Top

Published in:

01-01-2016 | Original Paper

Intra-operative gaps affect outcome and postoperative kinematics in vivo following cruciate-retaining total knee arthroplasty

Authors: Eisaku Fujimoto, Yoshiaki Sasashige, Tetsuya Tomita, Hirofumi Sasaki, Yoriko Touten, Yuusuke Fujiwara, Mitsuo Ochi

Published in: International Orthopaedics | Issue 1/2016

Abstract

Purpose

The following investigation evaluates the effect of intra-operative gaps after posterior cruciate ligament-retaining total knee arthroplasty using two-dimensional/three-dimensional registration and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).

Methods

Patients were divided into two groups according to their 90°-0° component gap changes using a device designed by our laboratory. The wide gap group was defined as more than 3 mm (4.3 ± 0.7 mm), and the narrow gap group was defined as less than 3 mm (1.3 ± 1.3 mm).

Results

Under non-WB (weight bearing) conditions, the wide flexion gap group (N = 10) showed a significant anterior displacement of the medial femoral condyle as compared with the narrow flexion gap group (N = 20). Despite no significant differences observed under WB conditions, both femoral condyle positions during flexion were significantly more posterior than during extension. WOMAC of the tight gap group showed worse scores for two functional items demanding knee flexion (bending to floor and getting on/off toilet).

Conclusion

The large flexion gap could influence the late rollback under non-WB conditions and better WOMAC functional scores in the flexion items. Three to four millimetre laxity at 90°–0° component gaps may be adequate and might be necessary to carry out daily life activities.

Matsumoto T, Muratsu H, Tsumura N, Mizuno K, Kuroda R, Yoshiya S, Kurosaka M (2006) Joint gap kinematics in posterior-stabilized total knee arthroplasty measured by a new tensor with the navigation system. J Biomech Eng 128(6):867–871PubMedCrossRef

Matsumoto T, Kuroda R, Kubo S, Muratsu H, Mizuno K, Kurosaka M (2009) The intra-operative joint gap in cruciate-retaining compared with posterior-stabilised total knee replacement. J Bone Joint Surg (Br) 91(4):475–480CrossRef

Fujimoto E, Sasashige Y, Masuda Y, Hisatome T, Eguchi A, Masuda T, Sawa M, Nagata Y (2013) Significant effect of the posterior tibial slope and medial/lateral ligament balance on knee flexion in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 21(12):2704–2712PubMedCrossRef

Nagai K, Muratsu H, Matsumoto T, Maruo A, Miya H, Kuroda R, Kurosaka M (2013) Influence of intra-operative parameters on postoperative early recovery of active knee flexion in posterior-stabilized total knee arthroplasty. Int Orthop 37(11):2153–2157PubMedPubMedCentralCrossRef

Takayama K, Matsumoto T, Kubo S, Muratsu H, Ishida K, Matsushita T, Kurosaka M, Kuroda R (2012) Influence of intra-operative joint gaps on post-operative flexion angle in posterior cruciate-retaining total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 20(3):532–537PubMedCrossRef

Matsumoto T, Mizuno K, Muratsu H, Tsumura N, Fukase N, Kubo S, Yoshiya S, Kurosaka M, Kuroda R (2007) Influence of intra-operative joint gap on post-operative flexion angle in osteoarthritis patients undergoing posterior-stabilized total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 15(8):1013–1018PubMedCrossRef

Fujimoto E, Sasashige Y, Tomita T, Iwamoto K, Masuda Y, Hisatome T (2013) Significant effect of the posterior tibial slope on the weight-bearing, midflexion in vivo kinematics after cruciate-retaining total knee arthroplasty. J Arthroplasty 29(12):2324–2330PubMedCrossRef

Futai K, Tomita T, Yamazaki T, Tamaki M, Yoshikawa H, Sugamoto K (2011) In vivo kinematics of mobile-bearing total knee arthroplasty during deep knee bending under weight-bearing conditions. Knee Surg Sports Traumatol Arthrosc 19(6):914–920PubMedCrossRef

Horiuchi H, Akizuki S, Tomita T, Sugamoto K, Yamazaki T, Shimizu N (2012) In vivo kinematic analysis of cruciate-retaining total knee arthroplasty during weight-bearing and non-weight-bearing deep knee bending. J Arthroplasty 27(6):1196–1202PubMedCrossRef

10.

Kurita M, Tomita T, Yamazaki T, Fujii M, Futai K, Shimizu N, Yoshikawa H, Sugamoto K (2012) In vivo kinematics of high-flex mobile-bearing total knee arthroplasty, with a new post-cam design, in deep knee bending motion. Int Orthop 36(12):2465–2471PubMedPubMedCentralCrossRef

11.

Shimizu N, Tomita T, Yamazaki T, Yoshikawa H, Sugamoto K (2011) The effect of weight-bearing condition on kinematics of a high-flexion, posterior-stabilized knee prosthesis. J Arthroplasty 26(7):1031–1037PubMedCrossRef

12.

Komistek RD, Mahfouz MR, Bertin KC, Rosenberg A, Kennedy W (2008) In vivo determination of total knee arthroplasty kinematics: a multicenter analysis of an asymmetrical posterior cruciate retaining total knee arthroplasty. J Arthroplasty 23(1):41–50PubMedCrossRef

13.

Zhao Z, Wang W, Wang S, Jiang L, Zhang S, Zhao Y (2015) Femoral rotation influences dynamic alignment of the lower extremity in total knee arthroplasty. Int Orthop 39(1):55–60PubMedCrossRef

14.

Hananouchi T (2015) Sagittal gap balancing with the concept of a single radius femoral component in posterior cruciate sacrificing total knee arthroplasty with patient-specific instrumentation. Int Orthop 39(4):659–665PubMedCrossRef

15.

Keshmiri A, Springorum H, Baier C, Zeman F, Grifka J, Maderbacher G (2015) Is it possible to re-establish pre-operative patellar kinematics using a ligament-balanced technique in total knee arthroplasty? A cadaveric investigation. Int Orthop 39(3):441–448PubMedCrossRef

16.

Yamazaki T, Watanabe T, Nakajima Y, Sugamoto K, Tomita T, Maeda D, Sato Y, Yoshikawa H, Tamura S (2005) Development of three-dimensional kinematic analysis system for artificial knee implants using X-ray fluoroscopic imaging. Nihon Hoshasen Gijutsu Gakkai zasshi 61(1):79–87PubMed

17.

Zuffi S, Leardini A, Catani F, Fantozzi S, Cappello A (1999) A model-based method for the reconstruction of total knee replacement kinematics. IEEE Trans Med Imaging 18(10):981–991PubMedCrossRef

18.

Han HS, Chang CB, Seong SC, Lee S, Lee MC (2008) Evaluation of anatomic references for tibial sagittal alignment in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 16(4):373–377PubMedCrossRef

19.

de Jong RJ, Heesterbeek PJ, Wymenga AB (2010) A new measurement technique for the tibiofemoral contact point in normal knees and knees with TKR. Knee Surg Sports Traumatol Arthrosc 18(3):388–393PubMedCrossRef

20.

Bellamy N (1989) Pain assessment in osteoarthritis: experience with the WOMAC osteoarthritis index. Semin Arthritis Rheum 18(4 Suppl 2):14–17PubMedCrossRef

21.

Matsueda M, Gengerke TR, Murphy M, Lew WD, Gustilo RB (1999) Soft tissue release in total knee arthroplasty. Cadaver study using knees without deformities. Clin Orthop Relat Res 366:264–273PubMedCrossRef

22.

Mihalko WM, Krackow KA (1999) Posterior cruciate ligament effects on the flexion space in total knee arthroplasty. Clin Orthop Relat Res 360:243–250PubMedCrossRef

23.

Dennis DA, Komistek RD, Mahfouz MR (2003) In vivo fluoroscopic analysis of fixed-bearing total knee replacements. Clin Orthop Relat Res 410:114–130PubMedCrossRef

24.

Kitagawa A, Tsumura N, Chin T, Gamada K, Banks SA, Kurosaka M (2010) In vivo comparison of knee kinematics before and after high-flexion posterior cruciate-retaining total knee arthroplasty. J Arthroplasty 25(6):964–969PubMedCrossRef

25.

Yoshiya S, Matsui N, Komistek RD, Dennis DA, Mahfouz M, Kurosaka M (2005) In vivo kinematic comparison of posterior cruciate-retaining and posterior stabilized total knee arthroplasties under passive and weight-bearing conditions. J Arthroplasty 20(6):777–783PubMedCrossRef

26.

Blunn GW, Walker PS, Joshi A, Hardinge K (1991) The dominance of cyclic sliding in producing wear in total knee replacements. Clin Orthop Relat Res 273:253–260PubMed

27.

Swany MR, Scott RD (1993) Posterior polyethylene wear in posterior cruciate ligament-retaining total knee arthroplasty. A case study. J Arthroplasty 8(4):439–446PubMedCrossRef

Title: Intra-operative gaps affect outcome and postoperative kinematics in vivo following cruciate-retaining total knee arthroplasty
Authors: Eisaku Fujimoto
Yoshiaki Sasashige
Tetsuya Tomita
Hirofumi Sasaki
Yoriko Touten
Yuusuke Fujiwara
Mitsuo Ochi
Publication date: 01-01-2016
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 1/2016
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-015-2847-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Intra-operative gaps affect outcome and postoperative kinematics in vivo following cruciate-retaining total knee arthroplasty

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2016

Patients with thoracic trauma and concomitant spinal cord injury have a markedly decreased mortality rate compared to patients without spinal cord injury

Comparative use of the computer-aided angiography and rapid prototyping technology versus conventional imaging in the management of the Tile C pelvic fractures

Early history of scapular fractures

Arthroplasty for unstable pertrochanteric hip fractures may offer a lower re-operation rate as compared to cephalomedullary nailing

Functional joint line obliquity after kinematic total knee arthroplasty

A novel patient-specific navigational template for anatomical reconstruction of the lateral ankle ligaments