Varus-valgus balance and range of movement after total knee arthroplasty

Matsuda, Yoshikazu; Ishii, Yoshinori; Noguchi, Hideo; Ishii, Ryo

doi:10.1302/0301-620x.87b6.15256

Cited by 105 publications

(55 citation statements)

References 20 publications

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“…In TKR proper axial alignment has a major impact on the longevity of the implant [20,21]. Malpositioning in any anatomical plane can cause significant complications with varus or valgus malalignment being the most common cause of early loosening, and this may lead to limited movement [8,13]. Computer-assisted systems have been recently developed in order to improve the alignment of components and soft tissue balancing.…”

Section: Discussionmentioning

confidence: 99%

Unicompartmental versus computer-assisted total knee replacement for medial compartment knee arthritis: a matched paired study

Manzotti¹,

Confalonieri²,

Pullen

2006

International Orthopaedics (SICOT)

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Patients older than 60 with unicompartmental knee arthritis can be treated with total or unicompartmental knee replacement. The aim of this study was to compare the results of matched paired groups of patients with isolated medial compartment knee arthritis replaced with either UKR (group A) or computer-assisted TKR (group B). The results included 68 knees at a minimum follow-up of 3 years. All patients had a varus deformity no greater than 8º and a BMI lower than 30. Patients were matched in terms of preoperative arthritis severity, age, gender and preoperative range of motion. In the computer-assisted TKR group, all the implants were positioned within 4º of the correct hip-knee-ankle angle and frontal tibial component angle. The surgical time and hospital stay were statistically longer in the CA TKR group. During the study no implant required revision. The results showed higher scores for a UKR in the treatment of isolated primary unicompartmental knee arthritis in patients older than 60 compared to a computer-assisted TKR. In this study a computer-assisted alignment system for TKR with optimal implant positioning did not produce equivalent clinical results compared to a UKR, but did increase the financial costs.Résumé Les patients âgés de plus de 60 ans, présentant une arthrose unicompartimentale du genou ont été traités soit par une prothèse totale, soit par une prothèse unicompartimentale. Le but de cette étude est de comparer les résultats de patients présentant une arthrose fémoro tibiale interne traités par une prothèse unicompartimentale (groupe A), ou par prothèse totale du genou mise en place par chirurgie assistée par ordinateur (groupe B). Les résultats incluent 68 genoux avec un suivi minimum de 3 ans. Tous les patients avaient une déformation en varus inferiure à 8 degrés et un BMI inférieur à 30. Les patients ont été comparés en fonction du degré d'arthrose, de l'âge, du sexe et de la mobilité pré opératoire. Dans la série prothèse totale, tous les implants ont été positionnés avec une marge de 4°par rapport à l'angle hanche cheville. Le temps opératoire et la durée d'hospitalisation ont été statistiquement plus importants dans le groupe prothèse totale. Aucun implant n'a nécessité de révision. Les résultats montrent que le score est bien meilleur dans les prothèses unicompartimentales pour le traitement des arthroses unicompartimentales, chez ces patients âgés de plus de 60 ans, comparé au traitement par prothèse totale avec chirurgie assistée par ordinateur. Cette étude montre que la mise en place par chirurgie assistée par ordinateur d'une prothèse totale du genou avec un positionnement optimal des implants peut donner un résultat équivalent à celui des prothèses unicompartimentales mais augmente le coût financier du traitement. IntroductionRecent trends in knee reconstructive surgery have included less invasive surgical approaches along with preserving

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Section: Discussionmentioning

confidence: 99%

Unicompartmental versus computer-assisted total knee replacement for medial compartment knee arthritis: a matched paired study

Manzotti¹,

Confalonieri²,

Pullen

2006

International Orthopaedics (SICOT)

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“…Moreover, they only simulate static conditions, and information on the soft tissue conditions, including dynamic conditions, is crucial for improving the preoperative planning. To our knowledge, this is the first study to focus on the quantitative preoperative joint laxity of patients undergoing total knee arthroplasty using an arthrometer, although many studies have evaluated the soft tissue laxity after total knee arthroplasty using this instrument [11,12,21]. Before total knee arthroplasty, the osteoarthritic knees had significantly greater laxity in adduction than normal.…”

Section: Discussionmentioning

confidence: 99%

“…Since a well- balanced knee after total knee arthroplasty is strongly correlated with good clinical results [12], the information from stress radiographs may help improve the preoperative planning to gain the optimal soft tissue laxity as deemed appropriate by the surgeon. It may be desirable for orthopaedic surgeons to take preoperative quantitative stress radiographs routinely in addition to the conventional manual assessment before total knee surgery.…”

Section: Discussionmentioning

confidence: 99%

Preoperative laxity in osteoarthritis patients undergoing total knee arthroplasty

Ishii¹,

Noguchi²,

Matsuda³

et al. 2007

International Orthopaedics (SICO

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A preoperative quantitative evaluation of soft tissues is helpful for planning total knee arthroplasty, in addition to the conventional clinical examinations involved in moving the knee manually. We evaluated preoperative coronal laxity with osteoarthritis in patients undergoing total knee arthroplasty by applying a force of 150 N with an arthrometer. We examined a consecutive series of 120 knees in 102 patients. The median laxity was 0°in abduction and 8°in adduction. The femorotibial angle on non-weight-bearing standard anteroposterior radiographs was 180°and correlated with both abduction (r=−0.244, p=0.007) and adduction (r=0.205, p=0.025) laxity. The results of a regression analysis suggested that the femorotibial angle is helpful for estimating both laxities. Considering the many reports on how to obtain well-balanced soft tissues, stress radiographs might help to improve the preoperative planning for gaining the optimal laxity deemed appropriate by surgeons.Résumé Une analyse avec évaluation quantitative préop-ératoire des tissus mous est nécessaire dans la planification d'une prothèse totale de genou, ceci en plus des examens cliniques conventionnels, notamment en ce qui concerne l'évaluation de la mobilité. Nous avons évalué, en préopératoire, les laxités ainsi que les stades de l'arthrose chez les patients qui ont bénéficié d'une prothèse totale du genou. Ces résultats ont été réalisés à l'arthromètre. Nous avons réalisé une série consécutive de 120 genoux chez 102 patients. La laxité moyenne était de 0°en abduction et de 8°en adduction. L'angle fémoro tibial, sans appui, sur les radiographies de face et de profil était de 180°et a été corrélé avec la laxité en abduction (r=−0.244, p=0.007) et en adduction (r=0.205, p= 0.025). Les résultats nous montrent que l'angle fémoro tibial est utile pour estimer les laxités. Si l'on considère les différentes études et la meilleure manière d'obtenir une bonne balance ligamentaire, les radiographies en stress permettent d'optimiser le planning opératoire et d'avoir une bonne idée des laxités.

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“…Several studies [14,30,32] report that ML soft tissue balance is an important factor for a successful TKA and that inadequate ML soft tissue balance is believed to result in poor outcomes. Some studies [17,28] have suggested that intraoperative and postoperative ML soft tissue balances averaged 0°to 2°at extension and at 90°knee flexion. We found gap tilt averaged 0.6°, consistent with previous reports.…”

Section: Discussionmentioning

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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Varus-valgus balance and range of movement after total knee arthroplasty

Cited by 105 publications

References 20 publications

Unicompartmental versus computer-assisted total knee replacement for medial compartment knee arthritis: a matched paired study

Unicompartmental versus computer-assisted total knee replacement for medial compartment knee arthritis: a matched paired study

Preoperative laxity in osteoarthritis patients undergoing total knee arthroplasty

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

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