Effects of posterior condylar osteophytes on gap balancing in computer-assisted total knee arthroplasty with posterior cruciate ligament sacrifice

Sriphirom, Pornpavit; Siramanakul, Chaiyaporn; Chanopas, Boonyawat; Boonruksa, Sirisuk

doi:10.1007/s00590-017-2118-2

Cited by 17 publications

(6 citation statements)

References 20 publications

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“…The outlined changes in the distracted joint gaps when pre-operatively accounting for osteophyte tenting is comparable to the intraoperative observations of the change in joint gaps with osteophyte removal [7]. A population level analysis displayed that out of the HKA angles analysed, the planned distracted HKA was the closest to the constitutional varus HKA angle of a healthy population [6].…”

Section: Discussionsupporting

confidence: 65%

Population Level Validation of a Novel Joint Distraction Radiology Protocol in Total Knee Arthroplasty Planning

Liu¹,

Jagota²,

Twiggs³

et al.

EPiC Series in Health Sciences

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A key goal of all TKA alignment strategies is to achieve joint balance. This study aims to compare the alignments achieved by preoperatively planning to a novel distracted joint gap protocol to common alignment strategies as well as to the alignment of a healthy non-arthritic population.A retrospective study comprised of 145 knees was performed. A long-leg supine CT scan, weightbearing AP knee X-ray and two distracted knee X-rays (one each in extension and flexion, making use of an ankle weight to open the joint) were taken pre-operatively. This imaging was used to perform segmentation, landmarking and 3D-to-2D registration. The medial and lateral joint gaps were determined in extension and flexion.The mean weightbearing, KA planned and distracted joint planned HKA were 4.7° (±5.9°) varus, 0.3° (±3.2°) varus, and 2.2° (±3.5°) varus. This compares to a healthy adult HKA of 1.3° (±2.3°) varus. A patient level comparison between the planned KA and distracted joint HKA found that the coronal angles of the two alignments are within 3° of each other for 64% patients, within 3-5° for 26% of patients and greater than 5° for the remaining 10% of patients.Of those compared, the planned distracted HKA was the closest to the constitutional varus HKA of a healthy population. Patient level analysis highlighted the fundamental differences between the planned KA and joint distracted alignments. By considering both hard and soft tissue, the planned joint distracted alignment allows for a more holistic foundation for pre-operative surgical planning for a given patient.

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Section: Discussionsupporting

confidence: 65%

Population Level Validation of a Novel Joint Distraction Radiology Protocol in Total Knee Arthroplasty Planning

Liu¹,

Jagota²,

Twiggs³

et al.

EPiC Series in Health Sciences

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“…Methodologically, it became unfeasible to continue increasing the size of the manufactured osteophytes affixed to the posterior femur after a certain point. The selected sizes of 10-15 mm of the synthetic osteophytes are in keeping with investigations of the measurements of posterior femoral osteophytes [ 23 ]. Finally, it was the aim of our study to provide information regarding the effect posterior osteophytes have on TKA balance, but in our experience, osteophytes rarely occur in isolation.…”

Section: Discussionmentioning

confidence: 99%

What is the Effect of Posterior Osteophytes on Flexion and Extension Gaps in Total Knee Arthroplasty? A Cadaveric Study

et al. 2021

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Background: Posterior compartment knee osteophytes may pose a challenge in achieving soft-tissue balance during total knee arthroplasty (TKA). Obtaining symmetry of flexion and extension gaps involves balance of both bony and soft-tissue structures. We hypothesize that space-occupying posteromedial femoral osteophytes affect soft-tissue balance. Methods: Five cadaveric limbs were acquired. Computed tomography scans were obtained to define the osseous contours. Three-dimensionally printed, specimen-specific synthetic posterior femoral osteophytes were fabricated in 10-mm and 15-mm sizes. TKAs were implanted. Medial and lateral compartment contact forces were measured during passive knee motion using pressure-sensing technology. For each specimen, trials were completed without osteophytes and with 10-mm and 15-mm osteophytes affixed to the posteromedial femoral condyle. Contact forces were obtained at full extension, 10 , 30 , 45 , 60 , and 90 of flexion. These were recorded across each specimen in each condition for three trials. Tukey post hoc tests were used with a repeated measures ANOVA for statistical data analysis. Results: The presence of posteromedial osteophytes increased asymmetric loading from full extension to 45 of flexion, with statistically significant differences observed at full extension and 30 . A reduction in lateral compartment forces was noted. The 25%-75% bounds of variability in the contact force was less than 3.5 lbs. Conclusions: Posteromedial femoral osteophytes caused an asymmetric increase in medial contact forces from full extension continuing into mid-flexion. The soft-tissue imbalance created from these osteophytes supports their removal before performing ligament releases to obtain desired soft-tissue balancing during TKA.

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“…A measured sizing and rotation guide was used to perform a 4-sided femoral cut at the femoral rotation angle displayed in the RTKB, and osteotomy was performed so that the extension and exion gaps were as equal as possible. Then, clearance of the posterior condylar osteophytes, which can impinge on the posterior lip, was performed [23]. The femoral and tibial components were then implanted, with no patella replaced.…”

Section: Csrp and Surgical Proceduresmentioning

confidence: 99%

Factors influencing the postoperative flexion angle in cruciate-sacrificing rotating platform of total knee arthroplasty

Matsuoka,

Inagaki,

Mawarikado

et al. 2023

Preprint

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Background Various factors affect the improvement of range of motion (ROM) after total knee arthroplasty (TKA). However, there are few reports specific to cruciate-sacrificing rotating platform (CSRP) TKA. In this study, factors affecting postoperative ROM improvement of CSRP TKA were investigated. Methods The study included 79 patients with knee osteoarthritis who underwent unilateral CSRP TKA at our institution. The group with an improvement of 5 degrees or more (Δflexion angle) than the preoperative was defined as the good Δflexion group (38 knees), and that with less than 5 degrees was defined as the poor Δflexion group (41 knees). The assessments were performed one day and one year after surgery. Factors including rest and walking pain, knee flexion and extension angle, isometric knee extension strength, the five subscales of KOOS, α, β, γ and δ angles, FTA, and condylar twist angle were assessed. Unpaired t-test, Mann–Whitney U test, and chi-square test were used to test differences between the good and poor Δflexion groups. Multiple logistic regression examined the association between each factor and the dependent variables (good Δflexion or poor Δflexion). Results Significant differences in the preoperative knee flexion, postoperative knee flexion, preoperative knee extension, and postoperative knee extension angles, postoperative KOOS pain and activity of daily living, β, ɤ angles were observed between the good and poor Δflexion groups. The model chi-squared test revealed that the ɤ angle was significantly affected with Δ flexion angle. Conclusions With the CSRP TKA, flexion insertion of the femoral component was associated with postoperative flexion ROM improvement.

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Effects of posterior condylar osteophytes on gap balancing in computer-assisted total knee arthroplasty with posterior cruciate ligament sacrifice

Cited by 17 publications

References 20 publications

Population Level Validation of a Novel Joint Distraction Radiology Protocol in Total Knee Arthroplasty Planning

Population Level Validation of a Novel Joint Distraction Radiology Protocol in Total Knee Arthroplasty Planning

What is the Effect of Posterior Osteophytes on Flexion and Extension Gaps in Total Knee Arthroplasty? A Cadaveric Study

Factors influencing the postoperative flexion angle in cruciate-sacrificing rotating platform of total knee arthroplasty

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