In Vivo Gap Analysis in Various Knee Flexion Angles During Navigation-Assisted Total Knee Arthroplasty

Yoon, Joonsung; Jeong, Hyeon-Il; Oh, Kwang-Jun; Yang, Jae Hyuk

doi:10.1016/j.arth.2013.04.043

Cited by 31 publications

(26 citation statements)

References 27 publications

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“…This is a point worth considering, as changing the posterior condylar offset has been associated with MFI in several other papers including the seminal article by Martin and Whiteside. 15,50,66 In these studies, changes to the joint line and posterior condylar offset were intrinsically related. While JLE has been the subject of interest, it may transpire that posterior condylar offset assumes an equal if not more important role in MFI.…”

Section: Discussionmentioning

confidence: 99%

“…In addition to what has been cited previously, it should be noted that there are several other studies that have identified discrete midflexion laxity. Investigators have used tensor devices, 45,65 navigation systems, 66 and fluoroscopic imaging 67 to demonstrate this observation. While these studies all fall short of identifying a cause for their findings, they are worth considering as they all support the concept of MFI being a distinct form of instability.…”

Section: Other Relevant Studiesmentioning

confidence: 97%

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Midflexion Instability in Primary Total Knee Arthroplasty

Nagle

Glynn

2019

J Knee Surg

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Instability is one of the most common causes of failure in total knee arthroplasty. Traditionally, it has been classified into three types: extension instability, flexion instability, and hyperextension instability. More recently, a fourth type of instability has been proposed, namely “midflexion instability” (MFI). Whether MFI is distinct from the aforementioned types of instability is contentious, and at present, the condition is yet to be clearly defined. This article reviews the current literature and identifies the best available evidence relevant to the concept of MFI. Our aim is to present an overview of the proposed causes and mechanisms for MFI. By doing so, we also aim to provide a focus on how MFI presents, whether it is indeed a discrete form of instability, and if it influences clinical results.

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Section: Discussionmentioning

confidence: 99%

Section: Other Relevant Studiesmentioning

confidence: 97%

Midflexion Instability in Primary Total Knee Arthroplasty

Nagle

Glynn

2019

J Knee Surg

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“…In TKA, assessment of the laxity is critical information and a routine component during the surgical procedure. 3,4,13,15,16,[18][19][20][21]23,24,27,31,32,37,38 We have developed a reproducible method when using navigation systems, representing the first step in this line of investigation, and are committed to increasing the relevance of the quantitative data provided by navigation systems, especially in postoperative analysis.…”

Section: Discussionmentioning

confidence: 99%

“…[11][12][13][14][15][16][17] Computer-assisted navigation has been developed to provide surgeons quantitative measurement tools for real-time assessment of lower limb alignment and kinematics. [18][19][20][21][22][23][24][25][26][27] The purpose of this study is to determine the dynamic coronal FTMA in osteoarthritic knees using computer navigation. We hypothesize that there are different varus-valgus patterns between flexion and extension in the osteoarthritic knee.…”

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confidence: 99%

Dynamic Alignment Analysis in the Osteoarthritic Knee Using Computer Navigation

et al. 2017

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The lower limb alignment is influenced by the geometry of the joint surfaces and surrounding soft tissue tension. The mechanical behavior changes in a normal, osteoarthritic, and postoperative knee. The purpose of this study is to determine the dynamic coronal femoral tibial mechanical angle (FTMA) in osteoarthritic knees using computer navigation. The authors hypothesize that there are different varus-valgus patterns between flexion and extension in the osteoarthritic knee. We conducted a transversal observational study and included patients with osteoarthritis who underwent primary navigation TKA (Orthopilot version 4.2; B. Braun Aesculap, Tuttlingen, Germany). In total, 98 consecutive patients with 100 osteoarthritic knee joints, on which total knee arthroplasty was performed in our institution from 2009 to 2010, were enrolled in this prospective study. The FTMA was measured with the patient supine with maximum knee extension possible (considering the value as 0), 30, 60, and 90 degrees. All FMTA data obtained were segmented by hierarchic cluster measuring method. Through the clustering system, five segments were generated for varus patients and three for valgus patients: expected varus, expected valgus, severe varus, severe valgus, structured varus, structured valgus, concave varus, mixed varus-valgus, and mixed valgus-varus. The findings of the present study have demonstrated that there is a well-defined dynamic alignment in osteoarthritic knees, resulting in a wide kinematic variation in the coronal FTMA between flexion and full extension. Further studies will be necessary to determine whether this dynamic approach to FTMA has clinical utility in the surgeon's decision-making process.

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“…Finally, having equal tensions of the ligament at 0°and 90°is not enough to prevent midflexion instability. In fact, a recent study demonstrated that a significant proportion (36%) of TKAs showed midflexion laxity even when rectangular extension and flexion gaps were achieved at 0°and 90°, respectively [12].…”

Section: Introductionmentioning

confidence: 99%

Measured Resection Versus Gap Balancing for Total Knee Arthroplasty

Abdel

2014

Clinical Orthopaedics &Amp; Related Research

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In Vivo Gap Analysis in Various Knee Flexion Angles During Navigation-Assisted Total Knee Arthroplasty

Cited by 31 publications

References 27 publications

Midflexion Instability in Primary Total Knee Arthroplasty

Midflexion Instability in Primary Total Knee Arthroplasty

Dynamic Alignment Analysis in the Osteoarthritic Knee Using Computer Navigation

Measured Resection Versus Gap Balancing for Total Knee Arthroplasty

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