Do high flexion posterior stabilised total knee arthroplasty designs increase knee flexion? A meta analysis

Sumino, Takanobu; Gadikota, Hemanth R.; Varadarajan, Kartik M.; Kwon, Young‐Min; Rubash, Harry E.; Li, Guoan

doi:10.1007/s00264-011-1228-4

Cited by 43 publications

(35 citation statements)

References 47 publications

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“…However, controversy exists whether improved flexion was achieved using a high-flex design. [15,16] Our results might provide useful information for prosthetic design. It might be better that the medial and lateral condyles have a lesser radius posteriorly than distally.…”

Section: Discussionmentioning

confidence: 99%

Prediction of post-operative range of motion using intra-operative soft tissue balance in total knee arthroplasty with navigation

Hasegawa

Takagita

Sudo

2015

Computer Aided Surgery

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This study evaluated the influence of intra-operative soft tissue balance on post-operative range of motion in patients undergoing posterior-stabilized total knee arthroplasty with navigation. After implantation of all components in 31 consecutive patients, the joint component gap was measured manually with the knee at 0 , 90 , and 120 as guided by a navigation system. We designated soft tissue balance as the absolute difference between varus stress and valgus stress (medio-lateral laxity). Changes in medio-lateral laxity were calculated from 120 to 90 , 120 to 0 , and 90 to 0 . Correlations among post-operative flexion angles and pre-operative flexion angles, intra-operative flexion angle after implantation, soft tissue balance, and the changes were analyzed. The mean preand post-operative knee flexion angles were 114 ± 20 and 127 ± 9 , respectively. The mean intraoperative flexion angle was 137 ± 6. The post-operative flexion angle was positively correlated with the pre-operative flexion angle and intra-operative flexion angle after implantation. The change in soft tissue balance between 120 and 90 showed a positive correlation with the postoperative flexion angle. In conclusion, Assessment of intra-operative soft tissue balance could predict post-operative flexion angle. ARTICLE HISTORY

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Section: Discussionmentioning

confidence: 99%

Prediction of post-operative range of motion using intra-operative soft tissue balance in total knee arthroplasty with navigation

Hasegawa

Takagita

Sudo

2015

Computer Aided Surgery

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“…Studies involved normal knees [17], cruciate ligament-deficient knees [18][19][20], and knees with a unicondylar [21] or bicondylar total knee arthroplasty [6,[21][22][23].…”

Section: Discussionmentioning

confidence: 99%

Comparing navigation-based in vivo knee kinematics pre- and postoperatively between a cruciate-retaining and a cruciate-substituting implant

Baier

Springorum

Götz

et al. 2013

International Orthopaedics (SICOT)

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Purpose Individual physiological knee kinematics are highly variable in normal knees and are altered following cruciatesubstituting (PS) and cruciate-retaining (CR) total knee arthroplasty (TKA). We wanted to know whether knee kinematics are different choosing two different knee designs, CR and PS TKA, during surgery using computer navigation. Methods For this purpose, 60 consecutive TKA were randomised, receiving either CR (37 patients) or PS TKA (23 patients). All patients underwent computer navigation, and kinematics were assessed prior to making any cuts or releases and after implantation. Outcome measures were relative rotation between femur and tibia, measured medial and lateral gaps and medial and lateral condylar lift-off. Results We were not able to demonstrate a significant difference in femoral external rotation between either group prior to implantation (7.9°CR vs. 7.4°PS) or after implantation (9.0°C R vs. 11.3°PS), both groups showed femoral roll-back. It significantly increased pre-to postoperatively in PS TKA. In the CR group both gaps increased, the change of the medial gap was significantly attributable to medial release. In the PS group both gaps increased and the change of the medial and of the lateral gap was significant. Condylar lift-off was observed in the CR group during 20°and 60°of flexion. Conclusion This study did not reveal significant differences in navigation-based knee kinematics between CR and PS implants. Femoral roll-back was observed in both implant designs, but significantly increased pre-to postoperatively in PS TKA. A slight midflexion instability was observed in CR TKA. Intra-operative computer navigation can measure knee kinematics during surgery before and after TKR implantation and may assist surgeons to optimise knee kinematics or identify abnormal knee kinematics that could be corrected with ligament releases to improve the functional result of a TKR, whether it is a CR or PS design. Our intraoperative finding needs to be confirmed using fluoroscopic or radiographic 3D matching after complete recovery from surgery.

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“…Excellent clinical results have been reported for cruciate-retaining as well as cruciate-substituting prostheses [1][2][3][4]. In recent years, demand has increased for TKA to achieve deeper flexion, e.g.…”

Section: Introductionmentioning

confidence: 99%

Is the effect of a posterior cruciate ligament resection in total knee arthroplasty predictable?

Schnurr

Eysel

König

2011

International Orthopaedics (SICOT)

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Purpose It is broadly supposed that in total knee arthroplasty, the flexion/extension gap ratio is increased after resection of the posterior cruciate ligament (PCL). However, studies are rare and results are inconsistent. Therefore, this study was conducted to determine whether PCL release regularly increases the flexion gap. Methods Data from 50 consecutive posterior stabilised knee prostheses were analysed retrospectively. Using imageless computer navigation, the joint-gap width was measured over the entire range of motion before and after PCL release. Results PCL release had no effect on the extension gap, but it increased the flexion gap significantly. An increase of >3 mm occurred in 36% of patients and of >5 mm in 12%. No clinically relevant effect (<2 mm) was found in 44% of patients. Conclusion PCL release increased the flexion/extension gap ratio on average, but the individual effect could not be predicted. Therefore, we recommend PCL release before the femoral resections are performed, as this step mainly determines the ratio between extension and flexion gap.

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Do high flexion posterior stabilised total knee arthroplasty designs increase knee flexion? A meta analysis

Cited by 43 publications

References 47 publications

Prediction of post-operative range of motion using intra-operative soft tissue balance in total knee arthroplasty with navigation

Prediction of post-operative range of motion using intra-operative soft tissue balance in total knee arthroplasty with navigation

Comparing navigation-based in vivo knee kinematics pre- and postoperatively between a cruciate-retaining and a cruciate-substituting implant

Is the effect of a posterior cruciate ligament resection in total knee arthroplasty predictable?

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