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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 8/2016

01-08-2016 | Knee

Assessing coronal laxity in extension and flexion at a minimum of 10 years after primary total knee arthroplasty

Authors: Yasushi Yoshihara, Yuji Arai, Shuji Nakagawa, Hiroaki Inoue, Keiichiro Ueshima, Hiroyoshi Fujiwara, Ryo Oda, Daigo Taniguchi, Toshikazu Kubo

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 8/2016

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Abstract

Purpose

Favourable long-term results after total knee arthroplasty (TKA) require appropriate soft tissue balance. However, the relationships between long-term results after TKA surgery and mediolateral laxities at extension and at 90° flexion remain unknown. This study therefore quantitatively assessed ligament balance at extension and at 90° knee flexion at least 10 years after primary TKA, as well as clarifying the relationships between long-term outcomes and mediolateral laxities.

Methods

This study included 49 knees (19 CR type and 30 PS type) of 33 patients followed up for at least 10 years after TKA at our hospital. Plain radiographs were obtained with about 150 N of varus or valgus stress using a Telos arthrometer at extension. At 90° flexion, epicondylar views were obtained under a 1.5-kg load and with about 10 kg of varus or valgus stress.

Results

Lateral laxity of about 5° was observed in both extension and flexion, with total laxities of varus and valgus stress each less than 10°. Postoperative clinical outcomes were good, with significant improvements in extension angle, femorotibial angle, and KSS, and no loosening in any knee.

Conclusions

Good long-term results of TKA can be obtained with a lateral laxity of about 5°, equivalent to that of healthy knees.

Level of evidence

III.
Literature
1.
Freeman MAR (1997) Soft tissues: a question of balance. Orthopedics 20:827–831PubMed
2.
Griffin FM, Insall JN, Scuderi GR (2000) Accuracy of soft tissue balancing in total knee arthroplasty. J Arthroplasty 15:970–973CrossRefPubMed
3.
Insall JN (1993) Surgery of the knee, vol 26, 2nd edn. Churchill Livingstone, New York, pp 739–804
4.
Ishi Y, Matsuda Y, Ishii R, Sakata S, Omori G (2003) Coronal laxity in extension in vivo after total knee arthroplasty. J Orthop Sci 8:538–542CrossRef
5.
Kanekasu K, Kondo M, Kadoya Y (2005) Axial radiography of the distal femur to assess rotational alignment in total knee arthroplasty. Clin Orthop Relat Res 434:193–197CrossRefPubMed
6.
Lewis P, Rorabeck CH, Bourne RB, Devane P (1994) Posteromedial tibial polyethylene failure in total knee replacements. Clin Orthop Relat Res 299:11–17PubMed
7.
Matsuda Y, Ishii Y, Noguchi H, Ishii R (2005) Varus–valgus balance and range of movement after total knee arthroplasty. J Bone Joint Surg 87-B:804–808CrossRef
8.
Matsumoto T, Muratsu H, Kawakami Y, Takayama K, Ishida K, Matsushita T, Akisue T, Nishida K, Kuroda R, Kurosaka M (2014) Soft-tissue balancing in total knee arthroplasty: cruciate-retaining versus posterior-stabilised, and measured-resection versus gap technique. Int Orthop 38:531–537CrossRefPubMed
9.
Matsumoto T, Muratsu H, Tsumura N, Mizuno K, Kurosaka M, Kuroda R (2009) Soft tissue balance measurement in posterior-stabilized total knee arthroplasty with a navigation system. J Arthroplasty 24:358–364CrossRefPubMed
10.
Moro-oka TA, Shiraishi H, Iwamoto Y, Banks SA (2010) Modified gap-balancing technique in total knee arthroplasty: evaluation of the post-operative coronal laxity. Knee Surg Sports Traumatol Arthrosc 18:375–380CrossRefPubMed
11.
Mullaji AB, Shetty GM (2013) Surgical technique: computer-assisted sliding medial condylar osteotomy to achieve gap balance in varus knees during TKA. Clin Orthop Relat Res 471:1484–1491CrossRefPubMedPubMedCentral
12.
Okamoto S, Okazaki K, Mitsuyasu H, Matsuda S, Mizu-uchi H, Hamai S, Tashiro Y, Iwamoto Y (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 22:3174–3180CrossRefPubMed
13.
Okazaki K, Miura H, Matsuda S, Takeuchi N, Mawatari T, Hashizume M, Iwamoto Y (2006) Asymmetry of mediolateral laxity of the normal knee. J Orthop Sci 11:264–266CrossRefPubMed
14.
Romero J, Stähelin T, Binkert C, Pfirrmann C, Hodler J, Kessler O (2007) The clinical consequences of flexion gap asymmetry in total knee arthroplasty. J Arthroplasty 22:235–240CrossRefPubMed
15.
Saeki K, Mihalko WM, Patel V, Conway J, Naito M, Thrum H, Vandenneuker H, Whiteside LA (2001) Stability after medial collateral ligament release in total knee arthroplasty. Clin Orthop Relat Res 392:184–189CrossRefPubMed
16.
Sekiya H, Takatoku K, Takada H, Sasanuma H, Sugimoto N (2009) Postoperative lateral ligamentous laxity diminishes with time after TKA in the varus knee. Clin Orthop Relat Res 467:1582–1586CrossRefPubMed
17.
Takeda M, Ishii Y, Noguchi H, Matsuda Y, Sato J (2012) Changes in varus–valgus laxity after total knee arthroplasty over time. Knee Surg Sports Traumatol Arthosc 20:1988–1993CrossRef
18.
Tokuhara Y, Kadoya Y, Kanekasu K, Kondo M, Kobayashi A, Takaoka K (2006) Evaluation of the flexion gap by axial radiography of the distal femur. J Bone Joint Surg 88-B:1327–1330CrossRef
19.
Tokuhara Y, Kadoya Y, Nakagawa S, Kobayashi A, Takaoka K (2004) The flexion gap in normal knees. An MRI study. J Bone Joint Surg 86-B:1133–1136CrossRef
20.
Wasielewski RC, Galante JO, Leighty RM, Natarajan RN, Rosenberg AG (1994) Wear patterns on retrieved polyethylene tibial inserts and their relationship to technical considerations during total knee arthroplasty. Clin Orthop Relat Res 299:31–43PubMed
21.
Yagishita K, Muneta T, Yamamoto H, Shinomiya K (2001) The relationship between postoperative ligament balance and preoperative varus deformity in total knee arthroplasty. Bull Hosp Jt Dis 60:23–28PubMed
Metadata
Title
Assessing coronal laxity in extension and flexion at a minimum of 10 years after primary total knee arthroplasty
Authors
Yasushi Yoshihara
Yuji Arai
Shuji Nakagawa
Hiroaki Inoue
Keiichiro Ueshima
Hiroyoshi Fujiwara
Ryo Oda
Daigo Taniguchi
Toshikazu Kubo
Publication date
01-08-2016
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 8/2016
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-015-3601-0

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