The correction of severe varus deformity in total knee arthroplasty by tibial component downsizing and resection of uncapped proximal medial bone

Dixon, Michael C.; Parsch, Dominik; Brown, R. R.; Scott, Richard D.

doi:10.1016/j.arth.2003.08.001

Cited by 62 publications

(42 citation statements)

References 6 publications

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“…Excessive MCL release for flexion contracture of the tibiofemoral joint compromises stability of the knee after TKA. To prevent ligamentous instability caused by over-release, Clayton et al3) recommended staged release and Dixon et al11) reported that proper release could be obtained with use of shift & resection technique. However, determining a proper release is challenging because when the semimembranosus and pes anserinus tendons are over-released, the flexion gap becomes larger than the extension gap3,12).…”

Section: Discussionmentioning

confidence: 99%

Rotational Alignment of Femoral Component for Minimal Medial Collateral Ligament Release in Total Knee Arthroplasty

Chon

Sun

Jung

et al. 2011

Knee Surg Relat Res

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PurposeWe attempted to determine the degree of rotation of the femoral component to achieve an ideal rectangular flexion gap with minimal medial collateral ligament (MCL) release using a modified measured technique.Materials and MethodsGroup I consisted of 60 osteoarthritis patients (72 cases) who underwent total knee arthroplasty (TKA) with minimal MCL release and Group II consisted of 48 patients without osteoarthritis (61 cases). We performed computed tomography (CT) scanning of the knee with 90 degree flexion in all of the patients and analyzed the angles between the distal femur landmarks and the tibial mechanical axis using a Picture Archiving Communication system. External rotation of the femoral component from the Whiteside line and posterior condylar line was measured in group I who underwent TKA with minimum MCL release. The variance in the mediolateral flexion gap according to the degree of rotation was also measured using an Auto-Computer Aided Design program.ResultsThe CT scans showed that the Whiteside line, posterior condylar line, and transepicondylar line was more internally rotated on average from the longitudinal axis of tibia by 4.12°, 5.54°, and 4.64°, respectively, in group I compared to group II. In group I, the femoral component was inserted with an average external rotation of 5.6° from the posterior condylar line and with an average external rotation of 2.0° from the Whiteside line with minimal MCL release. From the measurements of the femoral component size and the variance in the degree of rotation using an Auto-CAD program, it was found that the change in the mediolateral flexion gap was greater when the rotation angle was greater and it was greater when the size of femoral component was larger at the same rotation angle.ConclusionsThe average rotation angle of the femoral component to achieve an ideal rectangular flexion gap with minimal MCL release in TKA was an external rotation of 5.6° from the posterior condylar line and an external rotation of 2.0° from the Whiteside line. We concluded that when a femoral component is small in size, greater than average external rotation needs to be applied and when a femoral component is large in size, less than average external rotation needs to be applied.

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Section: Discussionmentioning

confidence: 99%

Rotational Alignment of Femoral Component for Minimal Medial Collateral Ligament Release in Total Knee Arthroplasty

Chon

Sun

Jung

et al. 2011

Knee Surg Relat Res

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“…40 Though the starting positions at extension were different in the three groups (varus for OA, neutral for normal, and valgus for PCR-TKA), they all changed to slightly varus at deep flexion, consistent with other studies. 17,41 As VV rotation directly affects the contact force distribution among the medial and lateral compartments, future studies should compare the effects of medial compartment OA and PCR-TKAs on force distribution in the joint.…”

Section: Discussionmentioning

confidence: 99%

Kinematics of medial osteoarthritic knees before and after posterior cruciate ligament retaining total knee arthroplasty

Yue

Varadarajan

Moynihan

et al. 2010

Journal Orthopaedic Research

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Total knee arthroplasty (TKA) is a widely accepted surgical procedure for the treatment of patients with end-stage osteoarthritis (OA). However, the function of the knee is not always fully recovered after TKA. We used a dual fluoroscopic imaging system to evaluate the in vivo kinematics of the knee with medial compartment OA before and after a posterior cruciate ligament-retaining TKA (PCR-TKA) during weight-bearing knee flexion, and compared the results to those of normal knees. The OA knees displayed similar internal/external tibial rotation to normal knees. However, the OA knees had less overall posterior femoral translation relative to the tibia between 0 • and 105 • flexion and more varus knee rotation between 0 • and 45 • flexion, than in the normal knees. Additionally, in the OA knees the femur was located more medially than in the normal knees, particularly between 30 • and 60 • flexion. After PCR-TKA, the knee kinematics were not restored to normal. The overall internal tibial rotation and posterior femoral translation between 0 • and 105 • knee flexion were dramatically reduced. Additionally, PCR-TKA introduced an abnormal anterior femoral translation during early knee flexion, and the femur was located lateral to the tibia throughout weight-bearing flexion. The data help understand the biomechanical functions of the knee with medial compartment OA before and after contemporary PCR-TKA. They may also be useful for improvement of future prostheses designs and surgical techniques in treatment of knees with end-stage OA.

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“…Minimal soft tissue release followed by resection of the proximal medial tibia along the longitudinal axis of the tibia can be considered as an alternative. This technique is expected to be a safer option that would reduce the incidence of complications, such as medial collateral ligament (MCL) rupture, by allowing minimal release of the superficial layer of the MCL from the tibial attachment site8). In spite of this, there has been no domestic study on this technique.…”

Section: Introductionmentioning

confidence: 99%

Comparative Study of Two Techniques for Ligament Balancing in Total Knee Arthroplasty for Severe Varus Knee: Medial Soft Tissue Release vs. Bony Resection of Proximal Medial Tibia

Ahn

Back

2013

Knee Surg Relat Res

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PurposeBony resection of the proximal medial tibia, an alternative technique for soft tissue balancing in total knee arthroplasty (TKA), was compared to the conventional medial soft tissue release technique.Materials and MethodsFrom June 2005 to June 2007, we performed 40 TKA in 27 patients with ≥10° tibio-femoral varus deformity. The conventional, medial soft tissue release technique was applied in 20 cases and bony resection of proximal medial tibia in the other 20 cases (vertical osteotomy group). Total operation time, knee range of motion (ROM), hospital for special surgery (HSS) scores, and tibio-femoral medial-lateral gap ratio in 0°, 90°, and 130° flexion at postoperative 6 months were compared between the groups.ResultsThe total operation time was shorter in the vertical osteotomy group. Tibio-femoral medial-lateral gap ratio in 130° flexion was closer to 1 in the vertical osteotomy group (p=0.000). There was no significant difference in the ROM, HSS score, or tibio-femoral medial-lateral gap ratio in 0° and 90° flexion at postoperative 6 months.ConclusionsIn severe varus knees, bony resection of proximal medial tibia can be considered as an alternative technique, in order to decrease total operation time and to obtain medial-lateral, soft-tissue balance in deep flexion.

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The correction of severe varus deformity in total knee arthroplasty by tibial component downsizing and resection of uncapped proximal medial bone

Cited by 62 publications

References 6 publications

Rotational Alignment of Femoral Component for Minimal Medial Collateral Ligament Release in Total Knee Arthroplasty

Rotational Alignment of Femoral Component for Minimal Medial Collateral Ligament Release in Total Knee Arthroplasty

Kinematics of medial osteoarthritic knees before and after posterior cruciate ligament retaining total knee arthroplasty

Comparative Study of Two Techniques for Ligament Balancing in Total Knee Arthroplasty for Severe Varus Knee: Medial Soft Tissue Release vs. Bony Resection of Proximal Medial Tibia

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