Femoral condylar lift-off in vivo in total knee arthroplasty

Dennis, Douglas A.; Komistek, Richard D.; Walker, Scott A.; Cheal, E. J.; Stiehl, James B.

doi:10.1302/0301-620x.83b1.0830033

Cited by 73 publications

(63 citation statements)

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“…Previous studies observed liftoff from 50 % to 86 % of cruciate-retaining TKA [7,14,26]. The average amount of condylar liftoff in the gap-balancing group was 1.3 mm, which is comparable with other study groups [7,14], in which an average liftoff between one and two millimetres is described. An increased midflexion instability in the gap-balancing group, however, could not be detected clinically up to the latest follow-up.…”

Section: Discussionsupporting

confidence: 77%

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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Section: Discussionsupporting

confidence: 77%

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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“…Furthermore a too tight or too loose PCL might have contributed to lift-off. Previous studies observed lift-off up to 50 %-86 % of cruciate-retaining total knee arthroplasties [27,31,32]. The average amount of condylar lift-off was 0.87 mm, which is low compared to other study groups [27,31] where an average lift-off between one and two millimetres is described.…”

Section: Discussionmentioning

confidence: 62%

Comparing navigation-based in vivo knee kinematics pre- and postoperatively between a cruciate-retaining and a cruciate-substituting implant

Baier

Springorum

Götz

et al. 2013

International Orthopaedics (SICOT)

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Purpose Individual physiological knee kinematics are highly variable in normal knees and are altered following cruciatesubstituting (PS) and cruciate-retaining (CR) total knee arthroplasty (TKA). We wanted to know whether knee kinematics are different choosing two different knee designs, CR and PS TKA, during surgery using computer navigation. Methods For this purpose, 60 consecutive TKA were randomised, receiving either CR (37 patients) or PS TKA (23 patients). All patients underwent computer navigation, and kinematics were assessed prior to making any cuts or releases and after implantation. Outcome measures were relative rotation between femur and tibia, measured medial and lateral gaps and medial and lateral condylar lift-off. Results We were not able to demonstrate a significant difference in femoral external rotation between either group prior to implantation (7.9°CR vs. 7.4°PS) or after implantation (9.0°C R vs. 11.3°PS), both groups showed femoral roll-back. It significantly increased pre-to postoperatively in PS TKA. In the CR group both gaps increased, the change of the medial gap was significantly attributable to medial release. In the PS group both gaps increased and the change of the medial and of the lateral gap was significant. Condylar lift-off was observed in the CR group during 20°and 60°of flexion. Conclusion This study did not reveal significant differences in navigation-based knee kinematics between CR and PS implants. Femoral roll-back was observed in both implant designs, but significantly increased pre-to postoperatively in PS TKA. A slight midflexion instability was observed in CR TKA. Intra-operative computer navigation can measure knee kinematics during surgery before and after TKR implantation and may assist surgeons to optimise knee kinematics or identify abnormal knee kinematics that could be corrected with ligament releases to improve the functional result of a TKR, whether it is a CR or PS design. Our intraoperative finding needs to be confirmed using fluoroscopic or radiographic 3D matching after complete recovery from surgery.

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“…A second limitation is the authors' inability to state, with 100% certainty, that all of the kinematic findings observed in this analysis are only limited to variations in surgical technique. Previous kinematic analyses performed in our laboratory have documented substantial kinematic variances are common following TKA [6][7][8]23]. Multiple factors influence kinematics including technique type and quality, implant design, and variances in the individuals tested (motion, stability, alignment, etc.).…”

Section: Discussionmentioning

confidence: 95%

“…This was determined by performing digital measurements of the distances from the medial and lateral femoral condyles to the tibial tray [8] (Fig. 3).…”

Section: Methodsmentioning

confidence: 99%

Gap Balancing versus Measured Resection Technique for Total Knee Arthroplasty

Dennis

Komistek

Kim³

et al. 2010

Clinical Orthopaedics &Amp; Related Research

239

197

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Multiple differing surgical techniques are currently utilized to perform total knee arthroplasty (TKA). We compared knee arthroplasties performed using either a measured resection or gap balancing technique to determine if either operative technique provides superior coronal plane stability as measured by assessment of the incidence and magnitude of femoral condylar lift-off. We performed 40 TKA using a measured resection technique (20 PCLretaining and 20 PCL-substituting) and 20 PCL-substituting TKA were implanted using gap balancing. All subjects were analyzed fluoroscopically while performing a deep knee bend. The incidence of coronal instability (femoral condylar lift-off) was then determined using a 3-D model fitting technique. The incidence of lift-off greater than 0.75 mm was 80% (maximum, 2.9 mm) and 70% (maximum, 2.5 mm) for the PCL-retaining and substituting TKA groups performed using measured resection versus 35% (maximum, 0.88 mm) for the gap-balanced group. Lift-off greater than 1 mm occurred in 60% and 45% of the PCL-retaining and -substituting TKA using measured resection versus none in the gap-balanced group. Rotation of the femoral component using a gap balancing technique resulted in better coronal stability which we suggest will improve functional performance and reduce polyethylene wear.

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Femoral condylar lift-off in vivo in total knee arthroplasty

Cited by 73 publications

References 0 publications

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

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

Comparing navigation-based in vivo knee kinematics pre- and postoperatively between a cruciate-retaining and a cruciate-substituting implant

Gap Balancing versus Measured Resection Technique for Total Knee Arthroplasty

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