Skip to main content
Top
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 11/2017

Open Access 01-11-2017 | Knee

The impact of generalized joint laxity on clinical outcomes of total knee arthroplasty

Authors: Sae Kwang Kwon, Hyuck Min Kwon, Youngho Kong, Kwan Kyu Park

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 11/2017

Login to get access

Abstract

Purpose

The aim of this study was to investigate whether the severity of generalized joint laxity influences preoperative and postoperative clinical outcomes and if patients with severe generalized joint laxity would require a thicker polyethylene (PE) liner during total knee arthroplasty (TKA).

Methods

A total of 338 female patients undergoing TKA were divided into two groups according to generalized joint laxity. Preoperative and postoperative (at 3 years) patellofemoral scale, AKS, WOMAC, ROM, and satisfaction VAS were compared between the two groups. Additionally, PE liner thickness was compared.

Results

Preoperatively, flexion contracture and WOMAC stiffness scores in the severe laxity group were significantly lower than those in the no to moderate laxity group (p < 0.001 for both). There was no significant difference in postoperative clinical outcomes of patellofemoral scale, AKS, WOMAC, or ROM or in satisfaction VAS between the two groups. There was a significant difference in PE liner thickness between the two groups (10.3 ± 1.3 versus 11.4 ± 1.2, p = 0.043).

Conclusions

There was no significant difference of clinical outcomes between the patients with and without severe generalized joint laxity after 3 years of follow-up after TKA, even though preoperative clinical outcomes indicated that the patients with severe generalized joint laxity showed significantly smaller flexion contraction and better WOMAC stiffness score. Since patients with generalized joint laxity require a thicker PE liner, care should be taken to avoid cutting too much bone from patients with severe generalized joint laxity.

Level of evidence

Retrospective comparative study, Level III.
Literature
1.
go back to reference al-Rawi Z, Nessan AH (1997) Joint hypermobility in patients with chondromalacia patellae. Br J Rheumatol 36(12):1324–1327CrossRefPubMed al-Rawi Z, Nessan AH (1997) Joint hypermobility in patients with chondromalacia patellae. Br J Rheumatol 36(12):1324–1327CrossRefPubMed
2.
go back to reference Beighton P, Horan F (1969) Orthopaedic aspects of the Ehlers–Danlos syndrome. J Bone Joint Surg Br 51(3):444–453PubMed Beighton P, Horan F (1969) Orthopaedic aspects of the Ehlers–Danlos syndrome. J Bone Joint Surg Br 51(3):444–453PubMed
3.
go back to reference Bellamy N, Buchanan WW (1986) A preliminary evaluation of the dimensionality and clinical importance of pain and disability in osteoarthritis of the hip and knee. Clin Rheumatol 5(2):231–241CrossRefPubMed Bellamy N, Buchanan WW (1986) A preliminary evaluation of the dimensionality and clinical importance of pain and disability in osteoarthritis of the hip and knee. Clin Rheumatol 5(2):231–241CrossRefPubMed
4.
go back to reference Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW (1988) Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 15(12):1833–1840PubMed Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW (1988) Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 15(12):1833–1840PubMed
5.
go back to reference Conrozier T, Favret H, Mathieu P, Piperno M, Provvedini D, Taccoen A, Colson F, Conrozier S, Vignon E (2004) Influence of the quality of tibial plateau alignment on the reproducibility of computer joint space measurement from Lyon schuss radiographic views of the knee in patients with knee osteoarthritis. Osteoarthritis Cartilage 12(10):765–770CrossRefPubMed Conrozier T, Favret H, Mathieu P, Piperno M, Provvedini D, Taccoen A, Colson F, Conrozier S, Vignon E (2004) Influence of the quality of tibial plateau alignment on the reproducibility of computer joint space measurement from Lyon schuss radiographic views of the knee in patients with knee osteoarthritis. Osteoarthritis Cartilage 12(10):765–770CrossRefPubMed
6.
go back to reference Dixit S, DiFiori JP, Burton M, Mines B (2007) Management of patellofemoral pain syndrome. Am Fam Physician 75(2):194–202PubMed Dixit S, DiFiori JP, Burton M, Mines B (2007) Management of patellofemoral pain syndrome. Am Fam Physician 75(2):194–202PubMed
7.
go back to reference Eriksson K, Sadr-Azodi O, Singh C, Osti L, Bartlett J (2010) Stress radiography for osteoarthritis of the knee: a new technique. Knee Surg Sports Traumatol Arthrosc 18(10):1356–1359CrossRefPubMed Eriksson K, Sadr-Azodi O, Singh C, Osti L, Bartlett J (2010) Stress radiography for osteoarthritis of the knee: a new technique. Knee Surg Sports Traumatol Arthrosc 18(10):1356–1359CrossRefPubMed
8.
go back to reference Fishkin Z, Miller D, Ritter C, Ziv I (2002) Changes in human knee ligament stiffness secondary to osteoarthritis. J Orthop Res 20(2):204–207CrossRefPubMed Fishkin Z, Miller D, Ritter C, Ziv I (2002) Changes in human knee ligament stiffness secondary to osteoarthritis. J Orthop Res 20(2):204–207CrossRefPubMed
9.
go back to reference Gibson PH, Goodfellow JW (1986) Stress radiography in degenerative arthritis of the knee. J Bone Joint Surg Br 68(4):608–609PubMed Gibson PH, Goodfellow JW (1986) Stress radiography in degenerative arthritis of the knee. J Bone Joint Surg Br 68(4):608–609PubMed
10.
go back to reference Halabchi F, Mazaheri R, Seif-Barghi T (2013) Patellofemoral pain syndrome and modifiable intrinsic risk factors; how to assess and address? Asian J. Sports Med 4(2):85–100 Halabchi F, Mazaheri R, Seif-Barghi T (2013) Patellofemoral pain syndrome and modifiable intrinsic risk factors; how to assess and address? Asian J. Sports Med 4(2):85–100
11.
go back to reference Hochberg MC, Altman RD, Brandt KD, Moskowitz RW (1997) Design and conduct of clinical trials in osteoarthritis: preliminary recommendations from a task force of the Osteoarthritis Research Society. J Rheumatol 24(4):792–794PubMed Hochberg MC, Altman RD, Brandt KD, Moskowitz RW (1997) Design and conduct of clinical trials in osteoarthritis: preliminary recommendations from a task force of the Osteoarthritis Research Society. J Rheumatol 24(4):792–794PubMed
12.
go back to reference Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 248:13–14 Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 248:13–14
13.
go back to reference Ishii Y, Noguchi H, Matsuda Y, Kiga H, Takeda M, Toyabe S (2009) Preoperative laxity in osteoarthritis patients undergoing total knee arthroplasty. Int Orthop 33(1):105–109CrossRefPubMed Ishii Y, Noguchi H, Matsuda Y, Kiga H, Takeda M, Toyabe S (2009) Preoperative laxity in osteoarthritis patients undergoing total knee arthroplasty. Int Orthop 33(1):105–109CrossRefPubMed
14.
go back to reference 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(6):967–971CrossRefPubMed 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(6):967–971CrossRefPubMed
15.
go back to reference Kanamiya T, Whiteside LA, Nakamura T, Mihalko WM, Steiger J, Naito M (2002) Ranawat Award paper. Effect of selective lateral ligament release on stability in knee arthroplasty. Clin Orthop Relat Res 404:24–31CrossRef Kanamiya T, Whiteside LA, Nakamura T, Mihalko WM, Steiger J, Naito M (2002) Ranawat Award paper. Effect of selective lateral ligament release on stability in knee arthroplasty. Clin Orthop Relat Res 404:24–31CrossRef
16.
go back to reference Khatri D, Malhotra R, Bhan S, Kumar V, Eachempati KK (2009) Comparison of total knee arthroplasty in stiff knees and knees with good preoperative range of motion. J Knee Surg 22(4):305–309CrossRefPubMed Khatri D, Malhotra R, Bhan S, Kumar V, Eachempati KK (2009) Comparison of total knee arthroplasty in stiff knees and knees with good preoperative range of motion. J Knee Surg 22(4):305–309CrossRefPubMed
17.
go back to reference Kim SJ, Chang JH, Oh KS (2009) Posterior cruciate ligament reconstruction in patients with generalized joint laxity. Clin Orthop Relat Res 467(1):260–266CrossRefPubMed Kim SJ, Chang JH, Oh KS (2009) Posterior cruciate ligament reconstruction in patients with generalized joint laxity. Clin Orthop Relat Res 467(1):260–266CrossRefPubMed
18.
go back to reference Kim SJ, Kim TE, Lee DH, Oh KS (2008) Anterior cruciate ligament reconstruction in patients who have excessive joint laxity. J Bone Joint Surg Am 90(4):735–741CrossRefPubMed Kim SJ, Kim TE, Lee DH, Oh KS (2008) Anterior cruciate ligament reconstruction in patients who have excessive joint laxity. J Bone Joint Surg Am 90(4):735–741CrossRefPubMed
19.
20.
go back to reference Kim SJ, Moon HK, Kim SG, Chun YM, Oh KS (2010) Does severity or specific joint laxity influence clinical outcomes of anterior cruciate ligament reconstruction? Clin Orthop Relat Res 468(4):1136–1141CrossRefPubMed Kim SJ, Moon HK, Kim SG, Chun YM, Oh KS (2010) Does severity or specific joint laxity influence clinical outcomes of anterior cruciate ligament reconstruction? Clin Orthop Relat Res 468(4):1136–1141CrossRefPubMed
21.
go back to reference Kujala UM, Jaakkola LH, Koskinen SK, Taimela S, Hurme M, Nelimarkka O (1993) Scoring of patellofemoral disorders. Arthroscopy 9(2):159–163CrossRefPubMed Kujala UM, Jaakkola LH, Koskinen SK, Taimela S, Hurme M, Nelimarkka O (1993) Scoring of patellofemoral disorders. Arthroscopy 9(2):159–163CrossRefPubMed
22.
go back to reference Nakahara H, Okazaki K, Hamai S, Okamoto S, Kuwashima U, Higaki H, Iwamoto Y (2015) Does knee stability in the coronal plane in extension affect function and outcome after total knee arthroplasty? Knee Surg Sports Traumatol Arthrosc 23(6):1693–1698CrossRefPubMed Nakahara H, Okazaki K, Hamai S, Okamoto S, Kuwashima U, Higaki H, Iwamoto Y (2015) Does knee stability in the coronal plane in extension affect function and outcome after total knee arthroplasty? Knee Surg Sports Traumatol Arthrosc 23(6):1693–1698CrossRefPubMed
23.
go back to reference Palmer SH, Servant CT, Maguire J, Machan S, Parish EN, Cross MJ (2004) Surgical reconstruction of severe patellofemoral maltracking. Clin Orthop Relat Res 419:144–148CrossRef Palmer SH, Servant CT, Maguire J, Machan S, Parish EN, Cross MJ (2004) Surgical reconstruction of severe patellofemoral maltracking. Clin Orthop Relat Res 419:144–148CrossRef
24.
go back to reference Quatman CE, Ford KR, Myer GD, Paterno MV, Hewett TE (2008) The effects of gender and pubertal status on generalized joint laxity in young athletes. J Sci Med Sport 11(3):257–263CrossRefPubMed Quatman CE, Ford KR, Myer GD, Paterno MV, Hewett TE (2008) The effects of gender and pubertal status on generalized joint laxity in young athletes. J Sci Med Sport 11(3):257–263CrossRefPubMed
25.
go back to reference Seo JG, Lee BH, Moon YW, Chang MJ (2014) Soft tissue laxity should be considered to achieve a constant polyethylene thickness during total knee arthroplasty. Arch Orthop Trauma Surg 134(9):1317–1323CrossRefPubMed Seo JG, Lee BH, Moon YW, Chang MJ (2014) Soft tissue laxity should be considered to achieve a constant polyethylene thickness during total knee arthroplasty. Arch Orthop Trauma Surg 134(9):1317–1323CrossRefPubMed
26.
go back to reference Seo JG, Moon YW, Kim SM, Park SH (2015) How to minimize rotational conflict between femoral & tibial component in total knee arthroplasty: the use of femoro-tibial axial synchronizer (Linker). Yonsei Med J 56(2):454–459CrossRefPubMedPubMedCentral Seo JG, Moon YW, Kim SM, Park SH (2015) How to minimize rotational conflict between femoral & tibial component in total knee arthroplasty: the use of femoro-tibial axial synchronizer (Linker). Yonsei Med J 56(2):454–459CrossRefPubMedPubMedCentral
27.
go back to reference Whiteside LA (1999) Selective ligament release in total knee arthroplasty of the knee in valgus. Clin Orthop Relat Res 367:130–140CrossRef Whiteside LA (1999) Selective ligament release in total knee arthroplasty of the knee in valgus. Clin Orthop Relat Res 367:130–140CrossRef
28.
go back to reference Whiteside LA, Saeki K, Mihalko WM (2000) Functional medical ligament balancing in total knee arthroplasty. Clin Orthop Relat Res 380:45–57CrossRef Whiteside LA, Saeki K, Mihalko WM (2000) Functional medical ligament balancing in total knee arthroplasty. Clin Orthop Relat Res 380:45–57CrossRef
29.
go back to reference Witvrouw E, Lysens R, Bellemans J, Cambier D, Vanderstraeten G (2000) Intrinsic risk factors for the development of anterior knee pain in an athletic population. A two-year prospective study. Am J Sports Med 28(4):480–489CrossRefPubMed Witvrouw E, Lysens R, Bellemans J, Cambier D, Vanderstraeten G (2000) Intrinsic risk factors for the development of anterior knee pain in an athletic population. A two-year prospective study. Am J Sports Med 28(4):480–489CrossRefPubMed
30.
go back to reference Yagishita K, Muneta T, Ikeda H (2003) Step-by-step measurements of soft tissue balancing during total knee arthroplasty for patients with varus knees. J Arthroplasty 18(3):313–320CrossRefPubMed Yagishita K, Muneta T, Ikeda H (2003) Step-by-step measurements of soft tissue balancing during total knee arthroplasty for patients with varus knees. J Arthroplasty 18(3):313–320CrossRefPubMed
Metadata
Title
The impact of generalized joint laxity on clinical outcomes of total knee arthroplasty
Authors
Sae Kwang Kwon
Hyuck Min Kwon
Youngho Kong
Kwan Kyu Park
Publication date
01-11-2017
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 11/2017
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-017-4486-x

Other articles of this Issue 11/2017

Knee Surgery, Sports Traumatology, Arthroscopy 11/2017 Go to the issue