Flexion and extension laxity after medial, mobile-bearing unicompartmental knee arthroplasty: a comparison between a spacer- and a tension-guided technique

Ham, Arno M. ten; Heesterbeek, Petra J.C.; Schaaf, David; Jacobs, W. C. H.; Wymenga, A. B.

doi:10.1007/s00167-012-2021-7

Cited by 12 publications

(9 citation statements)

References 17 publications

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“…In addition, the spacer-guided system is reported to approximate valgus laxity. 32 Furthermore, the purpose of this study was to clarify the relationship between JLE and the change of limb alignment, which is not related to the ligament balance. Second, the depth of tibial resection was evaluated radiographically.…”

Section: Discussionmentioning

confidence: 99%

Correction of coronal alignment correlates with reconstruction of joint height in unicompartmental knee arthroplasty

Kuwashima

Okazaki

Tashiro

et al. 2015

Bone & Joint Research

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ObjectivesBecause there have been no standard methods to determine pre-operatively the thickness of resection of the proximal tibia in unicompartmental knee arthroplasty (UKA), information about the relationship between the change of limb alignment and the joint line elevation would be useful for pre-operative planning. The purpose of this study was to clarify the correlation between the change of limb alignment and the change of joint line height at the medial compartment after UKA.MethodsA consecutive series of 42 medial UKAs was reviewed retrospectively. These patients were assessed radiographically both pre- and post-operatively with standing anteroposterior radiographs. The thickness of bone resection at the proximal tibia and the distal femur was measured radiographically. The relationship between the change of femorotibial angle (δFTA) and the change of joint line height, was analysed.ResultsThe mean pre- and post-operative FTA was 180.5° (172.2° to 184.8°) and 175.0° (168.5° to 178.9°), respectively. The mean δFTA was 5.5° (2.3° to 10.1°). The joint line elevation of the tibia (JLET) was 4.4 mm (2.1 to 7.8). The δFTA was correlated with the JLET (correlation coefficient 0.494, p = 0.0009).ConclusionsThis study indicated that there is a significant correlation between the change of limb alignment and joint line elevation. This observation suggests that it is possible to know the requirement of elevation of the joint line to obtain the desired correction of limb alignment, and to predict the requirement of bone resection of the proximal tibia pre-operatively.Cite this article: Bone Joint Res 2015;4:128–133

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Section: Discussionmentioning

confidence: 99%

Correction of coronal alignment correlates with reconstruction of joint height in unicompartmental knee arthroplasty

Kuwashima

Okazaki

Tashiro

et al. 2015

Bone & Joint Research

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“…Another issue is that the difference between the true thickness of the resected tibial bone and the total thickness of the tibial implant and polyethylene insert may have affected the tension and alignment. However, the spacer guided system is reported to approximate the valgus laxity well [35], and we believe that the technique of cutting the tibia first, positioning the femoral and tibial components parallel and adjusting the gap is more accurate in aligning the knee than the technique using a femoral intramedullary guide that resects the femur and tibia independently. This is supported by the data showing that the postoperative alignment consistently exhibited slight undercorrection (approximately 2° varus) from the valgus stress alignment in almost all cases and showed a strong correlation with that observed on the stress radiographs.…”

Section: Discussionmentioning

confidence: 99%

The coronal alignment after medial unicompartmental knee arthroplasty can be predicted: usefulness of full-length valgus stress radiography for evaluating correctability

Tashiro

Matsuda

Okazaki

et al. 2014

Knee Surg Sports Traumatol Arthrosc

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“…With these methods, researchers have shown differences in valgus laxity for patients receiving unicompartmental knee arthroplasty via different techniques [21], differences in laxity when stress tests are performed under anesthesia [23], the increase in medial gapping with simulated MCL injury [24, 27], and improvement with MCL repair [25]. However, despite these successes, some limitations of the approach remain, most notably that fluoroscopy exposes patients to ionizing radiation, which, even in low doses, can increase the risk for cancer [28].…”

Section: Introductionmentioning

confidence: 99%

The measurement of medial knee gap width using ultrasound

Slane

Scheys³

2017

Arch Orthop Trauma Surg

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Introduction Medial knee instability is a key clinical parameter for assessing ligament injury and arthroplasty success, but current methods for measuring stability are typically either qualitative or involve ionizing radiation. The purpose of this study was to perform a preliminary analysis of whether ultrasound (US) could be used as an alternate approach for quantifying medial instability by comparing an US method with an approach mimicking the current gold standard fluoroscopy method. Materials and Methods US data from the medial knee were collected while cadaveric lower limbs (n=8) were loaded in valgus (10 Nm). During post-processing, the US gap width was measured by identifying the medial edges of the femur and tibia and computing the gap width between these points. For comparison, mimicked fluoroscopy (mFluoro) images were created from specimen-specific bone models, developed from segmented CT scans, and from kinematic data collected during testing. Then, gap width was measured in the mFluoro images based on two different published approaches, with gap width measured either at the most medial or most distal aspect of the femur. Results Gap width increased significantly with loading (p<0.001), and there were no significant differences between the US method (unloaded: 8.7±2.4 mm, loaded: 10.7±2.2 mm) and the mFluoro method that measured gap width at the medial femur. In terms of the change in gap width with load, no correlation with the change in abduction angle was observed, with no correlation between the various methods. Inter-rater reliability for the US method was high (0.899–0.952). Conclusions Ultrasound shows promise as a suitable alternative for quantifying medial instability without radiation exposure. However, the outstanding limitations of existing approaches and lack of true ground-truth data require that further validation work is necessary to better understand the clinical viability of an US approach for measuring medial knee gap width.

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Flexion and extension laxity after medial, mobile-bearing unicompartmental knee arthroplasty: a comparison between a spacer- and a tension-guided technique

Cited by 12 publications

References 17 publications

Correction of coronal alignment correlates with reconstruction of joint height in unicompartmental knee arthroplasty

Correction of coronal alignment correlates with reconstruction of joint height in unicompartmental knee arthroplasty

The coronal alignment after medial unicompartmental knee arthroplasty can be predicted: usefulness of full-length valgus stress radiography for evaluating correctability

The measurement of medial knee gap width using ultrasound

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