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Archives of Orthopaedic and Trauma Surgery

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01-06-2014 | Knee Arthroplasty

Physiologic bone remodeling in medial aspect of proximal tibia after under-release of medial soft tissue during total knee arthroplasty

Authors: Sang-Min Kim, Jai-Gon Seo, Seung-Jae Lim, Sung-Sahn Lee, Young-Wan Moon

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 6/2014

Abstract

Introduction

This study was undertaken to investigate the incidence and to identify predictors of physiologic remodeling in the medial aspect of the proximal tibia in varus knees after total knee arthroplasty (TKA).

Materials and methods

One hundred and sixty-six consecutive patients (221 knees) who underwent navigation-assisted TKA and were followed for a minimum of 2 years were included. Changes in bone radiolucency in the medial aspect of the proximal tibia on the radiographs were investigated at each follow-up. All information on potential factors affecting medial tibial remodeling were retrieved and classified as being patient-, radiography-, or surgery-related.

Results

Radiographic change of bone stock in the medial aspect of the proximal tibia was observed in 18 % of knees (39/221). In all of these cases, this was first detected within 3 months after surgery. During the initial phase to 3 months after surgery, bone stock radiolucency typically increased, but then gradually decreased and after 1 year postoperatively, radiolucency no longer changes with time. Of the 15 variables analyzed, the difference between medial extension gap after bone cutting and prostheses thickness was found to be significantly associated with occurrence of radiographic change of bone stock.

Conclusion

In some varus knees showing physiologic bone remodeling in the medial aspect of the proximal tibia after TKA, prostheses thickness showed a strong tendency to be larger than the medial extension gap after bone cutting.

Akagi M, Matsusue Y, Mata T, Asada Y, Horiguchi M, Iida H, Nakamura T (1999) Effect of rotational alignment on patellar tracking in total knee arthroplasty. Clin Orthop Relat Res:155–163

Babazadeh S, Stoney JD, Lim K, Choong PF (2009) The relevance of ligament balancing in total knee arthroplasty: how important is it? A systematic review of the literature. Orthop Rev (Pavia) 1:e26CrossRef

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 15:1833–1840PubMed

Bellemans J, D’Hooghe P, Vandenneucker H, Van Damme G, Victor J (2006) Soft tissue balance in total knee arthroplasty: does stress relaxation occur perioperatively? Clin Orthop Relat Res 452:49–52PubMedCrossRef

Bono JV, Roger DJ, Laskin RS, Peterson MG, Paulsen CA (1995) Tibial intramedullary alignment in total knee arthroplasty. Am J Knee Surg 8:7–11 discussion 11–12PubMed

Ewald FC (1989) The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res:9–12

Insall JN (1988) Presidential address to The Knee Society. Choices and compromises in total knee arthroplasty. Clin Orthop Relat Res:43–48

Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res:13–14

Insall JN, Ranawat CS, Aglietti P, Shine J (1976) A comparison of four models of total knee-replacement prostheses. J Bone Joint Surg Am 58:754–765PubMed

10.

Ishii Y, Noguchi H, Matsuda Y, Kiga H, Takeda M, Toyabe S (2009) Preoperative laxity in osteoarthritis patients undergoing total knee arthroplasty. Int Orthop 33:105–109PubMedCentralPubMedCrossRef

11.

Jones ML, Hickman J, Middleton J, Knox J, Volp C (2001) A validated finite element method study of orthodontic tooth movement in the human subject. J Orthod 28:29–38PubMedCrossRef

12.

Luring C, Hufner T, Perlick L, Bathis H, Krettek C, Grifka J (2006) The effectiveness of sequential medial soft tissue release on coronal alignment in total knee arthroplasty: using a computer navigation model. J Arthroplasty 21:428–434PubMedCrossRef

13.

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:264–273

14.

Moon YW, Kim JG, Woo KJ, Lim SJ, Seo JG (2011) Analysis of medial flexion gap after medial release for varus deformity by navigation-guided TKA. Orthopedics 34:355PubMed

15.

Mullaji AB, Padmanabhan V, Jindal G (2005) Total knee arthroplasty for profound varus deformity: technique and radiological results in 173 knees with varus of more than 20 degrees. J Arthroplasty 20:550–561PubMedCrossRef

16.

Pa L (2003) Primary total knees: standard principles and techniques. In: Lotke PA, Lonner JH (eds) Knee arthroplasty. Lippincott Williams and Williams & Wilkins, Philadelphia, pp 49–72

17.

Rees JD, Wilson AM, Wolman RL (2006) Current concepts in the management of tendon disorders. Rheumatology (Oxford) 45:508–521CrossRef

18.

Sambatakakis A, Wilton TJ, Newton G (1991) Radiographic sign of persistent soft-tissue imbalance after knee replacement. J Bone Joint Surg Br 73:751–756PubMed

19.

Sculco TP (1991) Soft tissue balancing in total knee arthroplasty. In: Goldberg VM (ed) Controversies of total knee replacement. Faven Press, New York, pp 167–174

20.

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 467:1582–1586PubMedCentralPubMedCrossRef

21.

Seo JG, Moon YW, Park SH, Shim JW, Kim SM (2012) An alternative method to create extramedullary references in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 20:1339–1348PubMedCrossRef

22.

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 Arthrosc 20:1988–1993PubMedCrossRef

23.

Van Damme G, Defoort K, Ducoulombier Y, Van Glabbeek F, Bellemans J, Victor J (2005) What should the surgeon aim for when performing computer-assisted total knee arthroplasty? J Bone Joint Surg Am 87(Suppl 2):52–58PubMedCrossRef

24.

Victor J, Hoste D (2004) Image-based computer-assisted total knee arthroplasty leads to lower variability in coronal alignment. Clin Orthop Relat Res:131–139

25.

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

26.

Yau WP, Chiu KY, Zuo JL, Tang WM, Ng TP (2008) Computer navigation did not improve alignment in a lower-volume total knee practice. Clin Orthop Relat Res 466:935–945PubMedCentralPubMedCrossRef

Title: Physiologic bone remodeling in medial aspect of proximal tibia after under-release of medial soft tissue during total knee arthroplasty
Authors: Sang-Min Kim
Jai-Gon Seo
Seung-Jae Lim
Sung-Sahn Lee
Young-Wan Moon
Publication date: 01-06-2014
Publisher: Springer Berlin Heidelberg
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 6/2014
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-014-1954-3

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Physiologic bone remodeling in medial aspect of proximal tibia after under-release of medial soft tissue during total knee arthroplasty

Abstract

Introduction

Materials and methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusion

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