Changes of posterior condylar offset results in midflexion instability in single-radius total knee arthroplasty

Matziolis, Georg; Brodt, Steffen; Windisch, Christoph; Roehner, Eric

doi:10.1007/s00402-017-2671-5

Cited by 38 publications

(25 citation statements)

References 19 publications

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“…This already results in a different effect on the flexion gap; however, it was possible to see that the reduction of the tibial slope leads to larger posterior femoral resection in all cases to achieve the desired gap width. In this context, it has to be mentioned that reduction of posterior condylar offset (PCO) is critical for flexion ability and resulting stability of the knee [ 25 , 29 ]. Thus, the maximum posterior resection is now set to 9 mm in the algorithm, as Matziolis et al.…”

Section: Discussion and Current Evidencementioning

confidence: 99%

Individualized alignment in total knee arthroplasty using image-based robotic assistance

et al. 2018

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IntroductionOver the past decades many innovations were introduced in total knee arthroplasty (TKA) focusing on implant longevity and higher procedural precision; however, there are still a high number of dissatisfied patients. It was reported that better anatomical alignment may result in improved patient outcome; however, current technologies have limitations to achieve this. The aim of this video article is to describe the technique of individualized alignment in TKA with the use of image-based robotic assistance.MethodsThe technology is based on an individual patient knee model computed from segmented computed tomography (CT) scans. A preoperative planning of prosthesis position is conducted following the principle of kinematic alignment. Intraoperatively the soft tissue envelope is recorded and the computer predicts the gap balance based on the virtual planning. The prosthesis position is then adapted to achieve balanced gaps and to avoid soft tissue release. This technique is shown in a cadaver operation and clinical examples of two patients are described.ResultsWith the combination of anatomically oriented prosthesis positioning and minor adaptations with respect to the soft tissue, an individualized alignment is achieved with reduced need of soft tissue release. The robotic-assisted surgery guarantees a precise implementation of the planning. The initial experience showed a promising outcome in short-term follow-up.Video onlineThe online version of this article (10.1007/s00132-018-3637-1) contains a video on patient individualized alignment in total knee arthroplasty. The article and video are available in the electronic full text archive at SpringerMedizin.de under http://www.springermedizin.de/der-orthopaede. The video can be found at the end of the article as supplementary material.

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Section: Discussion and Current Evidencementioning

confidence: 99%

Individualized alignment in total knee arthroplasty using image-based robotic assistance

et al. 2018

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“…To the best of our knowledge, only one such study exists, which reported that JLE of up to 5 mm has no influence on stability at midflexion. 45 An interesting observation is that the same study reported that altering the posterior condylar offset had a profound effect on MFI. 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.…”

Section: Discussionmentioning

confidence: 94%

“…Indeed, anterior translation of the femoral component may have a more important role in laxity than proximalization. This is suggested in an in vivo study by Matziolis et al 45 Here the authors retrospectively looked at 42 PS SR TKRs and noted that altering the posterior condylar offset by more than 2 mm led to MFI in 44% of cases, whereas displacing the joint line up to 5mm had no influence on stability in midflexion.…”

Section: Elevation Of Joint Linementioning

confidence: 85%

“…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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“…2). Ein Verlust an posteriorem Kondylenoffset bedingt ein reduziertes femorales Rollback und kompromittiert damit die Beugefähigkeit und Stabilität [16,17]. Da trotz der angesprochenen Radiendifferenzen die konkreten Unterschiede der Femurgeometrien letztendlich im Millimeterbereich liegen, ist aufseiten des Femurs die akkurate Operationstechnik von entscheidenderer Bedeutung als das vorliegende Implantatdesign anzusehen.…”

Section: Introductionunclassified

Knieprothesendesign und Kinematik: Unterschiede in Radien, Konformität und Rotation/Pivot

et al. 2018

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Today, there is an almost endless variety of knee prosthesis models on the market from which the surgeon can choose. Although the designs appear closer and closer to one another, the industry makes a great effort to emphasise different features as beneficial and a stand-alone. It is increasingly difficult to keep an overview and to assess the clinical relevance of the diverse features. There is a clear lack of independent comparative studies and evidence is low. Nevertheless, different design philosophies require special surgical techniques, so that the surgeon must be familiar with the peculiarity of his/her prosthesis. Also, a differentiated indication for different designs appears to be an interesting concept. The aim of this essay is to give a brief overview of the major design concepts of current unconstrained knee prosthesis designs and their differences regarding biomechanics and kinematics.

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Changes of posterior condylar offset results in midflexion instability in single-radius total knee arthroplasty

Abstract: Whereas the joint line can be displaced by up to 5 mm without measurable changes in joint stability, reconstruction of the posterior offset within a tight range of 2 mm is necessary to avoid midflexion instability.

Cited by 38 publications

References 19 publications

Individualized alignment in total knee arthroplasty using image-based robotic assistance

Individualized alignment in total knee arthroplasty using image-based robotic assistance

Midflexion Instability in Primary Total Knee Arthroplasty

Knieprothesendesign und Kinematik: Unterschiede in Radien, Konformität und Rotation/Pivot

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