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Kamei G, Ishibashi S, Yoshioka K, Sakurai S, Inoue H, Mochizuki Y, Ishikawa M, Adachi N. Evaluation of the flexion gap with a distal femoral trial component in posterior-stabilized total knee arthroplasty. Knee Surg Relat Res 2022; 34:10. [PMID: 35272708 PMCID: PMC8908638 DOI: 10.1186/s43019-022-00142-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 02/24/2022] [Indexed: 11/10/2022] Open
Abstract
Purpose A distal femoral trial component was manufactured, and flexion gap size and inclination were evaluated with or without the distal femoral trial component in total knee arthroplasty (TKA). This study aimed to evaluate the effect of the distal femoral trial component on flexion gap size and joint inclination in posterior-stabilized (PS)-TKA. Materials and methods A total of 84 patients with medial osteoarthritis who underwent mobile-bearing PS-TKA using modified gap techniques were included in this retrospective study. The flexion gap size and inclination before and after setting the distal femoral trial component were evaluated and compared with the final gap size and inclination. Results The joint gap size and inclination were significantly lower in those with than in those without the distal femoral trial component (P = 0.005, P < 0.001). The final gap size and inclination were similar to the gap size and inclination with the distal trial component (P = 0.468, P = 0.158). Conclusions The joint gap size and medial tension in PS-TKA were significantly reduced after setting the distal femoral trial component. The flexion gap measured using the distal femoral trial component was similar to that when the final trial component was set. To more accurately perform the gap technique TKA, the flexion gap should be measured using the distal femoral trial component.
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Kawasaki M, Kaneyama R, Suzuki H, Fujitani T, Tsukamoto M, Sabanai K, Yoshioka T, Okimoto N, Nagamine R, Sakai A. Component gap control during posterior-stabilised total knee arthroplasty using the posterior condylar pre-cut technique. J Exp Orthop 2021; 8:77. [PMID: 34524551 PMCID: PMC8443714 DOI: 10.1186/s40634-021-00398-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/27/2021] [Indexed: 11/10/2022] Open
Abstract
Purpose Adjusting the gap lengths to ensure equal lengths in both extension and flexion during total knee arthroplasty (TKA) is important for achieving successful outcomes. We designed a new pre-cut trial component (PCT) for posterior-stabilised (PS) TKA and aimed to determine whether the pre-cut technique is useful for component gap (CG) control in PS TKA. Methods A total of 70 knees were included. The PS PCT for PS TKA is composed of a 9-mm-thick distal part and 5-mm-thick posterior part with a cam structure. First, the distal femur and proximal tibia were cut to create an extension gap. Next, a 4-mm pre-cut was made from the posterior femoral condylar line; then, the PS PCT was attached, and the CGs were checked and compared at 0° and 90° knee flexion. Final CGs with the trial femoral components were compared with gaps in PS PCT at 0° and 90° knee flexion. Results CGs using PS PCTs were 10.2 mm at 0° and 13.6 mm at 90° knee flexion. According to the release of the posterior capsule at intercondylar notch and the adjustment of the cutting level of posterior femoral condyle, the final CG on knee extension was 11.3 mm; it did not significantly differ from CGs with PS PCT. The final CG at 90° knee flexion was 12.7 mm; it did not significantly differ from the estimated gap (12.4 mm) in PS PCT after flexion gap control. Conclusion CG control using PS PCT is a useful technique during PS TKA. Level of evidence Level IV: Case series.
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Affiliation(s)
- Makoto Kawasaki
- Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka Yahatanishi-ku, Kitakyushu City, Fukuoka, 807-8555, Japan.
| | - Ryutaku Kaneyama
- Knee Joint Reconstruction Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura City, Kanagawa, 247-8533, Japan
| | - Hitoshi Suzuki
- Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka Yahatanishi-ku, Kitakyushu City, Fukuoka, 807-8555, Japan
| | - Teruaki Fujitani
- Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka Yahatanishi-ku, Kitakyushu City, Fukuoka, 807-8555, Japan
| | - Manabu Tsukamoto
- Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka Yahatanishi-ku, Kitakyushu City, Fukuoka, 807-8555, Japan
| | - Ken Sabanai
- Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka Yahatanishi-ku, Kitakyushu City, Fukuoka, 807-8555, Japan
| | - Toru Yoshioka
- Department of Orthopaedics, Shimura Hospital, 3-13 Funairimachi Naka-ku, Hiroshima, 730-0841, Japan
| | - Nobukazu Okimoto
- Okimoto Clinic, 185-4 Yutakamachikubi, Kure City, Hiroshima, 734-0304, Japan
| | - Ryuji Nagamine
- Center of Artificial Joint and Rheumatism, Fukuoka Tokushukai Medical Center, 4-5 Sugukita, Kasuga City, Fukuoka, 816-0864, Japan
| | - Akinori Sakai
- Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka Yahatanishi-ku, Kitakyushu City, Fukuoka, 807-8555, Japan
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Yamagami R, Inui H, Taketomi S, Kono K, Kawaguchi K, Tanaka S. Navigation-based analysis of associations between intraoperative joint gap and mediolateral laxity in total knee arthroplasty. Knee 2021; 30:314-321. [PMID: 34015588 DOI: 10.1016/j.knee.2021.04.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 03/10/2021] [Accepted: 04/23/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND No data have demonstrated how joint gap measured under a distraction force is actually associated with mediolateral laxity evaluated under a varus-valgus force during total knee arthroplasty (TKA). This study aimed to investigate the correlations between them using a navigation system. METHODS A total of 113 primary navigated TKAs were included. After bone resection and soft-tissue balancing, the component gap was measured with a distraction force of 60 N and 80 N for both the medial and lateral compartment (i.e. a total of 120 N and 160 N) at 0°, 10°, 30°, 60°, 90°, and 120° knee flexion. After the final prosthetic implantation and capsule closure, mediolateral laxity under a maximum varus-valgus stress was recorded with image-free navigation at each knee flexion angle. The correlation between joint gap laxity (total differences between component gap and insert thickness in the medial and lateral compartment) and mediolateral laxity was analyzed using Spearman's rank correlation coefficient. RESULTS The joint gap laxity under both distraction forces showed significant positive correlations with mediolateral laxity at 10°, 30°, 60°, and 90° flexion, whereas no correlation was observed at extension and 120° flexion. The correlations were stronger in gap measurement under 80 N than 60 N at all examined ranges. In patients with body mass indexes (BMIs) ≥ 30 kg/m2, the correlation became non-significant. CONCLUSION Intraoperative joint gap laxity was associated with mediolateral laxity after TKA, especially at mid-flexion angles. The factors weakening the correlations were a lower applied distraction force for gap measurement and a larger BMI.
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Affiliation(s)
- Ryota Yamagami
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Inui
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Shuji Taketomi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kenichi Kono
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kohei Kawaguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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Kamei G, Ishibashi S, Yoshioka K, Sakurai S, Inoue H, Ishikawa M, Mochizuki Y, Adachi N. Accuracy of total knee arthroplasty using the modified gap technique based on the bone gap: an evaluation of the bone gap with a distal femoral trial component. ARTHROPLASTY 2021; 3:17. [PMID: 35236501 PMCID: PMC8796463 DOI: 10.1186/s42836-021-00072-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 02/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In total knee arthroplasty (TKA) using the modified gap technique, the soft-tissue balance is measured after osteotomy of the distal femur and proximal tibia (conventional bone gap). However, after osteotomy, the flexion gap size during 90° knee flexion may be larger than that observed after implantation. The tension of the lateral compartment during 90° flexion may also be reduced after osteotomy of the distal femur. We manufactured a distal femoral trial component to reproduce the condition after implantation and prior to posterior condyle osteotomy. This study aimed to evaluate the effect of the trial component on the flexion gap. METHODS This prospective study included 21 consecutive patients aged 78 years with medial osteoarthritis who underwent cruciate-retaining TKA between February 2017 and March 2018. The postoperative flexion gap size and inclination during 90° flexion were compared between cases with and without the trial component. RESULTS The mean joint gap size with the trial component (13.4 ± 0.80 mm) was significantly smaller than that without the trial component (14.7 ± 0.84 mm). The mean gap inclination angle with the trial component (3.7° ± 0.62°) was significantly smaller than that without the trial component (5.5° ± 0.78°). CONCLUSIONS In the present study, the joint gap size and medial tension were significantly reduced after the trial component had been set. Accurate measurement of the soft-tissue balance is an important factor in the modified gap technique, and this method using a distal femoral trial component can offer better outcomes than those achieved with conventional methods.
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Affiliation(s)
- Goki Kamei
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Japan. .,Department of Orthopaedic Surgery, Hiroshima Prefectural Hospital, 1-5-54, Ujinakanda, Minami-ku, Hiroshima, Japan.
| | - Shigeki Ishibashi
- Department of Orthopaedic Surgery, Hiroshima Prefectural Hospital, 1-5-54, Ujinakanda, Minami-ku, Hiroshima, Japan
| | - Koki Yoshioka
- Department of Orthopaedic Surgery, Hiroshima Prefectural Hospital, 1-5-54, Ujinakanda, Minami-ku, Hiroshima, Japan
| | - Satoru Sakurai
- Department of Orthopaedic Surgery, Hiroshima Prefectural Hospital, 1-5-54, Ujinakanda, Minami-ku, Hiroshima, Japan
| | - Hiroyuki Inoue
- Department of Orthopaedic Surgery, Hiroshima Prefectural Hospital, 1-5-54, Ujinakanda, Minami-ku, Hiroshima, Japan
| | - Masakazu Ishikawa
- Department of Artificial Joints and Biomaterials, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, Japan
| | - Yu Mochizuki
- Department of Orthopaedic Surgery, Hiroshima Prefectural Hospital, 1-5-54, Ujinakanda, Minami-ku, Hiroshima, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Japan
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