Top

Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

01-05-2020 | KNEE

Coronal and sagittal laxity affects clinical outcomes in posterior-stabilized total knee arthroplasty: assessment of well-functioning knees

Authors: Toshifumi Watanabe, Hideyuki Koga, Hiroki Katagiri, Koji Otabe, Yusuke Nakagawa, Takeshi Muneta, Ichiro Sekiya, Tetsuya Jinno

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 5/2020

Abstract

Purpose

Both coronal and sagittal laxity of well-functioning knees after total knee arthroplasty (TKA) was examined, and the correlations between the joint laxity and the clinical outcomes were analyzed to clarify the adequate joint laxity for the prosthesis, and the relationship between the laxity and the outcomes.

Methods

Forty well-functioning TKA knees with a high-flexion posterior-stabilized (PS) prosthesis were studied. All patients were diagnosed as having osteoarthritis with varus deformity and were followed up for 2 years or more. The coronal and sagittal laxity was assessed at extension and flexion, and the correlations between the joint laxity and the clinical outcomes were evaluated.

Results

The varus and valgus laxity averaged 5.6 ± 1.8° and 3.6 ± 1.2° at 10° knee flexion, and 7.4 ± 5.1° and 3.6 ± 2.7° at 80° knee flexion, respectively, and the AP laxity at 30° and 75° knee flexion averaged 8.7 ± 3.6 mm and 6.6 ± 2.3 mm, respectively. Knee flexion angle correlated with the joint laxity, while the other outcomes including patient-reported pain and instability were adversely affected by the greater laxity.

Conclusions

This study exhibited the importance of consistent medial laxity both at extension and flexion, which averaged 3.6°. Care should be taken to maintain the medial stability and to obtain adequate laxity both at extension and flexion during surgery. A few degrees of medial tightness can be allowed to achieve excellent clinical results after TKA for preoperative varus knees.

Level of evidence

Therapeutic study, Level III.

Bourne RB, Chesworth B, Davis A, Mahomed N, Charron K (2010) Comparing patient outcomes after THA and TsKA: is there a difference? Clin Orthop Relat Res 468:542–546CrossRef

Calliess T, Ettinger M, Hulsmann N, Ostermeier S, Windhagen H (2015) Update on the etiology of revision TKA—evident trends in a retrospective survey of 1449 cases. Knee 22:174–179CrossRef

Dejour D, Deschamps G, Garotta L, Dejour H (1999) Laxity in posterior cruciate sparing and posterior stabilized total knee prostheses. Clin Orthop Relat Res 364:182–193CrossRef

Hino K, Kutsuna T, Watamori K, Kiyomatsu H, Ishimaru Y, Takeba J et al (2017) Varus-valgus stability at 90 degrees flexion correlates with the stability at midflexion range more widely than that at 0 degrees extension in posterior-stabilized total knee arthroplasty. Arch Orthop Trauma Surg 137:1429–1434CrossRef

Ishii Y, Noguchi H, Takeda M, Sato J, Sakurai T, Toyabe S (2014) In vivo anteroposterior translation after meniscal-bearing total knee arthroplasty: effects of soft tissue conditions and flexion angle. Eur J Orthop Surg Traumatol 24:967–971CrossRef

Jones DP, Locke C, Pennington J, Theis JC (2006) The effect of sagittal laxity on function after posterior cruciate-retaining total knee replacement. J Arthroplast 21:719–723CrossRef

Kamenaga T, Muratsu H, Kanda Y, Miya H, Kuroda R, Matsumoto T (2018) The influence of postoperative knee stability on patient satisfaction in cruciate-retaining total knee arthroplasty. J Arthroplasty 33:2475–2479CrossRef

Kuster MS, Bitschnau B, Votruba T (2004) Influence of collateral ligament laxity on patient satisfaction after total knee arthroplasty: a comparative bilateral study. Arch Orthop Trauma Surg 124:415–417CrossRef

Matsuda Y, Ishii Y, Noguchi H, Ishii R (2005) Varus-valgus balance and range of movement after total knee arthroplasty. J Bone Jt Surg Br 87:804–808CrossRef

10.

Matsumoto K, Ogawa H, Yoshioka H, Akiyama H (2017) Postoperative anteroposterior laxity influences subjective outcome after total knee arthroplasty. J Arthroplasty 32:1845–1849CrossRef

11.

Nabeyama R, Matsuda S, Miura H, Kawano T, Nagamine R, Mawatari T et al (2003) Changes in anteroposterior stability following total knee arthroplasty. J Orthop Sci 8:526–531CrossRef

12.

Nakahara H, Okazaki K, Hamai S, Okamoto S, Kuwashima U, Higaki H et al (2015) Does knee stability in the coronal plane in extension affect function and outcome after total knee arthroplasty? Knee Surg Sports Traumatol Arthrosc 23:1693–1698CrossRef

13.

Okamoto S, Okazaki K, Mitsuyasu H, Matsuda S, Mizu-Uchi H, Hamai S et al (2014) Extension gap needs more than 1-mm laxity after implantation to avoid post-operative flexion contracture in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 22:3174–3180CrossRef

14.

Okazaki K, Miura H, Matsuda S, Takeuchi N, Mawatari T, Hashizume M et al (2006) Asymmetry of mediolateral laxity of the normal knee. J Orthop Sci 11:264–266CrossRef

15.

Petrie JR, Haidukewych GJ (2016) Instability in total knee arthroplasty: assessment and solutions. Bone Jt J 98-B:116–119CrossRef

16.

Scuderi GR, Deshmane PP (2015) Instability of total knee replacement. In: Hirschmann MT, Becker R (eds) The unhappy total knee replacement. Springer, New York, pp 195–205

17.

Seah RB, Yeo SJ, Chin PL, Yew AK, Chong HC, Lo NN (2014) Evaluation of medial-lateral stability and functional outcome following total knee arthroplasty: results of a single hospital joint registry. J Arthroplasty 29:2276–2279CrossRef

18.

Tsukiyama H, Kuriyama S, Kobayashi M, Nakamura S, Furu M, Ito H et al (2017) Medial rather than lateral knee instability correlates with inferior patient satisfaction and knee function after total knee arthroplasty. Knee 24:1478–1484CrossRef

19.

Watanabe T, Muneta T, Koga H, Horie M, Nakamura T, Otabe K et al (2016) In-vivo kinematics of high-flex posterior-stabilized total knee prosthesis designed for Asian populations. Int Orthop 40:2295–2302CrossRef

20.

Watanabe T, Muneta T, Sekiya I, Banks SA (2013) Intraoperative joint gaps affect postoperative range of motion in TKAs with posterior-stabilized prostheses. Clin Orthop Relat Res 471:1326–1333CrossRef

21.

Watanabe T, Muneta T, Yagishita K, Hara K, Koga H, Sekiya I (2016) Closed suction drainage is not necessary for total knee arthroplasty: a prospective study on simultaneous bilateral surgeries of a mean follow-up of 5.5 years. J Arthroplasty 31:641–645CrossRef

22.

Wautier D, Thienpont E (2017) Changes in anteroposterior stability and proprioception after different types of knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 25:1792–1800CrossRef

23.

Yamakado K, Kitaoka K, Yamada H, Hashiba K, Nakamura R, Tomita K (2003) Influence of stability on range of motion after cruciate-retaining TKA. Arch Orthop Trauma Surg 123:1–4CrossRef

24.

Yoshihara Y, Arai Y, Nakagawa S, Inoue H, Ueshima K, Fujiwara H et al (2015) Assessing coronal laxity in extension and flexion at a minimum of 10 years after primary total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 24:2512–2516CrossRef

Title: Coronal and sagittal laxity affects clinical outcomes in posterior-stabilized total knee arthroplasty: assessment of well-functioning knees
Authors: Toshifumi Watanabe
Hideyuki Koga
Hiroki Katagiri
Koji Otabe
Yusuke Nakagawa
Takeshi Muneta
Ichiro Sekiya
Tetsuya Jinno
Publication date: 01-05-2020
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 5/2020
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-019-05500-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Coronal and sagittal laxity affects clinical outcomes in posterior-stabilized total knee arthroplasty: assessment of well-functioning knees

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

Please log in to get access to this content

Other articles of this Issue 5/2020

Sawing toward the fibular head during open-wedge high tibial osteotomy carries the risk of popliteal artery injury

Classical target coronal alignment in high tibial osteotomy demonstrates validity in terms of knee kinematics and kinetics in a computer model

Patients aged in their 70s do not have a high risk of progressive osteoarthritis following arthroscopic femoroacetabular impingement correction and labral preservation surgery

Uniplane medial opening wedge high tibial osteotomy relative to a biplane osteotomy can reduce the incidence of lateral-hinge fracture

Joint distraction force changes the three-dimensional articulation of the femur and tibia in total knee arthroplasty: a cadaveric study

Ten-year clinical and radiographic results of 1000 cementless Oxford unicompartmental knee replacements