The Effect of Distal Femoral Resection on Fixed Flexion Deformity in Total Knee Arthroplasty

Liu, David W.; Reidy, James; Beller, Elaine

doi:10.1016/j.arth.2015.07.033

Cited by 21 publications

(27 citation statements)

References 19 publications

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“…A 10° flexion contracture was chosen because it is commonly observed in the clinic and to match the flexion angle used in a previous in vitro study ( Cross et al, 2012 ). The increase in knee extension resulting from additional resection of the distal femur was then compared to data from previous in vitro experiments conducted by members of our research team and to clinical studies ( Cross et al, 2012 ; Kim et al, 2017a ; Liu et al, 2016 ).…”

Section: Methodsmentioning

confidence: 99%

“…Each TKA model was then extended until the resultant force carried by the posterior capsule again equaled that of the tensioned capsule at the original 10° contracted position. The new flexion angle was measured after the two additional resections and compared to a previous cadaveric study performed by several members of our research team ( Cross et al, 2012 ) and clinical data from the literature ( Kim et al, 2017a ; Liu et al, 2016 ). The statistical significance of the comparison was determined using a two-sample, two-tailed t -test (p< 0.05).…”

Section: Methodsmentioning

confidence: 99%

“…Several surgical approaches have been utilized to correct preoperative flexion contracture during TKA, including intraoperative manipulation ( Matsui et al, 2016 ), removal of posterior condylar osteophytes ( Massin et al, 2009 ; Mihalko and Whiteside, 2003 ; Whiteside and Mihalko, 2002 ), release of the posterior capsule ( Athwal et al, 2019 ; Okamoto et al, 2016 ), and additional distal femoral resection ( Kim et al, 2017a ; Liu et al, 2016 ). However, no consensus has emerged on a surgical strategy to restore the ability to achieve full extension.…”

Section: Introductionmentioning

confidence: 99%

“…However, no consensus has emerged on a surgical strategy to restore the ability to achieve full extension. Previous studies utilizing navigation technology ( Kim et al, 2017a ; Liu et al, 2016 ) or cadaveric models ( Cross et al, 2012 ) evaluated surgical techniques to achieve full extension and minimize undesirable outcomes such as knee instability. These clinical and cadaveric studies, however, lack the ability to precisely define important variables including the degree of flexion contracture, the amount of additional bone resection, or the level of ligament release while controlling for potential confounding factors such as variability in bony cuts, implant placement, and ligament properties.…”

Section: Introductionmentioning

confidence: 99%

“…Third, to quantify the amount of knee extension that would be restored by incrementally increasing the bone resection of the distal femur using the model. Finally, to compare model predictions to previously published clinical and cadaveric studies ( Cross et al, 2012 ; Kim et al, 2017b ; Liu et al, 2016 ).…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Simulation of preoperative flexion contracture in a computational model of total knee arthroplasty: Development and evaluation

Elmasry

Chalmers

Kahlenberg

et al. 2021

Journal of Biomechanics

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Preoperative flexion contracture is a risk factor for patient dissatisfaction following primary total knee arthroplasty (TKA). Previous studies utilizing surgical navigation technology and cadaveric models attempted to identify operative techniques to correct knees with flexion contracture and minimize undesirable outcomes such as knee instability. However, no consensus has emerged on a surgical strategy to treat this clinical condition. Therefore, the purpose of this study was to develop and evaluate a computational model of TKA with flexion contracture that can be used to devise surgical strategies that restore knee extension and to understand factors that cause negative outcomes. We developed six computational models of knees implanted with a posteriorly stabilized TKA using a measured resection technique. We incorporated tensions in the collateral ligaments representative of those achieved in TKA using reference data from a cadaveric experiment and determined tensions in the posterior capsule elements in knees with flexion contracture by simulating a passive extension exam. Subject-specific extension moments were calculated and used to evaluate the amount of knee extension that would be restored after incrementally resecting the distal femur. Model predictions of the extension angle after resecting the distal femur by 2 and 4 mm were within 1.2° (p ≥ 0.32) and 1.6° (p ≥ 0.25), respectively, of previous studies. Accordingly, the presented computational method could be a credible surrogate to study the mechanical impact of flexion contracture in TKA and to evaluate its surgical treatment.

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