The intra-operative joint gap in cruciate-retaining compared with posterior-stabilised total knee replacement

Abstract

We have developed a new tensor for total knee replacements which is designed to assist with soft-tissue balancing throughout the full range of movement with a reduced patellofemoral joint. Using this tensor in 40 patients with osteoarthritis we compared the intra-operative joint gap in cruciate-retaining and posterior-stabilised total knee replacements at 0 degrees , 10 degrees , 45 degrees , 90 degrees and 135 degrees of flexion, with the patella both everted and reduced. While the measurement of the joint gap with a reduced patella in posterior-stabilised knees increased from extension to flexion, it remained constant for cruciate-retaining joints throughout a full range of movement. The joint gaps at deep knee flexion were significantly smaller for both types of prosthetic knee when the patellofemoral joint was reduced (p < 0.05).

Soft Tissue Balance in Total Knee Arthroplasty

“…While the joint component gap measurements with a reduced patella of PS TKA increased from extension to flexion, these values remained constant for CR TKA throughout the full range of motion. Additionally, the joint component gaps at deep knee flexion were significantly smaller for both types of prosthetic knees when the PF joint was reduced [48]. From our data, the CR TKA had stable joint kinematics from extension into deep flexion, while the joint kinematics for the PS TKA were more dynamic.…”

“…One of the reasons for this discrepancy may be the different patterns of soft tissue balance between PS and CR TKA [48,49]. In that report, CR TKA showed significantly smaller gaps when the arc of movement ranged from mid-to deep flexion, compared to PS TKA [48]. The posterior cruciate ligament in osteoarthritic knee is considered relatively rigid and shortened despite being relatively macroscopically intact.…”

“…In either case, multivariate regression analysis among various values including various joint gap change values, ligament balance, and pre-operative knee flexion angle demonstrated the pre-operative knee flexion angle and the joint gap change value (90-0°) had a significant independent result on post-operative knee flexion angle [89]. One of the reasons for this discrepancy may be the different patterns of soft tissue balance between PS and CR TKA [48,49]. In that report, CR TKA showed significantly smaller gaps when the arc of movement ranged from mid-to deep flexion, compared to PS TKA [48].…”

Evaluation of patellofemoral joint in ADVANCE® Medial-pivot total knee arthroplasty

“…Another important reason could be considered from the viewpoint of femoro-tibial kinematics and joint gap theory [30,35,36]. Komistek et al pointed out that femoro-tibial kinematics can play a major role in patellofemoral kinematics [37].…”

Early Loosening after Total Knee Arthroplasty with Minimal Incision Surgery: A Report of Two Cases and A Review of the Literature

“…The MIS technique has been reported to increase the rate of component malalignment [13], however, there have been few reports regarding the actual rate of revision. Added to that, the rate of complications may reduced and the femoral component in place [22][23][24], the intraoperative kinematic pattern of soft tissue balance observed for MIS QS showed more varus imbalance compared with conventional TKA [25]. It is hypothesized that the limited working space in MIS QS TKA may compel surgeons to avoid a larger femoral component, and select larger bony cuts, which leads to difficulties in acquiring appropriate soft tissue balancing.…”