Preoperative radiographic valgus alignment predicts the extent of lateral soft tissue release and need for constraint in valgus total knee arthroplasty

Goltzer, Oren; Mroz, Tommy P.; Temkit, Mʼhamed; Clarke, Henry D.; Spangehl, Mark J.

doi:10.1016/j.artd.2017.06.003

Cited by 4 publications

(4 citation statements)

References 27 publications

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“…The results of the present study revealed that preoperative clinical correctability could also be used as a factor to predict the amount of soft-tissue release, as well as the necessity of constrained articulation. Some surgeons consider factors such as older age and gender in their decision-making to use a constrained articulation [16]. The results of the present study revealed no association between the demographic factors of the patients and the choice of prosthesis.…”

Section: Discussioncontrasting

confidence: 58%

“…Their analyses revealed that preoperative radiographic characteristics of the valgus knee could be implicated in predicting the extent of the lateral soft-tissue release and the necessity of constrained articulation in TKA. They suggested that this information could be useful to offer accurate preoperative counseling to patients and to ensure the availability of appropriate prosthesis during the operation [16].…”

Section: Discussionmentioning

confidence: 99%

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Preoperative Clinical Correctability and Prediction of the Prosthesis Type in Total Knee Arthroplasty for ‌Severe Osteoarthritic Varus Deformity

Shahpari

Bagherifard

Rahbar

et al. 2019

J. Res. Orthop. Sci.

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Background: The preoperative identification of patients who might need constrained condylar knee (CCK) prosthesis in total knee arthroplasty (TKA), is essential to ensure the availability of equipment and to address the patients’ expectations accurately. Objectives: In this study, we aimed at investigating if the preoperative features of the patients can provide this data. Methods: A total of 30 patients who underwent primary TKA for severe osteoarthritic genu varum deformity (varus angle ≥20º) were evaluated in this retrospective study. Prosthesis selection was based on preoperative and intraoperative information. Demographic data, preoperative correctability of the deformity, and intraoperative information, including the reduction osteotomy, soft-tissue release, and pie-crust technique, were retrospectively collected. Soft-tissue release was performed in a sequential manner in 3 steps. Results: The study population included 4 males and 26 females with a mean±SD age of 64.6±8.7 years. A CCK prosthesis was used in 11 (36.7%) cases. A significant association was found between the preoperative correctability and the type of prosthesis. In other words, all CCK prostheses were used in patients who were preoperatively non-correctable (P<0.001). Also, the step of release was significantly associated with the type of prosthesis, and CCK prosthesis was used in all patients with step 3 release (P<0.001). Preoperative correctability was significantly related to the step of release, as well. It means that all deformities with step 3 release were preoperatively non-correctable (P=0.008). Conclusion: The preoperative clinical evaluation of correctability could be used in the identification of patients who might need a CCK prosthesis.

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Section: Discussioncontrasting

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Preoperative Clinical Correctability and Prediction of the Prosthesis Type in Total Knee Arthroplasty for ‌Severe Osteoarthritic Varus Deformity

Shahpari

Bagherifard

Rahbar

et al. 2019

J. Res. Orthop. Sci.

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“…They concluded that the deformity was mainly due to bony deformities rather than soft tissue laxities, which is not consistent with our results. Other authors described a correlation between the tibio‐femoral angle and the extent of lateral release [18, 19]. It should be noted here that the amount of release needed based on the deformity could pre‐operatively only be planned for extension, however, not for mid‐flexion or flexion.…”

Section: Discussionmentioning

confidence: 92%

Dynamic gap analysis of valgus knees shows large inter-individual variability of gaps

Eller

Scior

Graichen

2022

Knee Surg Sports Traumatol Arthrosc

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PurposeThe purpose of this study was to investigate the dynamic gap widths of valgus knees in extension and flexion to evaluate the influence of deformity on gap differences and to find out whether different ligamentous subtypes in valgus knees exist. MethodsDynamic gap widths of 1000 consecutive total knee arthroplasty (TKA) patients were measured at different flexion angles by applying a computer‐assisted surgery (CAS) technique. 198 knees showed a valgus deformity and were assessed regarding its degree of fulfillment of the following criteria of valgus knee: 1. Medial extension gap greater than lateral; 2. Medial flexion gap greater than lateral; 3. Flexion gap greater than extension gap. A single‐factor ANOVA subgroup analysis was performed, based on the amount of deformity. The effect of other patient factors (age, gender, weight) on gap differences was investigated. ResultsThe medial extension gap (3.7 ± 2.2 mm) was significantly (p < 0.01) larger than the lateral extension gap (1.1 ± 2.9 mm). The amount of deformity correlated highly with gap difference in extension (r2 = 0.67) but not in flexion. In 92.4% (183), the flexion gap (6.2 ± 3.1 mm) was significantly (p < 0.01) larger than the extension gap (2.4 ± 2.3 mm). Only 29.3% (58) of patients met all three criteria, this was mainly due to the fact that in flexion the medial gap was larger than the lateral in only 35.4% (70). Patient factors showed no significant influences (NS) on the gap widths. ConclusionValgus knees show large variability in terms of gap widths. The extent of deformity correlates highly with gap difference in extension, but not in other flexion angles. Vast majority of valgus knees were valgus in extension only. Because of this variability, it should be aimed for an individualized balancing technique based on intraoperative gap sizes. Level of EvidenceLevel III.

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“…Future research could examine the role of RAS in possibly minimizing the risk of peroneal nerve palsy in patients with severe preoperative deformity. In addition, this patient's degree of preoperative deformity placed him at higher risk for requiring constraint to achieve appropriate balance (Goltzer et al 2017). This was not the case in our patient as we were able to achieve appropriate balancing throughout flexion and extension simply using a cruciatesubstituting, ultracongruent polyethylene insert.…”

Section: Journal Of Orthopaedic Experience and Innovationmentioning

confidence: 75%

Total Knee Arthroplasty in Valgus Deformity Made Easy Using Robotic-assisted Predictive Balancing Technique

Scanlon,

Passano,

Koenig

2022

Journal of Orthopaedic Experience &Amp; Innovation

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Total knee arthroplasty (TKA) performed for valgus osteoarthritis (OA) presents a challenge to the arthroplasty surgeon in regards to achieving appropriate soft tissue balance and alignment. Robotic assisted surgery (RAS) with navigation (NAV) has been proposed as a potential solution to assist surgeons when performing these difficult cases. Here, we present the case of a complex primary TKA in a patient with posttraumatic valgus arthritis performed using a novel RAS system with NAV. Appropriate balance was unable to be achieved with bony cuts alone, as the knee was found to be tight laterally in extension following bone preparation. Soft tissue releases were ultimately required. Use of the novel RAS system with NAV allowed for a titrated soft tissue release resulting in a balanced knee without overcorrection of the patient’s deformity. We also present a similar case of a patient with valgus knee OA in which there was residual tightness laterally in flexion. The different management strategies for each of these cases is discussed. Finally, we provide a review of the available literature regarding TKA in valgus knee OA and propose a new classification system and treatment algorithm that can be employed using a novel RAS system with predictive balancing technology to achieve optimal alignment and soft tissue balancing in valgus knees that remain unbalanced following bony cuts.

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Preoperative radiographic valgus alignment predicts the extent of lateral soft tissue release and need for constraint in valgus total knee arthroplasty

Cited by 4 publications

References 27 publications

Preoperative Clinical Correctability and Prediction of the Prosthesis Type in Total Knee Arthroplasty for ‌Severe Osteoarthritic Varus Deformity

Preoperative Clinical Correctability and Prediction of the Prosthesis Type in Total Knee Arthroplasty for ‌Severe Osteoarthritic Varus Deformity

Dynamic gap analysis of valgus knees shows large inter-individual variability of gaps

Total Knee Arthroplasty in Valgus Deformity Made Easy Using Robotic-assisted Predictive Balancing Technique

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