Mid-flexion laxity could be identified with continuous flexion-arc gap assessment in patients with a large preoperative convergence angle

Song, Sang Jun; Lee, Hyun Woo; Bae, Dae Kyung; Park, Cheol Hee

doi:10.1007/s00167-021-06846-8

Cited by 5 publications

(3 citation statements)

References 31 publications

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“…Second, a hybrid cementation was performed which could lead to potentially worse radiological results. However, recent studies found similar results between hybrid and full cementation TKA at long‐term follow‐up [4, 35]. Furthermore, all tibial components were cemented, and loosening was always observed on the tibial component in the present study.…”

Section: Discussionsupporting

confidence: 77%

Restricted kinematic alignment may be associated with increased risk of aseptic loosening for posterior-stabilized TKA: a case–control study

Sappey‐Marinier

Shatrov

Batailler

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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PurposeThe purpose of the study was to compare clinical and radiological results between kinematic alignment (KA) and mechanical alignment (MA) with a posterior-stabilized (PS) total knee arthroplasty (TKA) with a post-cam mechanism at a minimum follow-up of 3 years. The authors hypothesized a higher risk of aseptic loosening when performing KA using PS TKA. Methods A retrospective monocentric single surgeon case control study was performed comparing 100 matched patients who had TKA performed using a MA philosophy to 50 patients receiving TKA with a KA technique between January 2016 and October 2017. All patients had the same knee prosthesis (GMK primary posterior-stabilized, Medacta ® , Switzerland). Patient speciic cutting blocks were used in both groups and a restricted KA (rKA) was aimed in the KA group. A hybrid cementation technique was performed. The new Knee Society Score (KSS) and radiological assessment were collected preoperatively and at the inal follow-up. Comparisons between groups were done with the T test or Fisher exact test. Global survival curves were estimated with Kaplan-Meier model. Signiicance was set at p < 0.05. Results Mean follow-up was 42.9 months ± 3.6 (range 37.6-46.7) and 53.3 months ± 4.1 (range 45.5-59.8) for rKA and MA groups. Postoperatively, no signiicant diferences were found for clinical scores between both groups. Radiological assessment found similar postoperative Hip-Knee-Ankle angle for rKA and MA groups (178° versus 179° respectively, NS). At last follow-up, a signiicant higher survivorship was found for the MA group compared to the rKA group (97 versus 84%; p < 0.001) for aseptic loosening revision as the endpoint. Conclusion An increased risk of tibial implant loosening was found with rKA compared to MA using a posterior-stabilized TKA with a post-cam system at short-term follow-up. Caution should be taken when choosing the TKA design while performing rKA. Level of evidence Retrospective case-control study, Level IV.

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Section: Discussionsupporting

confidence: 77%

Restricted kinematic alignment may be associated with increased risk of aseptic loosening for posterior-stabilized TKA: a case–control study

Sappey‐Marinier

Shatrov

Batailler

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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“…Finally, previous research that has modelled radiostereometric analyses of the anterior‐posterior translation of TKA designs during sit‐to‐stand and deep knee lunges reported translations of 6.8‐9.9 mm, suggesting that activities which require higher degrees of flexion may result in translations >7 mm [28]. As a result, radiographic evaluation of the flexion‐arc gap throughout the knee's range of motion may be a more clinically appropriate and effective method of assessing mid‐flexion laxity [29].…”

Section: Discussionmentioning

confidence: 99%

Gait kinematics and knee stability 10‐years following posterior‐stabilised total knee arthroplasty comparable to healthy adults >55

Tawy,

Biant,

McNicholas

2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe purpose of this study was to compare the long‐term objective biomechanical and functional parameters of a high‐flexion total knee arthroplasty (TKA) design against healthy older adults to determine whether knee biomechanics are comparable in both populations.MethodsOne cohort of patients with a primary TKA, and a cohort of healthy adults over 55 years old with no musculoskeletal deficits or arthritis participated. Bilateral knee range of motion (RoM) was assessed with a goniometer, and gait patterns were analysed with a three‐dimensional‐motion capture system. An arthrometer quantified the anterior‐posterior laxity of each knee. Statistical analyses were performed in SPSS software (α = 0.05).ResultsTwenty‐three knees were replaced in 20 patients. At 9.8 ± 3.1 years postoperatively, patients' knees had a statistically significantly poorer RoM than healthy controls' knees (n = 23) due to limited flexion; p < 0.0001. Patients also failed to achieve the same degree of knee flexion as controls during downhill gait. No kinematic differences were observed during mid‐flexion in level nor downhill gait; a state that has been associated with instability (p = 0.614; not significant [n.s]). There were no differences between groups in knee laxity (n.s).ConclusionPatients in this study had similar gait patterns to healthy older adults during mid‐flexion and were no more likely than the healthy controls to exhibit anterior‐posterior translation of the knee > 7 mm; a known risk factor of instability. However, the knee flexion range was poorer. This likely led to bilateral pathological knee flexion patterns during downhill gait.Level of Evidence: Level III.

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“…A continuous radiological image study indicated that a small intercomponent distance of less than 2 mm does not result in lift-of phenomena or clinical patient discomfort [12]. While there is no conclusive evidence deining a permissible range for clinical outcomes, surgeons generally aim for less than 3 mm of component gap mismatch in the mid-lexion range after TKA [19]. The clinical relevance of 1.0 to 1.1 mm in postrelease mismatch reduction may be seen in the current cohort, where component gap mismatch in the mid-lexion range was reduced to a mean of 1.0 mm and 1.1 mm, such that 95% and 90% of the cases came to within the Posterior capsular release is recognized as an efective surgical method for addressing lexion contracture in TKA.…”

Section: Discussionmentioning

confidence: 99%

Limited medial posterior capsular release increases the intraoperative medial component gap while maintaining the joint varus angle at extension in posterior‐stabilized total knee arthroplasty

Katagiri

Saito

Shioda

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Purpose There is a lack of robust evidence for the magnitude of the efects of posterior capsular release (PCR) on intraoperative component gaps during total knee arthroplasty (TKA). The purpose of the present study was to quantify and compare the efects of partial versus full PCR on the intraoperative component gaps at various degrees of lexion during posteriorstabilized TKA. Methods Full PCR was performed on 39 consecutive cases (full PCR group), and partial PCR (the medial side up to and including the intercondylar notch) was performed on the subsequent 39 consecutive cases (partial PCR group) during posterior-stabilized TKA using the measured resection technique for varus knee osteoarthritis. Medial component gaps and varus angles at 0°, 10°, 45°, 90°, and a maximum of lexion were measured with a tensor device before and after the PCR. Diferences between the two groups in post-release medial component gap increase and post-release joint varus angle increase were assessed using a t test. Pre-to post-release medial component gaps and joint varus angles in each group were compared using a paired samples t test. ResultsIn both groups at 0° and 10° of lexion, post-release medial compartment gaps were signiicantly greater than prerelease gaps (all P < 0.001). At 45°, 90° and maximum lexion, the medial compartment gap increase did not exceed the minimal detectable change in either group. At 0° and 10° of lexion, there was no signiicant diference in post-release medial compartment gap change between the two groups. In the full PCR group, post-release joint varus angles at 0° of lexion were signiicantly greater than pre-release angles (P < 0.001), while there was no signiicant pre-and post-release diference in the partial PCR group. The change in post-release joint varus angles at 0° of lexion was signiicantly greater in the full PCR group than in the partial PCR group. Conclusion Both full and partial PCR show similar clinical usefulness for increasing the medial component gap at extension and reducing component gap mismatch. A partial PCR can be used to avoid increasing joint varus angles at 0° of lexion. Level of evidence Level 2 (prospective comparative study).

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Mid-flexion laxity could be identified with continuous flexion-arc gap assessment in patients with a large preoperative convergence angle

Cited by 5 publications

References 31 publications

Restricted kinematic alignment may be associated with increased risk of aseptic loosening for posterior-stabilized TKA: a case–control study

Restricted kinematic alignment may be associated with increased risk of aseptic loosening for posterior-stabilized TKA: a case–control study

Gait kinematics and knee stability 10‐years following posterior‐stabilised total knee arthroplasty comparable to healthy adults >55

Limited medial posterior capsular release increases the intraoperative medial component gap while maintaining the joint varus angle at extension in posterior‐stabilized total knee arthroplasty

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