Influence of intra-operative joint gap on post-operative flexion angle in osteoarthritis patients undergoing posterior-stabilized total knee arthroplasty

Matsumoto, Tomoyuki; Mizuno, Kiyonori; Muratsu, Hirotsugu; Tsumura, Nobuhiro; Fukase, Naomasa; Kubo, Seiji; Yoshiya, Shinichi; Kurosaka, Masahiro; Kuroda, Ryosuke

doi:10.1007/s00167-007-0331-y

Cited by 67 publications

(74 citation statements)

References 32 publications

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“…By contrast, there were no differences in the medial joint gaps among the groups. These results are similar to those of Matsumoto et al [13], which showed the lateral joint gap after bone resection was larger in the severe varus group than in the mild and moderate varus groups although they measured the gap after fitting the femoral trial prosthesis (Table 3). However, because they did not take into account the amount of resected bone, the study could not determine whether the cause of the larger joint gap was the increased amount of resected bone or loosening of the soft tissue.…”

Section: Discussionsupporting

confidence: 90%

“…Between the proximal tibia and the distal femur, we fitted the offset-type tensor device (ORF-tensor 1 ; Zimmer) on the cut surface to measure the extension gap. Joint distraction force was applied at 176.4 N (40 pounds) [13,14,18]. The tension device consisted of three parts: an upper seesaw plate, a lower platform plate, and an extraarticular main body (Fig.…”

Section: Methodsmentioning

confidence: 99%

“…1). The center joint gap and the varus angle between the seesaw plate and the platform plate were measured [13][14][15]. The measurements with the tensor were obtained three times by one surgeon (SM), and the average was used for data.…”

Section: Methodsmentioning

confidence: 99%

“…Proper soft tissue balance is reportedly one of the most important factors for postoperative function and implant durability in TKA [10,13,17,24,26]. Intraoperative soft tissue balance depends on the amount of resected bone and soft tissue release.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Lateral Soft Tissue Laxity Increases but Medial Laxity Does Not Contract With Varus Deformity in Total Knee Arthroplasty

Okamoto

Okazaki

Mitsuyasu

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Section: Discussionsupporting

confidence: 90%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Lateral Soft Tissue Laxity Increases but Medial Laxity Does Not Contract With Varus Deformity in Total Knee Arthroplasty

Okamoto

Okazaki

Mitsuyasu

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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“…Preoperative ROM is reportedly the most important factor influencing postoperative ROM [9,13,26], but many other factors, including implant design [6,23], mediolateral (ML) soft tissue balance [32], flexion-extension gap balance [11,18], joint-line height [20], femoral posterior condylar offset [3,8], and PCL tension [24,39], also influence postoperative ROM.…”

mentioning

confidence: 99%

Intraoperative Joint Gaps Affect Postoperative Range of Motion in TKAs With Posterior-stabilized Prostheses

Watanabe

Muneta

Sekiya

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Joint gaps and mediolateral (ML) soft tissue balance have long been known to affect clinical scores and patient function after TKA, but the relationship between gaps and soft tissue balance remain poorly defined. If specific relationships exist between soft tissue tension and patient function, then objective targets could be established to assist surgeons in achieving more consistent postoperative knee function. Questions/purposes By performing instrumented gap measurements during TKA, we sought to quantify the relationships between intraoperative soft tissue tension and clinical scores and patient function. Methods We prospectively followed 57 patients with 63 primary TKAs with posterior-stabilized prostheses. Joint gaps and ML soft tissue balance were measured intraoperatively from 0°to 135°with the patella reduced after independent bone cuts and soft tissue releases. We determined the relationships between these intraoperative measurements and postoperative ROM and Knee Society scores at minimum 2-year followup. Results Larger joint gaps at 120°and 135°flexion predicted larger postoperative knee flexion (r = 0.296 and r = 0.393, respectively), whereas larger gaps at 10°flexion predicted greater postoperative knee extension (r = 0.285).

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Flexion–extension gap in cruciate‐retaining versus posterior‐stabilized total knee arthroplasty: A cadaveric study

Matthews

Chong

McQueen

et al. 2014

Journal Orthopaedic Research

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We re-examined experimental model results using half-body specimens with intact extensor mechanisms and navigation to evaluate cruciate-retaining (CR) and posterior stabilized (PS) total knee arthroplasty (TKA) component gaps through an entire range of motion. Six sequential testing regimens were conducted with the knee intact, with a CR TKA in place, and with a PS TKA in place, with and without 22 N traction in place at each stage. Each of 10 knees was taken through six full ranges of motion from 0˚to 120˚at every stage using a navigated knee system to record component gapping. No significant difference was found between loaded and unloaded component gaps, and no significant differences were found in component gapping between CR and PS TKAs throughout a full range of motion. Flexion-extension gap measurements were significantly different from previously published data (at 90˚flexion). No difference was found in kinematics when comparing CR and PS TKA component designs. Our results suggest that intact extensor mechanisms may be required to perform proper kinematic studies of TKA. Our findings provide evidence that the extensor mechanism may play a major role in the flexion-extension gaps in cadaveric knees. ß 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 32:627-632, 2014.Keywords: flexion-extension gap; cruciate retaining; posterior stabilized; total knee arthroplasty Total knee arthroplasty (TKA) is performed to relieve pain and restore function in patients with knee arthritis. Good clinical outcomes depend on achieving proper alignment of the implants and stability of the soft tissue envelope. The most common prostheses for primary TKA are cruciate retaining (CR) or posterior stabilized (PS) designs. To achieve stability, the surgeon must know what effect posterior cruciate excision will have on the biomechanics of the implanted prosthesis.In the literature on kinematics of TKA, discrepancy exists between biomechanical and clinical outcome studies when comparing CR versus PS designs. [1][2][3][4][5][6][7][8] Mihalko and Krackow 3 performed a biomechanical study investigating knee flexion-extension gaps in TKA before and after posterior cruciate ligament (PCL) resection and found a significant increase in flexion gap after PCL resection. Their study was conducted on specimens without an intact extensor mechanism using static measurements at 0˚and 90˚. They concluded that either additional distal femur could be resected or the posterior tibial slope could be decreased to balance flexion-extension gaps when performing PS TKA.To evaluate CR and PS TKA constructs, it is critical to understand the flexion-extension gap between the femoral and tibial articulating surfaces during knee motion. We re-evaluated the biomechanical study results using half-body specimens with intact extensor mechanisms and navigation to evaluate PS and CR component gaps through an entire range of motion. MATERIALS AND METHODSThe lower halves of five fresh-frozen non-preserved (one female, fou...

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Influence of intra-operative joint gap on post-operative flexion angle in osteoarthritis patients undergoing posterior-stabilized total knee arthroplasty

Cited by 67 publications

References 32 publications

Lateral Soft Tissue Laxity Increases but Medial Laxity Does Not Contract With Varus Deformity in Total Knee Arthroplasty

Lateral Soft Tissue Laxity Increases but Medial Laxity Does Not Contract With Varus Deformity in Total Knee Arthroplasty

Intraoperative Joint Gaps Affect Postoperative Range of Motion in TKAs With Posterior-stabilized Prostheses

Flexion–extension gap in cruciate‐retaining versus posterior‐stabilized total knee arthroplasty: A cadaveric study

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