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Huan W, Mochizuki T, Tanifuji O, Kawashima H. Variability of functional knee phenotype for coronal alignment in advanced varus knee osteoarthritis in the Japanese population. Knee Surg Sports Traumatol Arthrosc 2022; 31:1451-1461. [PMID: 36449045 DOI: 10.1007/s00167-022-07248-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 11/21/2022] [Indexed: 12/02/2022]
Abstract
PURPOSE New concept of functional knee phenotypes in Caucasians demonstrated the variability of coronal alignment in knee osteoarthritis (OA), but it remains unclear in Japanese. This study aims to analyze the knee phenotype in advanced varus knee OA for Japanese. In addition, the ethnical difference is discussed. METHODS This study analyzed 879 knees involving 186 males (74 years) and 693 females (74 years). The knee phenotypes were assessed by the definition in Hirschmann's group. The hip-knee-ankle angle (HKA), femoral mechanical angle (FMA) and tibial mechanical angle (TMA) were assessed in CT data according to the coordinate system. The neutral angle was 180° in HKA, 93° in FMA and 87° in TMA. The smaller angle means larger varus angles. RESULTS The average angle (males, females) of the HKA (170.9 ± 4.3°, 169.4 ± 5.0°), FMA (91.5 ± 2.7°, 90.6 ± 3.0°), and TMA (82.4 ± 3.6°, 82.7 ± 3.7°) demonstrated varus angles with the sex difference (HKA, p < 0.001; FMA, p = 0.001). The phenotypes were 73 types in males and 150 types in females with a mild correlation between the HKA and the FMA or TMA. In 61.3% of males and 52.2% of females, the TMA was greater than the FMA, while the FMA was greater in 16.7% of males and 23.1% of females. CONCLUSION There were many functional knee phenotypes with sex differences for advanced varus knee OA in Japanese, showing ethnical differences of larger varus angles compared to those for Caucasians in the previous report. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Wang Huan
- Division of Orthopedic Surgery, Niigata University Medical and Dental Hospital, 1-757 Asahimachi-dori Chuo-ku, Niigata City, 951-8510, Japan.,Department of Orthopedic Surgery, The First Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Tomoharu Mochizuki
- Division of Orthopedic Surgery, Niigata University Medical and Dental Hospital, 1-757 Asahimachi-dori Chuo-ku, Niigata City, 951-8510, Japan.
| | - Osamu Tanifuji
- Division of Orthopedic Surgery, Niigata University Medical and Dental Hospital, 1-757 Asahimachi-dori Chuo-ku, Niigata City, 951-8510, Japan
| | - Hiroyuki Kawashima
- Division of Orthopedic Surgery, Niigata University Medical and Dental Hospital, 1-757 Asahimachi-dori Chuo-ku, Niigata City, 951-8510, Japan
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Mochizuki T, Omori G, Nishino K, Tanaka M, Tanifuji O, Koga H, Mori T, Koga Y, Kawashima H. The medial inclination of the proximal tibia is associated with the external knee adduction moment in advanced varus knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2022; 30:574-583. [PMID: 33067660 DOI: 10.1007/s00167-020-06323-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 10/05/2020] [Indexed: 01/04/2023]
Abstract
PURPOSE Whether the inclined articular surface on the medial proximal tibia and the external knee adduction moment (KAM) correlate remains unclear. The hypothesis was that a steeper inclined articular surface correlated with a larger KAM in advanced knee osteoarthritis (OA). METHODS A total of 44 females (non-OA, 9 knees; early OA, 14 knees; advanced OA, 21 knees; mean age, 58 ± 16 years) were examined. Three-dimensional (3D) assessment was used on biplanar long-leg radiographs and 3D bone models using a 3D to 2D image registration technique. The approximation plane in the proximal tibia was determined using the least-square method. The joint moments were mathematically calculated in a gait analysis, applying a motion capture system and force plates. The main evaluation parameters were the femorotibial angle (FTA), the coronal inclination of the approximation plane in the medial proximal tibia (coronal inclination), and internal knee joint moments. The KAM means the external moments balanced with the internal knee abduction moments. RESULTS The advanced OA showed a larger internal abduction moment (p = 0.017) at the loading response than the other groups. The larger FTA and steeper coronal inclination correlated with the larger internal abduction moment (FTA, p < 0.001; coronal inclination, p = 0.003) at the loading response. CONCLUSIONS As the clinical relevance, the association among the coronal inclination of the medial proximal tibia, lower extremity alignment, and KAM is one of the key factors to help better understand the etiology of knee OA. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Tomoharu Mochizuki
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Science, 1-757 Asahimachi-dori Chuo-ku, Niigata City, Niigata, 951-8510, Japan.
| | - Go Omori
- Department of Health and Sports, Faculty of Health Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | | | - Masaei Tanaka
- Niigata Institute for Health and Sports Medicine, Niigata, Japan
| | - Osamu Tanifuji
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Science, 1-757 Asahimachi-dori Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Hiroshi Koga
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Science, 1-757 Asahimachi-dori Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Takahiro Mori
- Graduate School of Science and Technology, Niigata University, Niigata, Japan
| | - Yoshio Koga
- Department of Orthopaedic Surgery, Nioji Onsen Hospital, Niigata, Japan
| | - Hiroyuki Kawashima
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Science, 1-757 Asahimachi-dori Chuo-ku, Niigata City, Niigata, 951-8510, Japan
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Toyooka S, Masuda H, Nishihara N, Kobayashi T, Miyamoto W, Ando S, Kawano H, Nakagawa T. Postoperative laxity of the lateral soft tissue is largely negligible in total knee arthroplasty for varus osteoarthritis. J Orthop Surg (Hong Kong) 2021; 29:23094990211002002. [PMID: 33787403 DOI: 10.1177/23094990211002002] [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] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To evaluate the integrity of lateral soft tissue in varus osteoarthritis knee by comparing the mechanical axis under varus stress during navigation-assisted total knee arthroplasty before and after compensating for a bone defect with the implant. METHODS Sixty-six knees that underwent total knee arthroplasty were investigated. The mechanical axis of the operated knee was evaluated under manual varus stress immediately after knee exposure and after navigation-assisted implantation. The correlation between each value of the mechanical axis and degree of preoperative varus deformity was compared by regression analysis. RESULTS The maximum mechanical axis under varus stress immediately after knee exposure increased in proportion to the degree of preoperative varus deformity. Moreover, the maximum mechanical axis under varus stress after implantation increased in proportion to the degree of preoperative varus deformity. Therefore, the severity of varus knee deformity leads to a progressive laxity of the lateral soft tissue. However, regression coefficients after implantation were much smaller than those measured immediately after knee exposure (0.99 vs 0.20). Based on the results of the regression formula, the postoperative laxity of the lateral soft tissue was negligible, provided that an appropriate thickness of the implant was compensated for the bone and cartilage defect in the medial compartment without changing the joint line. CONCLUSION The severity of varus knee deformity leads to a progressive laxity of the lateral soft tissue. However, even if the degree of preoperative varus deformity is severe, most cases may not require additional procedures to address the residual lateral laxity.
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Affiliation(s)
- Seikai Toyooka
- Department of Orthopaedic Surgery, 13094Teikyo University School of Medicine, Tokyo, Japan
| | - Hironari Masuda
- Department of Orthopaedic Surgery, 13094Teikyo University School of Medicine, Tokyo, Japan
| | - Nobuhiro Nishihara
- Department of Orthopaedic Surgery, 13094Teikyo University School of Medicine, Tokyo, Japan
| | - Takashi Kobayashi
- Department of Orthopaedic Surgery, 13094Teikyo University School of Medicine, Tokyo, Japan
| | - Wataru Miyamoto
- Department of Orthopaedic Surgery, 13094Teikyo University School of Medicine, Tokyo, Japan
| | - Shuji Ando
- Department of Information Engineering, 13094Tokyo University of Science, Tokyo, Japan
| | - Hirotaka Kawano
- Department of Orthopaedic Surgery, 13094Teikyo University School of Medicine, Tokyo, Japan
| | - Takumi Nakagawa
- Department of Orthopaedic Surgery, 13094Teikyo University School of Medicine, Tokyo, Japan
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Sato Y, Hasegawa K, Okamoto M, Hatsushikano S, Ishii Y, Watanabe K, Oshima Y, Shimoda H, Homma T. Correction surgery for adult spinal deformity improves not only spinopelvic alignment but also the three-dimensional alignment of the lower extremities. J Orthop Sci 2020; 25:946-952. [PMID: 31918899 DOI: 10.1016/j.jos.2019.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 11/27/2019] [Accepted: 12/10/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND It is well known that correction surgery for adult spinal deformity (ASD) improves sagittal and coronal spinopelvic alignment, but the surgery effect on lower extremities (LE) is not well clarified. The aim of this study was to test the hypothesis that LE alignment also improves following spinopelvic correction surgery for ASD as a function of compensatory mechanism, and to clarify an effect of the severity of knee osteoarthritis (OA) on the improvement. METHODS We retrospectively evaluated spinopelvic alignment, hip knee ankle angle (HKA), knee flexion angle (KF), and severity of the knee OA in thirty-nine patients with ASD before, two weeks and three months after the surgery. The grade of knee OA was evaluated by Kellgren Lawrence grading, and classified grade 0 to 2 into mild, and 3, 4 into severe OA. All the values were compared by paired t test or Wilcoxon signed rank test with significant p value of <0.05. RESULTS Following the surgery, not only spinopelvic, but also bilateral HKA and KF were significantly improved. HKA in mild OA side was more normalized compared to that in severe side. Although KF of both bilateral mild and bilateral severe OA groups improved, the improvement of mild group was more significant. CONCLUSION The 3D alignment of LE improved following spinopelvic correction surgery. The improvement was inadequate in cases with severe knee OA.
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Affiliation(s)
- Yusuke Sato
- Niigata Spine Surgery Center, Niigata, Japan; Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan.
| | | | | | | | | | - Kei Watanabe
- Department of Orthopaedic Surgery, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Yasushi Oshima
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | | | - Takao Homma
- Niigata Spine Surgery Center, Niigata, Japan
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Kaneko T, Mochizuki Y, Hada M, Toyoda S, Takada K, Ikegami H, Musha Y. Greater postoperative relatively medial loose gap at 90° of flexion for varus knees improves patient-reported outcome measurements in anatomical bi-cruciate retaining total knee arthroplasty. Knee 2020; 27:1534-1541. [PMID: 33010771 DOI: 10.1016/j.knee.2020.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/24/2020] [Accepted: 08/05/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND The purpose of the present study was to measure the intraoperative joint gap using tensor device and pre- and, postoperative joint stability at 0, 30 and 90° of flexion using stress radiography and to identify whether these factors influence patient-reported outcome measurement (PROM) in anatomical bi-cruciate retaining (BCR) knee arthroplasty (TKA). METHODS Fifty-three knees with preoperative varus osteoarthritis of the knee underwent anatomical BCR TKA with oblique three-degree angle femorotibial joint line. The intraoperative medial and lateral joint gap using a tensor device and gap difference (lateral minus medial; varus laxity) were also calculated. Postoperative joint stability was measured using stress radiographs. PROM was also evaluated at 1.5 years postoperatively. The effect of intraoperative and postoperative joint stabilities on PROMs were analyzed using Spearman's rank correlation analysis. RESULTS Intraoperative greater difference between medial joint gap at 140° and 0° of flexion showed significant positive correlation with postoperative function of patellofemoral joint. Intraoperative varus laxity at extension improved postoperative symptoms in 2011 Knee Society Score (2011 KSS); greater postoperative lateral stability at 30 and 90° of flexion with the varus stress test was associated with the better patient expectation in 2011 KSS. Postoperative medial laxity at 90° of flexion with the valgus stress test positively correlated with the patient expectation and satisfaction in 2011 KSS. CONCLUSIONS Surgeons should notice that the postoperative lateral stability and medial laxity at 90° of flexion improved PROM in anatomical BCR TKA.
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Affiliation(s)
- Takao Kaneko
- Department of Orthopedic Surgery, Toho University School of Medicine, Japan.
| | - Yuta Mochizuki
- Department of Orthopedic Surgery, Toho University School of Medicine, Japan
| | - Masaru Hada
- Department of Orthopedic Surgery, Toho University School of Medicine, Japan
| | - Shinya Toyoda
- Department of Orthopedic Surgery, Toho University School of Medicine, Japan
| | - Kazutaka Takada
- Department of Orthopedic Surgery, Toho University School of Medicine, Japan
| | - Hiroyasu Ikegami
- Department of Orthopedic Surgery, Toho University School of Medicine, Japan
| | - Yoshiro Musha
- Department of Orthopedic Surgery, Toho University School of Medicine, Japan
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Kaneko T, Mochizuki Y, Hada M, Toyoda S, Takada K, Ikegami H, Musha Y. Erratum to "Greater postoperative relatively medial loose gap at 90° of flexion for varus knees improves patient-reported outcome measurements in anatomical bi-cruciate retaining total knee arthroplasty" [The Knee 27(5) (2020) 1534-1541]". Knee 2020; 27:1646-1659. [PMID: 33190718 DOI: 10.1016/j.knee.2020.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The purpose of the present study was to measure the intraoperative joint gap using tensor device and pre- and, postoperative joint stability at 0, 30 and 90° of flexion using stress radiography and to identify whether these factors influence patient-reported outcome measurement (PROM) in anatomical bi-cruciate retaining (BCR) knee arthroplasty (TKA). METHODS Fifty-three knees with preoperative varus osteoarthritis of the knee underwent anatomical BCR TKA with oblique 3° angle femorotibial joint line. The intraoperative medial and lateral joint gap using a tensor device and gap difference (lateral minus medial; varus laxity) were also calculated. Postoperative joint stability was measured using stress radiographs. PROM was also evaluated at 1.5 years postoperatively. The effect of intraoperative and postoperative joint stabilities on PROMs were analyzed using Spearman's rank correlation analysis. RESULTS Intraoperative greater difference between medial joint gap at 140° and 0° of flexion showed significant positive correlation with postoperative function of patellofemoral joint. Intraoperative varus laxity at extension improved postoperative symptoms in 2011 Knee Society Score (2011 KSS); greater postoperative lateral stability at 30 and 90° of flexion with the varus stress test was associated with the better patient expectation in 2011 KSS. Postoperative medial laxity at 90° of flexion with the valgus stress test positively correlated with the patient expectation and satisfaction in 2011 KSS. CONCLUSION Surgeons should notice that the postoperative lateral stability and medial laxity at 90° of flexion improved PROM in anatomical BCR TKA.
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Affiliation(s)
- Takao Kaneko
- Department of Orthopedic Surgery, Toho University School of Medicine, Japan.
| | - Yuta Mochizuki
- Department of Orthopedic Surgery, Toho University School of Medicine, Japan
| | - Masaru Hada
- Department of Orthopedic Surgery, Toho University School of Medicine, Japan
| | - Shinya Toyoda
- Department of Orthopedic Surgery, Toho University School of Medicine, Japan
| | - Kazutaka Takada
- Department of Orthopedic Surgery, Toho University School of Medicine, Japan
| | - Hiroyasu Ikegami
- Department of Orthopedic Surgery, Toho University School of Medicine, Japan
| | - Yoshiro Musha
- Department of Orthopedic Surgery, Toho University School of Medicine, Japan
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Ishii Y, Noguchi H, Sato J, Ishii H, Ishii R, Toyabe SI. Predictive factors for longer operative times in patients with medial knee osteoarthritis undergoing total knee arthroplasty. J Orthop 2020; 20:181-185. [PMID: 32025145 PMCID: PMC6995888 DOI: 10.1016/j.jor.2020.01.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 01/24/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Prolonged operative time has frequently been implicated as a risk factor for various complications after total knee arthroplasty (TKA). We aimed to determine whether preoperative factors such as sex, age, body mass index (BMI), prosthetic design, tibiofemoral angle (TFA), range of motion, coronal laxity, Hospital for Special Surgery score and periarticular bone mineral density (BMD) affect operative time. METHODS We evaluated 164 patients (187 knees) with medial osteoarthritis who underwent primary TKA performed by a single surgeon. The medical records of 27 males and 137 females (median age of 77 and 72 years, respectively) were retrospectively reviewed. TFA was measured on non-weightbearing, standard radiographs. We used dual-energy X-ray absorptiometry to measure BMD, and an arthrometer to evaluate total coronal laxity in each patient. RESULTS According to univariate analyses, there was a weak positive correlation between BMI and operative time (r = 0.265, p < 0.001), between TFA and operative time (r = 0.235, p = 0.001) and between BMD of the femur and tibia and operative time (r = 0.280, p < 0.001, r = 0.286, p < 0.001, respectively). No significant correlations were found between the other factors and operative time. Based on multivariate analyses, only BMD of the tibia and TFA were significantly correlated with operative time (β = 0.418, p < 0.001 and β = 0.182, p = 0.007, respectively). CONCLUSIONS TFA and BMD of the tibia were the variables more strongly correlated with operative time. Surgeons should recognize preoperatively that patients who have increased TFA, higher periarticular BMD, and higher BMI may have longer operative times. LEVEL OF EVIDENCE Level IV retrospective study.
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Affiliation(s)
- Yoshinori Ishii
- Ishii Orthopaedic & Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama, 361-0037, Japan
| | - Hideo Noguchi
- Ishii Orthopaedic & Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama, 361-0037, Japan
| | - Junko Sato
- Ishii Orthopaedic & Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama, 361-0037, Japan
| | - Hana Ishii
- Kanazawa Medical University, School of Plastic Surgery, 1-1 Daigaku Uchinada, Ishikawa, 920-0253, Japan
| | - Ryo Ishii
- Sado General Hospital, 161 Chikusa Sado, Niigata, 952-1209, Japan
| | - Shin-ichi Toyabe
- Niigata University Crisis Management Office, Niigata University Hospital, Niigata University Graduate School of Medical and Dental Sciences, 1 Asahimachi Dori Niigata, Niigata, 951-8520, Japan
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Ishii Y, Noguchi H, Sato J, Ishii H, Ishii R, Todoroki K, Ezawa N, Toyabe SI. Size of Medial Knee Osteophytes Correlates With Knee Alignment But Not With Coronal Laxity in Patients With Medial Knee Osteoarthritis. J Orthop Res 2020; 38:639-644. [PMID: 31709593 DOI: 10.1002/jor.24501] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 10/25/2019] [Indexed: 02/04/2023]
Abstract
The severity of osteoarthritis (OA) has been related to osteophyte size. However, the effects on osteophyte size of repeated and increased loading associated with joint laxity and varus misalignment remain unclear. We investigated these relationships in patients with medial knee OA and compared the performances of computed tomography (CT) and radiography for assessing osteophyte parameters. We examined knee joint alignment on radiographs and knee laxity using arthrometry in 191 patients with medial knee OA who were undergoing total knee arthroplasty. We also measured femur and tibia osteophyte distance (largest perpendicular distance from the cortical line to outer margin of the osteophyte) using radiography and CT, osteophyte areas (largest area surrounded by the outer margin of an osteophyte) by CT and determined the locations of the osteophytes in the femur and tibia by CT. We then analyzed the correlations between the variables using Spearman's rank correlation tests. Osteophyte sizes in the femur and tibia as determined by radiography (distance) or CT (distance and area) were positively correlated with the degree of varus alignment but not with medial or lateral laxity. There was also a significant correlation between maximum osteophyte distances measured by radiography and CT. The greatest number and the largest osteophytes were located in the posterior third of the femur and middle third of the tibia, respectively. Osteophyte size was correlated with preoperative knee alignment but not with knee laxity in patients with medial knee OA. Osteophyte size can be evaluated using conventional radiography, without the need for CT. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:639-644, 2020.
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Affiliation(s)
- Yoshinori Ishii
- Ishii Orthopaedic & Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama, 361-0037, Japan
| | - Hideo Noguchi
- Ishii Orthopaedic & Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama, 361-0037, Japan
| | - Junko Sato
- Ishii Orthopaedic & Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama, 361-0037, Japan
| | - Hana Ishii
- School of Plastic Surgery, Kanazawa Medical University, 1-1 Daigaku Uchinada, Ishikawa, 920-0253, Japan
| | - Ryo Ishii
- Sado General Hospital, 161 Chikusa Sado, Niigata, 952-1209, Japan
| | - Koji Todoroki
- Ishii Orthopaedic & Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama, 361-0037, Japan
| | - Nobukazu Ezawa
- Ishii Orthopaedic & Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama, 361-0037, Japan
| | - Shin-Ichi Toyabe
- Niigata University Crisis Management Office, Niigata University Hospital, Niigata University Graduate School of Medical and Dental Sciences, 1 Asahimachi Dori Niigata, Niigata, 951-8520, Japan
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Mediolateral coronal laxity does not correlate with knee range of motion after total knee arthroplasty. Arch Orthop Trauma Surg 2019; 139:851-858. [PMID: 30859302 DOI: 10.1007/s00402-019-03161-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION It remains controversial whether coronal laxity after total knee arthroplasty (TKA) is a critical factor in determining clinical outcomes such as knee range of motion (ROM). The purpose of this study was to evaluate the correlation between postoperative ROM and coronal laxity, which was defined as the angular motion from the neutral, unloaded position to the loaded position, in patients with medial knee osteoarthritis undergoing TKA. MATERIALS AND METHODS Preoperative and 1-year postoperative coronal laxity were assessed using radiographs by applying a force of 150 N with an arthrometer. A consecutive series of 204 knees was examined. A knee was defined as clinically "balanced" when the difference between medial and lateral laxity was 3° or less. Active ROM was measured using a goniometer. Values were expressed as median values. RESULTS The ROM was 105° preoperatively and 110° postoperatively, with the correlation being weak (r = 0.372, p < 0.001) between the periods. The total laxity also revealed a weak correlation (r = 0.270, p < 0.001) between the periods. Preoperative laxity was significantly larger (4° vs. 3°) on the medial side (p < 0.001) and postoperative laxity was larger (4° vs. 3°) laterally (p = 0.001). There was no significant correlation between postoperative ROM and laxity pre- and postoperatively. Additionally, there were no differences in ROM between the balanced and unbalanced groups in the pre- and postoperative periods. CONCLUSIONS This study indicated that mediolateral coronal laxity in patients with an osteoarthritic knee did not correlate with knee ROM after TKA when 3°-4° of laxity in the medial and lateral orientations was maintained.
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