Additional Distal Femoral Resection Minimally Improves Terminal Knee Extension: A Systematic Review and Meta-Regression Challenging the Dogma

Hardy, William R.; Landy, David C.; Chalmers, Brian P.; Sabatini, Franco M.; Duncan, Stephen T.

doi:10.1016/j.artd.2022.101083

Cited by 3 publications

(8 citation statements)

References 43 publications

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“…improvement of extension (30). Therefore, resecting an additional 2 mm of distal femur is not likely to improve knee extension by more than 5 degrees (30). Matsiolis et al and Liu et al demonstrated similar results with posterior stabilized implants with 1 mm of additional distal femoral bone resection allowing for 2.2 degrees and 2.8 degrees of correction, respectively (24,31).…”

Section: Accepted Manuscriptmentioning

confidence: 92%

“…improvement of extension (30). Therefore, resecting an additional 2 mm of distal femur is not likely to improve knee extension by more than 5 degrees (30).…”

Section: Accepted Manuscriptmentioning

confidence: 98%

“…These values represent less correction than historically presumed with additional distal femur resection and should be considered accordingly. While failure to perform adequate bone resection can result in residual deformity, overresection can cause midflexion instability, patella baja, and even destabilize the knee joint (30). Precise planning of surgical techniques is essential to achieve desired bony resection.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…While failure to perform adequate bone resection can result in residual deformity, overresection can cause midflexion instability, patella baja, and even destabilize the knee joint. 30 Precise planning of surgical techniques is essential to achieve desired bony resection.…”

Section: Implant Selection: Varying Levels Of Constraintmentioning

confidence: 99%

“…Recently, however, Hardy et al performed a systemic review evaluating additional distal femoral resection techniques for addressing flexion contractures and found that each 1 mm resected (more than the thickness of the femoral implant) produced roughly a 2-degree improvement of extension. 30 Therefore, resecting an additional 2 mm of distal femur is not likely to improve knee extension by more than 5 degrees. 30 Matziolis et al and Liu et al demonstrated similar results with posterior-stabilized implants with 1 mm of additional distal femoral bone resection allowing for 2.2 and 2.8 degrees of correction, respectively.…”

Section: Implant Selection: Varying Levels Of Constraintmentioning

confidence: 99%

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Correction of Sagittal Deformity with Bone Resection and Soft Tissue Releases

Stephens

Lombardi

2023

J Knee Surg

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Fixed flexion deformities (FFD) present several unique challenges in total knee arthroplasty (TKA) and require careful consideration to achieve optimal outcomes. FFD alters normal knee biomechanics and increases energy expenditure (1). They may be attributed to both bony deformities and fibrosed soft tissues, which must be addressed in stepwise fashion at the time of surgery. A literature review was conducted utilizing key words “fixed flexion deformity TKA”. This review article aims to discuss the anatomy and pathology, preoperative evaluation, classification system, surgical techniques for addressing deformity, implant selection considerations, postoperative protocols, clinical outcomes, and potential complications associated with correcting FFD. By comprehensively addressing these aspects, surgeons can optimize surgical planning and improve outcomes in patients with FFD undergoing TKA.

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Section: Accepted Manuscriptmentioning

confidence: 92%

“…improvement of extension (30). Therefore, resecting an additional 2 mm of distal femur is not likely to improve knee extension by more than 5 degrees (30).…”

Section: Accepted Manuscriptmentioning

confidence: 98%

Section: Accepted Manuscriptmentioning

confidence: 99%

Section: Implant Selection: Varying Levels Of Constraintmentioning

confidence: 99%

Section: Implant Selection: Varying Levels Of Constraintmentioning

confidence: 99%

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Correction of Sagittal Deformity with Bone Resection and Soft Tissue Releases

Stephens

Lombardi

2023

J Knee Surg

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Results of Surgical Correction of Fixed Flexion Deformity during Total Knee Arthroplasty in Patient of Knee Osteoarthritis: A Comprehensive Review

Easa El-Sharkawy,

M. El-Sharkawy,

A. Mashhour

et al. 2023

Benha Journal of Applied Sciences

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Background: Fixed flexion deformity (FFD) is a common manifestation of knee osteoarthritis (OA) that significantly impacts patients' functional abilities and quality of life. Surgical correction of FFD during total knee arthroplasty (TKA) aims to restore joint alignment and improve range of motion. However, a comprehensive understanding of the outcomes and factors influencing the success of this procedure is essential. Objectives: This review article aims to provide a comprehensive overview of the results of surgical correction of FFD during TKA in patients with knee OA. It examines the surgical techniques used, evaluates functional outcomes, pain relief, and range of motion improvements, and assesses the reported rates of complications. Additionally, the durability of the correction and its impact on patient satisfaction and quality of life are explored. Factors influencing long-term success or failure of the procedure are identified. Conclusions: Surgical correction of FFD during TKA has shown promising results in terms of functional improvements, pain relief, and range of motion. Patients experience enhanced functional abilities and improved quality of life following surgery. While complications can occur, meticulous surgical techniques, proper patient selection, and adherence to best practices can help minimize their occurrence. Factors such as surgical technique, patient compliance with rehabilitation, implant selection, and patient-specific characteristics influence the long-term success of the procedure.

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Mid-Flexion Instability in Total Knee Arthroplasty: Insights from Robotic-Assisted Surgery

Bosco,

Giustra,

Rovere

et al. 2024

Applied Sciences

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Despite technological advancements with robotic-assisted surgery, instability remains a challenge in total knee arthroplasty (TKA). Mid-flexion instability (MFI) has been reported to cause patient dissatisfaction. With no universal diagnostic criteria, the MFI concept is still ambiguous, and no specific treatment algorithm is defined. This study aims to analyze the MFI concept and risk factors and investigate how robotic surgery, compared to manual TKA, could impact the MFI concept. A comprehensive investigation of the current literature regarding MIF, focusing especially on its relationship with robotic surgery TKA, was conducted using the PubMed and Scopus databases. The MIF concept remains poorly understood, so it is crucial to prevent it by recognizing risk factors, which are technique-related, implant-related, and patient-related. Since robotics offers optimal balancing in TKA and reduces causes affecting MFI, it could indirectly impact and prevent this complication. This review suggests that robotics utilization improving TKA balancing has the potential to impact and reduce MFI. However, further research in this area is essential to provide insight regarding the role of robotics in mitigating the MFI risk.

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Additional Distal Femoral Resection Minimally Improves Terminal Knee Extension: A Systematic Review and Meta-Regression Challenging the Dogma

Cited by 3 publications

References 43 publications

Correction of Sagittal Deformity with Bone Resection and Soft Tissue Releases

Correction of Sagittal Deformity with Bone Resection and Soft Tissue Releases

Results of Surgical Correction of Fixed Flexion Deformity during Total Knee Arthroplasty in Patient of Knee Osteoarthritis: A Comprehensive Review

Mid-Flexion Instability in Total Knee Arthroplasty: Insights from Robotic-Assisted Surgery

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