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Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

09-09-2022 | KNEE

Dynamic gap analysis of valgus knees shows large inter-individual variability of gaps

Authors: Kim Eller, Wolfgang Scior, Heiko Graichen

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 4/2023

Abstract

Purpose

The purpose of this study was to investigate the dynamic gap widths of valgus knees in extension and flexion to evaluate the influence of deformity on gap differences and to find out whether different ligamentous subtypes in valgus knees exist.

Methods

Dynamic gap widths of 1000 consecutive total knee arthroplasty (TKA) patients were measured at different flexion angles by applying a computer-assisted surgery (CAS) technique. 198 knees showed a valgus deformity and were assessed regarding its degree of fulfillment of the following criteria of valgus knee: 1. Medial extension gap greater than lateral; 2. Medial flexion gap greater than lateral; 3. Flexion gap greater than extension gap. A single-factor ANOVA subgroup analysis was performed, based on the amount of deformity. The effect of other patient factors (age, gender, weight) on gap differences was investigated.

Results

The medial extension gap (3.7 ± 2.2 mm) was significantly (p < 0.01) larger than the lateral extension gap (1.1 ± 2.9 mm). The amount of deformity correlated highly with gap difference in extension (r² = 0.67) but not in flexion. In 92.4% (183), the flexion gap (6.2 ± 3.1 mm) was significantly (p < 0.01) larger than the extension gap (2.4 ± 2.3 mm). Only 29.3% (58) of patients met all three criteria, this was mainly due to the fact that in flexion the medial gap was larger than the lateral in only 35.4% (70). Patient factors showed no significant influences (NS) on the gap widths.

Conclusion

Valgus knees show large variability in terms of gap widths. The extent of deformity correlates highly with gap difference in extension, but not in other flexion angles. Vast majority of valgus knees were valgus in extension only. Because of this variability, it should be aimed for an individualized balancing technique based on intraoperative gap sizes.

Level of Evidence

Level III.

Ranawat AS, Ranawat CS, Elkus M, Rasquinha VJ, Rossi R, Babhulkar S (2005) Total knee arthroplasty for severe valgus deformity. J Bone Joint Surg Am 87(1):271–284CrossRefPubMed

Rossi R, Rosso F, Cottino U, Dettoni F, Bonasia DE, Bruzzone M (2014) Total knee arthroplasty in the valgus knee. Int Orthop 38(2):273–283CrossRefPubMed

Lange J, Haas SB (2017) Correcting severe valgus deformity: taking out the knock. Bone Joint J 99(1):60–64CrossRefPubMed

Lombardi AV Jr, Dodds KL, Berend KR, Mallory TH, Adams JB (2004) An algorithmic approach to total knee arthroplasty in the valgus knee. J Bone Joint Surg Am 86(2):62–71CrossRefPubMed

McAuliffe MJ, Roe J, Garg G, Whitehouse SL, Crawford R (2017) The varus osteoarthritic knee has no coronal contractures in 90 degrees of flexion. J Knee Surg 30(4):297–303PubMed

Nikolopoulos D, Michos I, Safos G, Safos P (2015) Current surgical strategies for total arthroplasty in valgus knee. World J Orthop 6(6):469–482CrossRefPubMedPubMedCentral

van der List JP, Chawla H, Joskowicz L, Pearle AD (2016) Current state of computer navigation and robotics in unicompartmental and total knee arthroplasty: a systematic review with meta-analysis. Knee Surg Sports Traumatol Arthrosc 24(11):3482–3495CrossRefPubMed

Hirschmann MT, Moser LB, Amsler F, Behrend H, Leclerq V, Hess S (2019) Functional knee phenotypes: a novel classification for phenotyping the coronal lower limb alignment based on the native alignment in young non-osteoarthritic patients. Knee Surg Sports Traumatol Arthrosc 27(5):1394–1402CrossRefPubMed

Deep K, Shankar S, Mahendra A (2017) Computer assisted navigation in total knee and hip arthroplasty. SICOT J 3(50):1–6

10.

Pertusson G, Fentad AM, Gothesen O, Dyrhovden GS, Hallan G, Röhrl SM et al (2018) Computer-assisted compared with conventional total knee replacement. J Bone Joint Surg Am 100(15):1265–1274CrossRef

11.

Graichen H, Lekkreusuwan K, Eller K, Grau T, Hirschmann MT, Scior W (2021) A single type of varus knee does not exist: morphotyping and gap analysis in varus OA. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-021-06688-4CrossRefPubMedPubMedCentral

12.

Hohman DW Jr, Nodzo SR, Phillips M, Fitz W (2015) The implications of mechanical alignment on soft tissue balancing in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 23(12):3632–3636CrossRefPubMed

13.

Springer B, Bechler U, Waldstein W, Rueckl K, Boettner CS, Boettner F (2020) The influence of femoral and tibial bony anatomy on valgus OA of the knee. Knee Surg Sports Traumatol Arthrosc 28(9):2998–3006CrossRefPubMed

14.

McAuliffe MJ, Garg G, Orschulok T, Roe J, Whitehouse SL, Crawford R (2019) Coronal plane laxity of valgus osteoarthritic knee. J Orthop Surg 27(1):2309499019833058. https://doi.org/10.1177/2309499019833058CrossRef

15.

Mehliß V, Strauch Leira M, Serrano Olaizola A, Scior W, Graichen H (2019) Proven accuracy for a new dynamic gap measurement in navigated TKA. Knee Surg Sports Traumatol Arthrosc 27(4):1189–1195CrossRefPubMed

16.

Brilhault J, Burdin P, Canciani JP, Courage O, Hulet C, Letenneur J (2004) Les prothèses totales de genou dans les grandes de ́viations axiales. Ann Orthop Ouest 36:253–288

17.

Matziolis G, Matziolis D, Perka C (2012) Pre-operative frontal plane malalignment predicts the extension gap asymmetry in knee osteoarthritis. Int Orthop 36:79–82CrossRefPubMed

18.

Goltzer O, Mroz TP, Temkit M, Clarke HD, Spangehl MJ (2017) Preoperative radiographic valgus alignment predicts the extent of lateral soft tissue release and need for constraint in valgus total knee arthroplasty. Arthroplasty Today 3(4):303–308CrossRefPubMedPubMedCentral

19.

Xie K, Lyons ST (2017) Soft tissue releases in total knee arthroplasty for valgus deformities. J Arthroplasty 32(6):1814–1818CrossRefPubMed

20.

Bellemans J, Vandenneucker H, Vanlauwe J, Victor J (2010) The influence of coronal plane deformity on mediolateral ligament status: an observational study in varus knees. Knee Surg Sports Traumatol Arthrosc 18:152–156CrossRefPubMed

21.

Roth JD, Howell SM, Hull ML (2015) Native knee laxities at 0°, 45°, and 90° of flexion and their relationship to the goal of the gap-balancing alignment method of total knee arthroplasty. J Bone Joint Surg Am 97:1678–1684CrossRefPubMed

22.

Tokuhara Y, Kadoya Y, Nakagawa S, Kobayashi A, Takaoka K (2004) The flexion gap in normal knees An MRI study. J Bone Joint Surg Br 86(8):1133–1136CrossRefPubMed

Title: Dynamic gap analysis of valgus knees shows large inter-individual variability of gaps
Authors: Kim Eller
Wolfgang Scior
Heiko Graichen
Publication date: 09-09-2022
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 4/2023
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-022-07088-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Dynamic gap analysis of valgus knees shows large inter-individual variability of gaps

Abstract

Purpose

Methods

Results

Conclusion

Level of Evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Level of Evidence

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