Lateral Soft Tissue Laxity Increases but Medial Laxity Does Not Contract With Varus Deformity in Total Knee Arthroplasty

Okamoto, Shogo; Okazaki, Ken; Mitsuyasu, Hiromichi; Matsuda, Shuichi; Iwamoto, Yukihide

doi:10.1007/s11999-012-2745-1

Cited by 87 publications

(63 citation statements)

References 27 publications

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“…If normal ligamentous tension is preserved in preoperative knees, recreating pre-OA alignment, such as kinematic alignment, could be one of the reasonable ways to achieve near normal kinematics. In knees with severe varus deformity, however, lateral soft tissues are stretched out [21], and slight undercorrection does not guarantee normal soft-tissue balance. I believe near-neutral alignment is important to avoid abnormal knee motion under the weight-bearing condition.…”

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confidence: 99%

Clinical Faceoff: Do We Need Special Strategies for Asian Patients with TKA?

Kim

Matsuda

Kim

2016

Clinical Orthopaedics &Amp; Related Research

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confidence: 99%

Clinical Faceoff: Do We Need Special Strategies for Asian Patients with TKA?

Kim

Matsuda

Kim

2016

Clinical Orthopaedics &Amp; Related Research

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“…Bellmans et al 9 reported that a suitable correction was possible with osteophyte removal alone in patients with less than 185˚ of FTA. Ushio et al 10 and Okamoto et al 11 reported that medial structures, including the MCL, are not shortened in knees with varus deformity. The present study's results and these reports suggest that osteophyte removal alone can achieve a certain degree of correction, at least in knees with FTA less than 185˚.…”

Section: Resultsmentioning

confidence: 99%

Effect of Medial Osteophyte Removal on Correction of Varus Deformity in Total Knee Arthroplasty

et al. 2020

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Background: In order to restore the neutral limb alignment in total knee arthroplasty (TKA), surgical procedure usually starts with removing osteophytes in varus osteoarthritic knees, however, that the exact influence on alignment correction is unknown. The purpose of this study was to define the influence of osteophyte removal alone on limb alignment correction in the coronal plane in TKA for varus knee. Methods: Fifteen medial osteoarthritic knees with varus malalignment scheduled for TKA were included in this study. After registration of a navigation system, each knee was tested at maximum extension, and at 30, 40 and 60 degrees of flexion before and after osteophyte removal. External loads of 10 N-m valgus torque at each angle and in both states were applied. Subsequently, the widths of the resected osteophytes were measured. Results: The average pre-operative hip-knee-ankle angle was-14.2 degrees. The average width of osteophytes was 7.6 mm in femur and 5.3 mm in tibia, respectively. Angle corrections after osteophyte removal were 3.4 degrees at maximum extension, 3.4 degrees at 30 degrees flexion and 3.6 degrees at 60 degrees flexion; and at all angles, the difference was significant. There was positive correlation between the widths of osteophytes and the degree of angle correction at 30 degrees. Conclusion: Correlation was found at 30 degrees of knee flexion between the widths of osteophytes and the degree of angle correction in the coronal plane in TKA. We found the degree of angle correction per 1mm width of osteophyte removal to be 0.4 degrees.

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“…(►Table 3). [5][6][7][8][9][10][14][15][16][17][18][19][20] This makes direct comparison of studies difficult. To our knowledge, the OA knee has not been examined in vivo in 90 degrees of flexion.…”

Section: Discussionmentioning

confidence: 99%

“…5 In contrast, Okamoto et al found increased lateral (varus) laxity in the varus knee but no alteration in the medial tissue at the time of TKA. 6 These papers focused on the varus knee in maximal extension. Numerous authors have examined the mediallateral laxity of the healthy knee at flexion angles between 70 and 90 degrees.…”

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The Varus Osteoarthritic Knee Has No Coronal Contractures in 90 Degrees of Flexion

et al. 2016

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Medial and lateral coronal soft tissue laxity in 90 degrees of flexion in the varus osteoarthritic (OA) knee at the time of total knee arthroplasty (TKA) is unknown, meaning, key information as to how the flexion gap should be addressed by surgery is not available. The purpose of this study was to define the coronal plane medial and lateral laxity in 90 degrees of flexion in the end-stage OA knee. Computer assisted surgery (CAS) displays and direct joint observations were used to manipulate the knee to its neutral position in 90 degrees of flexion prior to any surgical releases. Laxity was measured as medial and lateral displacement from the neutral axis of the knee and compared with literature values for healthy subjects. The 72 knees examined had a mean varus deformity, measured in maximum extension, of -7.9 ± 3.1 degrees (-0.5 to -15 degrees). At 90 degrees of flexion, mean medial and lateral laxity as measured by displacement from the neutral axis of the knee was 3.8 ± 1.4 degrees and 4.7 ± 2 degrees respectively. This medial laxity was significantly greater -1.7 degrees (95% CI, -3.1 to -0.3 degrees) than that seen in healthy knees ( < 0.0001) whereas the measured lateral laxity displayed a nonsignificant difference compared with healthy knees. The mean difference in medial-lateral laxity was 1.5 ± 1.1 degrees. A medial-lateral difference of ≤2.5 degrees was present in 91.6% of knees. We found no evidence of contractures in the coronal plane tissue of the end-stage OA knee at the time of TKA. Absolute medial-lateral balance is not typical of the end-stage OA knee in 90 degrees of flexion with a small medial-lateral difference typically present. Careful examination of the soft tissues in flexion at the commencement of TKA may help guide surgery to optimize the coronal plane soft tissue envelope. Our findings would suggest that large releases during either a gap-balanced or a measured-resection TKA would not typically be necessary, and that releases that increase laxity in flexion may increase often already lax medial tissue or increase laxity within lateral tissues that typically already have physiological tension.

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Lateral Soft Tissue Laxity Increases but Medial Laxity Does Not Contract With Varus Deformity in Total Knee Arthroplasty

Cited by 87 publications

References 27 publications

Clinical Faceoff: Do We Need Special Strategies for Asian Patients with TKA?

Clinical Faceoff: Do We Need Special Strategies for Asian Patients with TKA?

Effect of Medial Osteophyte Removal on Correction of Varus Deformity in Total Knee Arthroplasty

The Varus Osteoarthritic Knee Has No Coronal Contractures in 90 Degrees of Flexion

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