No detrimental effect of ligament balancing on functional outcome after total knee arthroplasty: a prospective cohort study on 129 mechanically aligned knees with 3 years’ follow-up

Abstract

Background and purpose — In the classical mechanical alignment technique, ligament balancing is considered a prerequisite for good function and endurance in total knee arthroplasty (TKA). However, it has been argued that ligament balancing may have a negative effect on knee function, and some authors advocate anatomic or kinematic alignment in order to reduce the extent of ligament releases. The effect of the trauma induced by ligament balancing on functional outcome is unknown; therefore, the aim of this study was to investigate this effect.Patients and methods — 129 knees (73 women) were investigated. Mean age was 69 years (42–82), and mean BMI was 29 (20–43). Preoperatively 103 knees had a varus deformity, 21 knees had valgus deformity, and 5 knees were neutral. The primary outcome measure was the Knee injury and Osteoarthritis Outcome Score (KOOS). Secondary outcome measures were the Oxford Knee Score (OKS) and patient satisfaction (VAS). All ligament releases were registered intraoperatively and outcome at 3 years’ follow-up in knees with and without ligament balancing was comparedResults — 86 knees were ligament balanced and 43 knees were not. Ligament-balanced varus knees had more preoperative deformity than varus knees without ligament balancing (p = 0.01). There were no statistically significant differences in outcomes between ligament-balanced and non-ligament-balanced knees at 3 years’ follow-up. No correlation was found between increasing numbers of soft tissue structures released and outcome.Interpretation — We did not find any negative effect of the trauma induced by ligament balancing on knee function after 3 years.

Satisfaction after total knee replacement for osteoarthritis is usually high, but what are we measuring? A systematic review

“…[ 23 ] 2016 Sweden 68.5 (4) RCT 74 21 Degree of satisfaction with the operated knee: ‘very satisfied’, ‘satisfied’, ‘uncertain’, ‘dissatisfied’ Satisfaction with the operated knee Ali et al. [ 24 ] 2017 Sweden 72.9 (9.7) RCT 186 16 Degree of satisfaction with the operated knee: ‘very satisfied’, ‘satisfied’, ‘uncertain’, ‘dissatisfied’ Satisfaction with the operated knee Aunan and Rohl [ 25 ]. 2018 Norway 69.3 (7.4) Prospective cohort 129 73 Patient satisfaction measures on a VAS Satisfaction Baker et al.…”

“…One study used a question that was an item from the Self-Administered Patient Satisfaction Scale (SAPSS) [ 32 ], and 2 used an item from the surgeon-completed multi-domain British Orthopaedic Association (BOA) grading system [ 42 , 43 ]. Of the remaining studies, 13 provided no citation in support of the single item question used [ 25 , 27 , 34 , 36 , 37 , 39 , 48 , 50 , 52 , 53 , 56 , 62 , 63 ], and 1 study provided a citation that had no evidence of satisfaction content [ 49 ].…”

“…Additionally, the Osteoarthritis Research Society International, which developed the PASS, has identified problems with the consistency of the PASS question and timeline of measurement in this population, suggesting further development studies are required [ 70 ]. Lastly, Dailiana [ 32 ], who cited the SAPSS, modified the instrument to include only three items of satisfaction as opposed to the four-item questionnaire designed by Mahomed [ 25 ], therefore not accurately representing the original intentions of the validated instrument.…”

Is Standing Coronal Long-Leg Alignment View Effective in Predicting the Extent of Medial Soft Tissue Release in Varus Deformity during Total Knee Arthroplasty?

“…Medial soft tissue release is an important issue related strongly to the postoperative outcomes and patient satisfactions as well as the alignment, but there is no consensus in terms of the necessity, extent, timing, and sequences of release. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][30][31][32] Nowadays, intraoperative computerized navigation and other smart utilities were found to improve the alignment, and ligament balancing but still the gold standard for achieving these goals is controversial. 6,21,24,25 The preoperative risk factors of the extent of medial release in varus knee during TKA have been evaluated in a few studies, but most of them have focused on the stress or distractive angles and radiographs.…”

“…collateral soft tissue release is associated with many challenges in the need for and the extent of ligament balancing as well as the time (in relation to bone cuts) and the sequence of release. 11 A correct soft tissue balance is the most important factor for the durability of the prosthesis and improper release of the medial collateral ligament (MCL) may result in pain, deteriorated patellofemoral biomechanics, joint stiffness, tibiofemoral instability, polyethylene wear, osteolysis, aseptic loosening, and early implant failure. [12][13][14][15] Also, excessive soft tissue release can lead to significant mediolateral instability, and an unbalanced flexion and extension gap that may necessitate the use of a constrained prosthesis.…”