, clinical efficacy and life‐span of CR TKA and posterior stabilized TKA. Each type of prosthesis has advantages and disadvantages. The aim of TKA is to reconstruct the mechanical axis of the knee via bone resection and/or soft tissue balance.…”

Section: Discussionmentioning

confidence: 99%

Partial versus Intact Posterior Cruciate Ligament‐retaining Total Knee Arthroplasty: A Comparative Study of Early Clinical Outcomes

Zhang

Cheng

et al. 2016

Orthopaedic Surgery

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“…Knee kinematics after TKA revealed a variety of movement patterns, including almost physiological sequences but also paradoxical forward slide of the femoral condyles during flexion [3,13,22]. Regardless of cruciate-retaining or cruciate-substituting implants, normal knee kinematics are rarely observed [13,31]. Intra-operative knee kinematics can be influenced by implant design and surgical technique.…”

Section: Discussionmentioning

confidence: 99%

Improved kinematics of total knee replacement following partially navigated modified gap-balancing technique

Baier

Fitz

Craiovan

et al. 2013

International Orthopaedics (SICOT)

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Purpose Navigation-based total knee arthroplasty (TKA) has proven its value for restoration of the limb axis. However, patient-orientated results after TKA show a wide variation from the correct implantation technique. Nonphysiological kinematics without posterior femoral rollback and tibial internal rotation in flexion could be one reason for this. We postulated that a modified gap-balancing technique with navigation of the tibia alone, in comparison to a conventional navigated technique, would: (1) obtain lateral femoral rollback, (2) alter condylar liftoff without midflexion instability, (3) significantly differ in femoral and tibial cuts, (4) not be inferior in leg-axis restoration and (5) be comparable in clinical short-term scores. Methods In this prospective study, we compared in vivo navigation-based kinematics pre-and postoperatively of 40 consecutive TKA comprising 21 conventional navigationbased TKA and 19 TKA with the modified gap-balancing technique and a reduced navigation workflow. All cuts were double checked and compared with cuts proposed by the navigation system. Clinical results were assessed preoperatively and six months postoperatively. Results The modified gap-balancing technique resulted in significantly increased lateral femoral rollback (mean 16.3 mm) and lateral condylar liftoff (mean 1.3 mm) compared to the conventional group. The modified technique comprised an average of 2.1 mm less distal femoral resection and an average of 4°less external rotation and 3.5°more flexion of the femoral component compared with the control group. Average tibial resection height was 1.1 mm greater and average tibial slope was 0.5°elevated compared to the control group. A neutral leg axis was achieved in all cases. Results showed no significant differences in clinical scores between groups. Conclusion A partial navigation solely of the tibial cut can securely restore the leg axis. Modification of the surgical technique can possibly reproduce more physiological knee kinematics with higher lateral femoral rollback in flexion without midflexion instability. This might help reduce postoperative problems with the new implant and thus reduce the amount of unsatisfactory results. Despite equal short-term results, mid-to long-term results are needed to prove whether or not this correlates with better clinical results and at least equal implant longevity.

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Differences in knee joint kinematics and forces after posterior cruciate retaining and stabilized total knee arthroplasty

Cited by 45 publications

References 44 publications

Soft-tissue balancing in total knee arthroplasty: cruciate-retaining versus posterior-stabilised, and measured-resection versus gap technique

Soft-tissue balancing in total knee arthroplasty: cruciate-retaining versus posterior-stabilised, and measured-resection versus gap technique

Partial versus Intact Posterior Cruciate Ligament‐retaining Total Knee Arthroplasty: A Comparative Study of Early Clinical Outcomes

Improved kinematics of total knee replacement following partially navigated modified gap-balancing technique

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