Soft Tissue Balance Measurement in Posterior-Stabilized Total Knee Arthroplasty With a Navigation System

Matsumoto, Tomoyuki; Muratsu, Hirotsugu; Tsumura, Nobuhiro; Mizuno, Kiyonori; Kurosaka, Masahiro; Kuroda, Ryosuke

doi:10.1016/j.arth.2008.01.001

Cited by 68 publications

(66 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Malaligned knees where both components were placed accurately were probably the result of mediolateral soft tissue imbalance. Although computer navigation is reportedly accurate and reliable for measuring soft tissue balance intraoperatively [15], the technique of soft tissue balance is complex and based on surgeon technique and subjective assessment. Although the senior author has ensured mediolateral soft tissue balance of within 2 mm at the end of each TKA, it is possible this balance may undergo change over time postoperatively.…”

Section: Discussionmentioning

confidence: 99%

Which Factors Increase Risk of Malalignment of the Hip-Knee-Ankle Axis in TKA?

Mullaji

Shetty

Lingaraju

et al. 2013

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

Background Computer navigation has improved accuracy and reduced the percentage of alignment outliers in TKA. However, the characteristics of outliers and the risk factors for limb malalignment after TKA are still unclear. Questions/Purposes We therefore addressed the following questions: (1) What is the incidence and characteristics of outliers for postoperative limb mechanical axis (hip-knee-ankle [HKA] angle outside the conventional 180°± 3°range) and component alignment in TKA? And (2) what are the preoperative clinical or radiographic risk factors for limb mechanical axis malalignment in TKA? Methods We retrospectively reviewed the clinical and radiographic records of 1500 computer-assisted TKAs to identify outliers for postoperative HKA axis and component alignment and determined risk factors for malalignment. Full-length hip-to-ankle and knee radiographs were used to measure preoperative HKA angle, femoral coronal bowing, joint divergence angle, tibial subluxation, and tibial bone loss and postoperative HKA angle and femoral and tibial component angle. Results The incidence of outliers for postoperative limb mechanical axis, femoral component alignment, and tibial component alignment was 7% (112 of 1500 TKAs), 7%, and 8%, respectively, with 70% of limbs placed in excessive varus and 30% in excessive valgus. Preoperative varus deformity of more than 20°and femoral bowing of more than 5°were associated with increased risk of placing the limb mechanical axis outside the acceptable ± 3°range after computer-assisted TKA. Conclusions The presence of preoperative radiographic risk factors should alert the surgeon to increased chance of malalignment and every measure should be undertaken in such at-risk knees to ensure proper limb and component alignment and soft tissue balance.

show abstract

Section: Discussionmentioning

confidence: 99%

Which Factors Increase Risk of Malalignment of the Hip-Knee-Ankle Axis in TKA?

Mullaji

Shetty

Lingaraju

et al. 2013

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

show abstract

“…Measurements were performed with the patella subluxed because eversion may influence the gaps. Matsumoto et al 15 found that with an everted patella, The estimates show how much the log-transformed gap width elongation is expected to change between the baseline level and an alternative level of a factor (in the table, the notation is alternative-baseline). The intercept is the expected log-transformed gap width when all factors are set to their baseline levels (HPD CI, higher posterior density confidence interval).…”

Section: Discussionmentioning

confidence: 99%

“…15,16 Even preparation of the flexion gap can influence the extension gap. Minoda et al 17 found that preparation of the flexion gap resulted in significant widening of the extension gap during cruciate-retaining TKA.…”

mentioning

confidence: 99%

Measurement of knee joint gaps without bone resection: “Physiologic” extension and flexion gaps in total knee arthroplasty are asymmetric and unequal and anterior and posterior cruciate ligament resections produce different gap changes

Nowakowski

Majewski

Müller‐Gerbl

et al. 2011

Journal Orthopaedic Research

View full text Add to dashboard Cite

General agreement is that flexion and extension gaps should be equal and symmetrical in total knee arthroplasty (TKA) procedures. However, comparisons using a standard TKA approach to normal knee joints that have not undergone bone resection are currently unavailable. Since bony preparation can influence capsule and ligament tension, our purpose was to perform measurements without this influence. Ten normal cadaveric knees were assessed using a standard medial parapatellar TKA approach with patellar subluxation. Gap measurements were carried out twice each alternating 100 and 200 N per compartment using a prototypical forcedetermining ligament balancer without the need for bony resection. Initial measurements were performed in extension, followed by 908 of flexion. The ACL was then resected, and finally the PCL was resected, and measurements were carried out in an analogous fashion. In general, the lateral compartment could be stretched further than the medial compartment, and the corresponding flexion gap values were significantly larger. ACL resection predominantly increased extension gaps, while PCL resection increased flexion gaps. Distraction force of 100 N per compartment appeared adequate; increasing to 200 N did not improve the results. ß

show abstract

“…The flexion and extension gaps are influenced by various factors, including deformities and osteolysis [4], contractures of the soft tissue mantle [8], operative approach [9], osteophytes [10,11], and eversion of the patella [12,13]. Even preparation of the flexion gap can influence the magnitude of the extension gap [14].…”

Section: Introductionmentioning

confidence: 99%

Influence of tibial slope on extension and flexion gaps in total knee arthroplasty: increasing the tibial slope affects both gaps

Nowakowski

Kamphausen

Pagenstert

et al. 2014

International Orthopaedics (SICOT)

View full text Add to dashboard Cite

Purpose Increasing the tibial slope is often performed if the flexion gap is narrower than the extension gap. The main hypothesis of this study is that increasing the tibial slope coincidentally enlarges the extension gap. Methods Twenty formalin-fixed cadaveric knees were obtained for study. After CT in full extension and 90°flexion, the data of each specimen were entered into a standardized coordinate system and virtual bone cuts were performed with incrementally increasing the posterior slope. Gaps were measured at tibiofemoral contact points in 90°-flexion and full extension in the medial and lateral compartment. Results Increasing the tibial slope did significantly widen both the extension and the flexion gaps (p<0.001). In extension, the opening rates, i.e. the gap increase per degree of slope increase, were equal medially and laterally (0.5 mm ±0.1) medial vs 0.6 mm (±0.0) lateral), whereas in flexion the lateral gap did open significantly more than the medial one (0.6 mm ±0.1) medial vs 0.9 mm (±0.1) lateral (p<0.001), resulting in a significantly greater flexion gap laterally.Conclusions Increasing the tibial slope beyond the preoperative planning in order to widen a tight flexion gap intra-operatively is not recommended as doing so will increase the extension gap simultaneously and will make the medial and lateral flexion gaps unequal.

show abstract

Soft Tissue Balance Measurement in Posterior-Stabilized Total Knee Arthroplasty With a Navigation System

Cited by 68 publications

References 18 publications

Which Factors Increase Risk of Malalignment of the Hip-Knee-Ankle Axis in TKA?

Which Factors Increase Risk of Malalignment of the Hip-Knee-Ankle Axis in TKA?

Measurement of knee joint gaps without bone resection: “Physiologic” extension and flexion gaps in total knee arthroplasty are asymmetric and unequal and anterior and posterior cruciate ligament resections produce different gap changes

Influence of tibial slope on extension and flexion gaps in total knee arthroplasty: increasing the tibial slope affects both gaps

Contact Info

Product

Resources

About