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Ueyama H, Nakagawa S, Minoda Y, Fukunaga K, Takemura S, Koyanagi J, Yamamura M. Association of intraoperative medial joint gap laxity in the flexion position with subjective knee instability after fixed-bearing posterior-stabilised total knee arthroplasty. Knee 2024; 51:65-73. [PMID: 39241672 DOI: 10.1016/j.knee.2024.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 07/05/2024] [Accepted: 08/09/2024] [Indexed: 09/09/2024]
Abstract
BACKGROUND Postoperative subjective knee instability is an important clinical outcome after total knee arthroplasty (TKA), however the association with intraoperative soft tissue balance remains unclear. This study aimed to assess the association between intraoperative soft tissue balance and postoperative subjective knee instability in fixed-bearing posterior-stabilised (PS) TKA. METHODS This retrospective case-control study included 457 patients who underwent fixed-bearing PS TKA. Intra-articular distraction force was quantitatively applied to measure the gap parameters (length and angle) during surgery. The intraoperative joint gap parameters and postoperative clinical outcomes between the patients with (n = 90) and without (n = 367) subjective knee instability were compared. The risk factors for subjective postoperative knee instability were analysed using multivariate logistic regression analysis. RESULTS The patients with subjective knee instability demonstrated a medially wider intra-articular gap angle and worse Knee Society Score 2011 symptoms (18 vs. 21; p < 0.01), satisfaction (27 vs. 30; p < 0.01), functional activity (55 vs. 65; p < 0.01), and Forgotten Joint Score 12 items (51 vs. 65; p < 0.01) than those in the patients without subjective knee instability. The use of measured resection technique (odds ratio, 2.3; 95% CI, 1.1-4.8; p = 0.02) and the medial laxity of joint gap balance in the flexion position (odds ratio, 1.2; 95% CI, 1.0-1.4; p = 0.04) were detected as risk factors for postoperative subjective knee instability. CONCLUSION In fixed-bearing PS TKA, intraoperative medial joint laxity in the flexion position was associated with postoperative subjective knee instability, and surgical techniques to achieve sufficient soft tissue balance contributed to improve postoperative subjective clinical outcomes. LEVEL OF EVIDENCE Ⅲ (case-control study).
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Affiliation(s)
- Hideki Ueyama
- Department of Orthopedic Surgery, Osaka Rosai Hospital 1179-3 Nagasonecho, Kitaku, Sakaishi, Osaka, Japan.
| | - Shigeru Nakagawa
- Department of Orthopedic Surgery, Hanwa Memorial Hospital 3-5-8 Minamisumiyoshi, Sumiyoshiku, Osaka, Japan
| | - Yukihide Minoda
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno ward, Osaka, 545-8585, Japan
| | - Kenji Fukunaga
- Department of Orthopedic Surgery, Osaka Rosai Hospital 1179-3 Nagasonecho, Kitaku, Sakaishi, Osaka, Japan
| | - Susumu Takemura
- Department of Orthopedic Surgery, Osaka Rosai Hospital 1179-3 Nagasonecho, Kitaku, Sakaishi, Osaka, Japan
| | - Junichiro Koyanagi
- Department of Orthopedic Surgery, Osaka Rosai Hospital 1179-3 Nagasonecho, Kitaku, Sakaishi, Osaka, Japan
| | - Mitsuyoshi Yamamura
- Department of Orthopedic Surgery, Osaka Rosai Hospital 1179-3 Nagasonecho, Kitaku, Sakaishi, Osaka, Japan
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Hishimura R, Iwasaki K, Suzuki Y, Matsuoka M, Onodera T, Kondo E, Iwasaki N. Elucidation of the association between additional distal femoral resection and extension angle improvement following the actual surgical steps with the Robot-TKA system. Knee 2024; 49:36-44. [PMID: 38843674 DOI: 10.1016/j.knee.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 04/24/2024] [Accepted: 05/20/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND This study investigates the association between additional distal femoral resection and improved flexion contracture in total knee arthroplasty (TKA) with a robot-assisted system. Flexion contracture is a common issue in patients with knee osteoarthritis, which causes postoperative complications and functional limitations. This study aims to evaluate the effectiveness of additional bone resection in flexion contracture correction and knee extension angle improvement after the actual surgical steps. METHODS The study included 11 patients who underwent posterior-stabilized (PS)-type TKA with a robot-assisted system. The surgical technique consisted of precise bone resection and range of motion evaluation using a navigation system. A precut technique was used to facilitate posterior access and remove osteophytes that cause the contracture. The amount of additional distal femoral resection was determined based on the thickness of the insert trial required for achieving full extension. RESULTS The flexion contracture correction angle and the amount of additional distal femoral resection demonstrated a linear relationship. An average of 2.0° with the standard error (SE) of 0.6° improvement in flexion contracture was observed per 1.0 mm of additional bone resection. The postoperative evaluation demonstrated a significant improvement in knee extension angle, thereby reducing the contracture degree. CONCLUSION This study was the first to perform the additional distal femoral resection on the living knee, which closely replicates the actual surgical steps. The current study revealed that an additional 1.0 mm of distal femoral resection in PS-type TKA improves knee extension angle by 2.0° (SE 0.6°) within an additional resection range of 1.0 mm to 3.3 mm.
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Affiliation(s)
- Ryosuke Hishimura
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15 jo, Nishi 7 chome, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
| | - Koji Iwasaki
- Department of Functional Reconstruction for the Knee Joint, Graduate School of Medicine, Hokkaido University, Kita 15 jo, Nishi 7 chome, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
| | - Yuki Suzuki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15 jo, Nishi 7 chome, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
| | - Masatake Matsuoka
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15 jo, Nishi 7 chome, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
| | - Tomohiro Onodera
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15 jo, Nishi 7 chome, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
| | - Eiji Kondo
- Centre for Sports Medicine, Hokkaido University Hospital, North 14 West 5, Kita-Ku, Sapporo 060-8648, Japan.
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15 jo, Nishi 7 chome, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
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