Efficacy and Safety of a Novel Three-Step Medial Release Technique in Varus Total Knee Arthroplasty

Kim, Min Woo; Koh, In Jun; Kim, Woo Jung; Jung, Jae Jong; In, Yong

doi:10.1016/j.arth.2015.03.037

Cited by 22 publications

(11 citation statements)

References 36 publications

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“…Future randomized studies of these covariates may be required to decrease the issue of selection bias. Numerous studies have shown a relationship between medial release and increment of the medial tibiofemoral gap [5,6,21,27,31,42]. In the current study, gap increment according to each compartment showed that the medial flexion gap was the most-increased compartment, followed by the medial extension gap, as a progressively larger release was done.…”

Section: Discussionsupporting

confidence: 54%

What Factors Are Associated With Femoral Component Internal Rotation in TKA Using the Gap Balancing Technique?

Lee

Lim

Jang

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Section: Discussionsupporting

confidence: 54%

What Factors Are Associated With Femoral Component Internal Rotation in TKA Using the Gap Balancing Technique?

Lee

Lim

Jang

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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“…For distal femoral osteotomy, the apex of the intercondylar notch was used as the intramedullary positioning rod entry point, and the appropriate valgus angle was selected according to the hip-knee-shaft angle (HKS) measured on the FLX to perform a standard distal osteotomy of 9 mm. Extramedullary test of the lower limb alignment was performed; the cruciate ligament, osteophyte, and residual meniscus tissues were removed to balance the extension gap, and appropriate lateral release was conducted if necessary as described by Kim and Ranawat [25,26]. After the extension gap was well balanced, the femoral osteotomy at the flexion position was conducted referring to the Whiteside's line, then referring to the tibial plateau osteotomy surface and the extension gap to balance the flexion gap.…”

Section: Preoperative Design and Surgical Techniquesmentioning

confidence: 99%

Clinical value of CT-based patient-specific 3D preoperative design combined with conventional instruments in primary total knee arthroplasty: a propensity score-matched analysis

et al. 2020

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Purpose To evaluate the operation and early clinical effect in primary total knee arthroplasty (TKA) about the novel combination of CT-based patient-specific three-dimensional (3D) preoperative design and conventional osteotomy instruments, compared with the conventional method. Methods After a 1:1 propensity score-matching (PSM), patients were matched to the novel technique group and the conventional group, 109 cases in each group. The conventional group adopted a preoperative design based on a full-length radiograph (FLX) and received TKA with conventional osteotomy instruments. The novel technique group used a CT-based patient-specific 3D preoperative design combined with conventional osteotomy instruments; during the surgery, the femoral entry point, femoral valgus osteotomy angle, the fix point of tibial plateau extramedullary guide pin, and the position of tibial extramedullary positioning rod were accurately selected according to the preoperative 3D design to ensure accurate intraoperative implementation. The lower limb alignment, component position, operation time, tourniquet time, hospital stay, blood loss volume, incidence of postoperative complications, visual analog scale (Vas) score, and New Knee Society Score System (NEW-KSS) at 1 day before operation and 1, 6, and 12 months after operation were recorded and compared. Results The novel technique group was significantly better than the conventional group in controlling lateral tibial component angle (LTC) (P < 0.001), and the novel technique group had lower percentages of hip-knee-ankle angle (HKA) outliers (P < 0.001) and overcorrection (P = 0.003). The operation time, tourniquet time, and hospital stay of the novel technique group was shorter (P < 0.05). In 1 month after the operation, the novel technique group achieved a significantly better VAS score (P < 0.05), but a similar NEW-KSS score (P > 0.05) when compared with the conventional group. But in 6 and 12 months after surgery, no statistical differences were seen in the above two scores (P > 0.05). Conclusion The novel technique of CT-based patient-specific 3D preoperative design combined with conventional instruments can improve the accuracy of osteotomy in primary total knee arthroplasty, with benefits of significantly reducing pain and rapid recovery during the early postoperative period, but having no obvious effect on outcome after a 1-year follow-up.

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“…For example, 4-mm reduction osteotomy provides approximately 1.7° and 0.7° varus improvement in flexion and extension, respectively, while 8-mm reduction osteotomy only improves 2.8° and 0.9° in flexion and extension, respectively [ 15 ]. In addition, employment of a stepwise release technique could avoid unnecessary over release [ 7 , 9 ].…”

Section: Discussionmentioning

confidence: 99%

Selective medial soft tissue release combined with tibial reduction osteotomy in total knee arthroplasty

Tang

Shang

et al. 2017

J Orthop Surg Res

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BackgroundTo obtain the correct coronal alignment and balancing in flexion and extension, we established a selective medial release technique and investigated the effectiveness and safety of the technique during primary total knee arthroplasty (TKA).MethodsFour hundred sixty-six primary TKAs with varus deformity were prospectively evaluated between June 2013 and June 2015. A knee joint position similar to Patrick’s sign was used to release the medial structure. The medial release technique consisted of release of the capsule and the deep medial collateral ligament (dMCL) (step1), selective release of superficial medial collateral ligament (sMCL) or posterior oblique ligament (POL) (step 2), and selective tibial reduction osteotomy (step 3). Improvement of medial joint gap at each step and other clinical outcomes were evaluated.ResultsAmong the 466 knees, symmetrical gaps could be achieved by the limited release of the capsule and the dMCcL in 276 (59%) knees. One hundred fifty-two (33%) required additional sMCL release with 2–5 cm from the joint line distally or POL release. Thirty-eight (8%) necessitated an additional tibial reduction osteotomy. Anterior-medial release and 4-mm medial osteotomy contributed to more improvement of medial gap in flexion than in extension (each p < 0.01). Posteromedial release and posteromedial osteotomy contributed to more improvement in extension than in flexion (each p < 0.01). No specific complication related to our technique was identified.ConclusionThe technique of the tibial reduction osteotomy combined with medial soft structure release using Patrick’s sign is effective, safe, and minimally invasive to obtain balanced mediolateral and extension-flexion gaps in primary TKA.

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Efficacy and Safety of a Novel Three-Step Medial Release Technique in Varus Total Knee Arthroplasty

Cited by 22 publications

References 36 publications

What Factors Are Associated With Femoral Component Internal Rotation in TKA Using the Gap Balancing Technique?

What Factors Are Associated With Femoral Component Internal Rotation in TKA Using the Gap Balancing Technique?

Clinical value of CT-based patient-specific 3D preoperative design combined with conventional instruments in primary total knee arthroplasty: a propensity score-matched analysis

Selective medial soft tissue release combined with tibial reduction osteotomy in total knee arthroplasty

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