共查询到20条相似文献，搜索用时 31 毫秒
1.
Masanori Tsubosaka Hirotsugu Muratsu Koji Takayama Hidetoshi Miya Ryosuke Kuroda Tomoyuki Matsumoto 《The Journal of arthroplasty》2018,33(3):729-734
Background
Medial stability of the knee is considered to be associated with good clinical results after total knee arthroplasty (TKA). This study aimed to compare intraoperative soft tissue balance between cruciate-retaining (CR) and posterior-stabilized (PS) TKA performed by a newly developed medial preserving gap technique, which aimed at preserving medial stability throughout the range of motion.Methods
Seventy CR-TKAs and 70 PS-TKAs were performed in patients with varus type osteoarthritis with the novel technique guided by tensor measurements. Final intraoperative soft tissue balance with femoral trial component in place and patellofemoral joint reduced, including the joint component gap and varus/valgus ligament balance (varus angle), with the knee at 0° (full extension), 10° (extension), 30°, 45°, 60°, 90° (flexion), 120°, and 135° (deep flexion), was measured with Offset Repo-Tensor under 40 lbs of joint distraction force. The medial compartment gap (MCG), lateral compartment gap, and medial joint looseness (MCG-polyethylene insert thickness) at each flexion angle were calculated from the measured joint component gap and varus ligament balance, and compared between CR-TKA and PS-TKA.Results
The MCGs from extension to deep flexion of the knee showed no significant differences between CR-TKA and PS-TKA. The lateral compartment gaps in PS-TKA from 30° to 60° of knee flexion was significantly larger than those in CR-TKA (P < .05). Medial joint looseness showed no significant differences between CR-TKA and PS-TKA which is consistent within 1 mm from extension to flexion of the knee.Conclusion
PS-TKA similarly achieved medial stability comparable to CR-TKA using the medial preserving gap technique. 相似文献2.
Background
It has been widely accepted in total knee arthroplasty (TKA) that flexion and extension gaps in the disarticulated knee during surgery should be equalized. We hypothesized that tensioning during assessment of the flexion gap can induce temporary widening of the gap due to posterior tibial translation. We aimed to describe posterior tibial translation at flexion gap (90°) assessments and assess the correlation of tibial translation with laxity (flexion space increase) using constrained and non-constrained inserts.Methods
Imageless navigation was used to measure flexion angle, tibial position relative to the femoral axis, and lateral/medial laxity in 30 patients undergoing primary TKA. Trialing was conducted using posteriorly stabilized and cruciate retaining trials of the same size to elucidate the association of posterior tibial translation with changes in joint capsule laxity at 90° knee flexion.Results
All patients demonstrated posterior tibial translation during flexion gap assessment relative to their subsequent final implantation [mean ± standard deviation (range), 11.3 ± 4.4 (4-21) mm]. Positive linear correlation [r = 0.69, 95% confidence interval (CI) 0.44-0.84, P ≤ .001] was demonstrated between translations [8.7 ± 2.4 (3-13) mm] and laxity changes [2.9° ± 2.0° (?0.7° to 7.4°)] at 90° of flexion.Conclusion
Posterior tibial translation can cause artifactual widening of the flexion gap during gap balancing in posteriorly stabilized TKA, which can be of sufficient magnitude to alter femoral component size selection for some patients. Recognition and management of these intra-operative dynamics for optimal kinematics could be feasible with the advent of robotic applications. 相似文献3.
Yukihide Minoda Shigeru Nakagawa Ryo Sugama Tessyu Ikawa Takahiro Noguchi Masashi Hirakawa 《The Journal of arthroplasty》2018,33(3):735-739
Background
Postoperative knee flexion angle is one of the most important outcomes of total knee arthroplasty (TKA). Intraoperative ligament balancing may affect the postoperative range of motion of the knee. However, the relationship between intraoperative ligament balancing and postoperative flexion angle was still controversial. The purpose of this study was to determine whether intraoperative joint gap affects postoperative knee flexion angle or not.Methods
Prospective multicenter study of 246 knees with varus osteoarthritis undergoing a posterior–stabilized, mobile-bearing TKA was performed. The joint gap before implantation and after implantation was measured. The joint gap after implantation was measured using a specially designed tensor device with the same shape of a total knee prosthesis at 0°, 30°, 60°, 90°, 120°, and 145° of flexion with the reduction of the patellofemoral joint. Stepwise multiple regression analysis was conducted to determine the predictors of the flexion angle of the knee after the operation.Results
Predictors were identified in the following 3 categories: (1) preoperative flexion angle, (2) intraoperative flexion angle, and (3) joint gap looseness at 120° of flexion (joint gap after implantation at 120° of flexion ? joint gap after implantation at 0° of flexion) (R = 0.472, P < .01).Conclusion
Flexion angle after TKA was not affected by the flexion joint gap looseness before implantation and the joint gap looseness after implantation from 30° to 90° of flexion. Surgeons should notice that joint gap looseness in mid-flexion range did not increase the postoperative knee flexion angle. 相似文献4.
Man S. Kim In J. Koh Young J. Choi Yong D. Kim Yong In 《The Journal of arthroplasty》2017,32(5):1488-1495
Background
Extensive medial soft tissue release may be necessary to correct severe varus deformity during total knee arthroplasty (TKA). However, this procedure may result in instability. Here, we describe a novel soft tissue balancing technique, which can minimize medial release in severe varus deformity during TKA.Methods
Fifty knees (40 patients) with hip-knee-ankle angle of more than 20° of varus were corrected using this technique (group 1). After achieving flexion gap balancing by needle puncturing and spreading of the superficial medial collateral ligament, extension gap balancing was obtained by gradual extension with the trial components in place. After group 1 was set, a one-to-one patient-matched control group who had mild varus deformity was selected by propensity score matching (50 knees, 48 patients, group 2). At postoperative 1 year, mediolateral laxity was compared between the 2 groups using the stress radiographs. Clinical outcomes were also compared using the Knee Society Score and Western Ontario and McMaster Universities Osteoarthritis Index score.Results
There were no differences in mean medial and lateral laxities between groups 1 and 2 at 1 year after the operation (medial laxity: 2.3° ± 1.4° and 2.7° ± 1.3°, respectively, P = .310) (lateral laxity: 3.6° ± 1.7° and 3.2° ± 2.0°, respectively, P = .459). There were no significant differences in postoperative clinical scores and knee alignment.Conclusion
Our technique of obtaining extension gap balancing using trial components led to safe and effective balancing by avoiding unnecessary extensive release in severe varus deformity during TKA. 相似文献5.
Kanto Nagai Hirotsugu Muratsu Yoshiki Takeoka Masanori Tsubosaka Ryosuke Kuroda Tomoyuki Matsumoto 《The Journal of arthroplasty》2017,32(10):2995-2999
Background
During modified gap-balancing technique, there is no consensus on the best method for obtaining appropriate soft-tissue balance and determining the femoral component rotation.Methods
Sixty-five varus osteoarthritic patients underwent primary posterior-stabilized total knee arthroplasty using modified gap-balancing technique. The influence of joint distraction force on the soft-tissue balance measurement during the modified gap-balancing technique was evaluated with Offset Repo-Tensor between the osteotomized surfaces at extension, and between femoral posterior condyles and tibial osteotomized surface at flexion of the knee before the resection of femoral posterior condyles. The joint center gap (millimeters) and varus ligament balance (°) were measured under 20, 40, and 60 pounds of joint distraction forces, and the differences in these values at extension and flexion (the value at flexion minus the value at extension) were also calculated.Results
The differences in joint center gap (?6.7, ?6.8, and ?6.9 mm for 20, 40, and 60 pounds, respectively) and varus ligament balance (3.5°, 3.8°, and 3.8°) at extension and flexion were not significantly different among different joint distraction forces, although the joint center gap and varus ligament balance significantly increased stepwise at extension and flexion as the joint distraction force increased.Conclusion
The difference in joint center gap and varus ligament balance at extension and flexion were consistent even among the different joint distraction forces. This novel index would be useful for the determination of femoral component rotation during the modified gap-balancing technique. 相似文献6.
Shady S. Elmasry Carl W. Imhauser Timothy M. Wright Andrew D. Pearle Michael B. Cross David J. Mayman Geoffrey H. Westrich Peter K. Sculco 《The Journal of arthroplasty》2019,34(5):981-986.e1
Background
Whether anterior referencing (AR) or posterior referencing (PR) produces a more balanced flexion gap in total knee arthroplasty (TKA) using measured resection remains controversial. Our goal was to compare AR and PR in terms of (1) medial and lateral gaps at full extension and 90° of flexion, and (2) maximum medial and lateral collateral ligament (MCL and LCL) forces in flexion.Methods
Computational models of 6 knees implanted with posterior-stabilized TKA were virtually positioned with both AR and PR techniques. The ligament properties were standardized to achieve a balanced knee at full extension. Medial-lateral gaps were measured in response to varus and valgus loading at full extension and 90° of flexion; MCL and LCL forces were estimated during passive flexion.Results
At full extension, the maximum difference in the medial-lateral gap for both AR and PR was <1 mm in all 6 knee models. However, in flexion, only 3 AR and 3 PR models produced a difference in medial-lateral gap <2 mm. During passive flexion, the maximum MCL force ranged from 2 N to 87 N in AR and from 17 N to 127 N in PR models. The LCL was unloaded at >25° of flexion in all models.Conclusion
In measured resection TKA, neither AR nor PR better balance the ligaments and produce symmetrical gaps in flexion. Alternative bone resection techniques and rotation alignment targets are needed to achieve more predictable knee balance. 相似文献7.
Kyoung-Tak Kang Yong-Gon Koh Juhyun Son Oh-Ryong Kwon Jun-Sang Lee Sae-Kwang Kwon 《The Journal of arthroplasty》2018,33(2):572-579
Background
The reconstructed posterior tibial slope (PTS) plays a significant role in restoring knee kinematics in cruciate-retaining-total knee arthroplasty (TKA). A few studies have reported the effect of the PTS on biomechanics.Methods
This study investigates the effect of the PTS on tibiofemoral (TF) kinematics, patellofemoral (PF) contact stress, and forces at the quadriceps, posterior cruciate ligament (PCL) and collateral ligament after cruciate-retaining-TKA using computer simulations. The simulation for the validated TKA finite element model was performed under deep knee bend condition. All analyses were repeated from ?3° to 15° PTS in increments of 3°.Results
The kinematics on the TF joint translated increasingly posteriorly when the PTS increased. Medial and lateral contact points translated in posterior direction in extension and flexion as PTS increased. The maximum contact stress on the PF joint and quadriceps, and collateral ligament force decreased when the PTS increased. An implantation of the tibial plate with increased PTS reduced the PCL load. Physiologic insert movement led to an increasingly posterior position of the femur and reduced quadriceps force especially for knee flexion angles above high flexion (120°) when compared to TKA with a decreased slope of the tibial base plate.Conclusion
An increase in the PTS increased medial and lateral movements without paradoxical motion. However, an excessive PTS indicated progressive loosening of the TF joint gap due to a reduction in collateral ligament tension during flexion. 相似文献8.
Keizo Wada Daisuke Hamada Shunsuke Tamaki Kosaku Higashino Yoshihiro Fukui Koichi Sairyo 《The Journal of arthroplasty》2017,32(1):270-273
Background
Previous studies suggested that changes in kinematics in total knee arthroplasty (TKA) affected satisfaction level. The aim of this cadaveric study was to evaluate the effect of medial collateral ligament (MCL) release by multiple needle puncture on knee rotational kinematics in posterior-stabilized TKA.Methods
Six fresh, frozen cadaveric knees were included in this study. All TKA procedures were performed with an image-free navigation system using a 10-mm polyethylene insert. Tibial internal rotation was assessed to evaluate intraoperative knee kinematics. Multiple needle puncturing was performed 5, 10, and 15 times for the hard portion of the MCL at 90° knee flexion. Kinematic analysis was performed after every 5 punctures. After performing 15 punctures, a 14-mm polyethylene insert was inserted, and kinematic analysis was performed.Results
The tibial internal rotation angle at maximum knee flexion without multiple needle puncturing was significantly larger (9.42°) than that after 15 punctures (3°). Negative correlation (Pearson r = ?0.715, P < .001) between tibial internal rotation angle at maximum knee flexion and frequency of puncture was observed. The tibial internal rotation angle with a 14-mm insert was significantly larger (7.25°) compared with the angle after 15 punctures.Conclusion
Tibial internal rotation during knee flexion was reduced by extensive MCL release using multiple needle puncturing and was recovered by increasing of medial tightness. From the point of view of knee kinematics, medial tightness should be allowed to maintain the internal rotation angle of the tibia during knee flexion which might lead to patient satisfaction. 相似文献9.
Masanori Tsubosaka Koji Takayama Shinya Oka Hirotsugu Muratsu Ryosuke Kuroda Tomoyuki Matsumoto 《Journal of orthopaedic science》2017,22(6):1071-1076
Purpose
This study aimed to clarify the influence of the posterior condylar offset (PCO) on intraoperative soft tissue balance including the joint component gap and varus ligament balance measured by an offset-type tensor during posterior-stabilized (PS) total knee arthroplasty (TKA).Methods
In this study, 35 patients with osteoarthritis of the knee underwent PS TKA. Intraoperative soft tissue balance including the joint component gap and varus/valgus ligament balance were assessed at 0°, 10°, 45°, 90°, and 135° of flexion with an offset-type tensor that could be used with the femoral component placement and patellofemoral joint reduction. The correlations between the postoperative PCO and the intraoperative soft tissue balance parameters were assessed using simple regression analysis.Results
The joint component gap at 0° extension was inversely correlated with the PCO (R = ?0.41, p < 0.05). The joint component gap of 10°–0° was positively correlated with the PCO (R = 0.35, p < 0.05). No other soft tissue balance parameters were correlated with the PCO.Conclusions
A larger PCO was confirmed to reduce joint component gap in extension but not always in flexion in PS TKA. 相似文献10.
Background
Excellent medium-term to long-term results for function and survivorship have been shown with mobile-bearing (MB) total knee arthroplasty (TKA). One of the key arguments against its use is the risk of “spinout” or dislocation of the MB.The aim of this study is to discuss the etiology, prevention, incidence, management, and outcome of spinout.Methods
Between October 1993 and February 2016, 8373 consecutive primary MB TKAs were performed irrespective of preoperative deformity.Before 2001, soft-tissue knee balancing was achieved by release of collateral ligaments and all spinouts were treated by open reduction. Thereafter, soft-tissue balancing was achieved without ligament release and with the use of a higher conformity MB and all spinouts were reduced closed, giving 2 comparative cohorts.Results
Twenty-six spinouts occurred in 8373 (0.31%) patients. In the first cohort up until May 2001, there were 14 spinouts of 2379 (0.58%) cases. There were 12 in cohort 2, in those patients having surgery after May 2001, thus giving an incidence of 12 of 5994 (0.2%), which was significantly lower than in cohort 1 (P < .01). Spinout was associated with the valgus knee (P < .01) and most (73%) occurred within the first 6 months. There was 1 arthrodesis in cohort 1 and 1 both-component revision in cohort 2.Conclusion
The etiology of spinout is flexion gap instability. It can normally be reduced closed with recurrence being uncommon. Focus on soft-tissue balance necessary with an MB TKA can reduce the incidence of revision for instability as compared to a fixed-bearing TKA. Therefore, the risk of spinout should not be used as an argument against the MB TKA. 相似文献11.
Alejandro Lizaur-Utrilla Daniel Martinez-Mendez Santiago Gonzalez-Parreño Luis Marco-Gomez Francisco A. Miralles Muñoz Fernando A. Lopez-Prats 《The Journal of arthroplasty》2018,33(7):2141-2145
Background
Few studies have analyzed the outcomes of total knee arthroplasty (TKA) in patients with prior anterior cruciate ligament (ACL) reconstruction, and the reported outcomes are controversial. The purpose of this study is to assess if prior ACL reconstruction had any impact on the outcome of subsequent TKA.Methods
A matched case-control study was conducted in patients who underwent TKA, including 37 with prior ACL reconstruction and 37 patients without ACL reconstruction. Preoperative and postoperative clinical and radiological data were collected from a prospective arthroplasty database with a minimum follow-up of 5 years. The mean age was 69.6 years, and 59.4% were men. The Knee Society scores, Short Form-12, and Western Ontario and McMaster Universities questionnaires were used for functional evaluations. Visual analogue scale 0-10 was used for patient satisfaction.Results
The mean follow-up after TKA was 6.1 (range 5-7.3) years. Two patients in the ACL group developed knee stiffness requiring manipulation under anesthesia, while 1 patient in the control group suffered superficial wound infection. At last follow-up, no significant differences in functional or radiologic outcomes were found between both groups. The performance of TKA in ACL patients had increased technical difficulty and significantly longer time of surgery, but this had no influence on the outcomes. In the ACL group, 24 knees had technical difficulty in surgery. The main difficulty in most ACL patients was due to varus deformity and increased retraction of the medial soft structures which required progressive medial release. Other 2 knees had difficult knee exposure. One was an unexpected partial patellar tendon avulsion and the other required planned quadriceps snip.Conclusion
TKA was an effective procedure for patients with prior ACL reconstruction. The surgeon should be warned of the possible difficulties in the knee exposure and possible need of medial release to obtain an appropriate ligament balance. However, these additional procedures had no negative effect on the outcomes of TKA. 相似文献12.
Tadashi Tsukeoka Yoshikazu Tsuneizumi Kensuke Yoshino 《Journal of orthopaedic science》2017,22(2):313-317
Background
The knee flexion angle after a total knee arthroplasty is an important indicator of clinical outcome. However, there is little appropriate information about the correlation between the ligament balancing and knee flexion angle after total knee arthroplasty. The purpose of this study was to investigate the effect of the ligamentous balance in extension and flexion on knee flexion angle one year after posterior cruciate ligament sacrificing rotating platform total knee arthroplasty.Methods
Eighty-five total knee arthroplasties in 71 patients were investigated in this study. The postoperative knee flexion angle and the percentage of improvement in the balanced group in which the difference between varus and valgus was less than 2° and the unbalanced group in extension and the rectangular group in which the asymmetry of the flexion gap was within 2° and the trapezoidal group in flexion were compared. The factors affecting postoperative knee flexion angle were also investigated in a forced entry multiple regression analysis.Results
The mean flexion angle improved significantly from 116.2° to 122.5° in the rectangular group. By contrast, in the trapezoidal group, no significant improvement was seen (from 115.5° to 117.4°). The statistically significant difference was found between the rectangular and trapezoidal group in flexion in terms of the improvement of the knee flexion angle while there was no difference between the balanced and unbalanced group in extension. The multiple regression analysis showed that the asymmetry of the flexion gap was a predictor of the postoperative knee flexion angle.Conclusions
Asymmetric flexion gap affected negatively the postoperative knee flexion angle after posterior cruciate ligament sacrificing rotating platform total knee arthroplasty. A gap balancing technique is recommended for this type of implant. 相似文献13.
Kazuhisa Hatayama Masanori Terauchi Kenichi Saito Hiroshi Higuchi 《The Journal of arthroplasty》2017,32(6):1808-1813
Background
The purpose of this study is to investigate whether varus-valgus laxity of cruciate-retaining (CR) total knee arthroplasty (TKA) changes between 1 year and >5 years after surgery based on postoperative limb alignment.Methods
One hundred twenty-one varus osteoarthritic knees that underwent CR TKA were included. The minimum follow-up was 5 years. Weight-bearing full-leg radiographs were obtained postoperatively and the hip-knee-ankle (HKA) angle was measured. Knees were grouped in varus (HKA angle ≤ ?3°, 47 knees) and neutral groups (?3° < HKA angle < 3°, 70 knees). The range of motion was measured and a Hospital for Special Surgery score was obtained at the last follow-up. Varus-valgus laxity at 15° of knee flexion was measured with stress radiographs after 1 year and at the last follow-up.Results
No knees required revision surgery. The mean knee flexion angle (121.0° vs 117.1°) and Hospital for Special Surgery score (90.3 vs 90.4) at the last follow-up were not significantly different between the varus and neutral groups. In both groups, there was no significant change in varus or valgus laxity between 1 year and at the last follow-up.Conclusion
Postoperative residual varus limb alignment did not lead to increasing varus laxity after CR TKA in the mid-term. 相似文献14.
Kazu Matsumoto Hiroyasu Ogawa Hiroki Yoshioka Haruhiko Akiyama 《The Journal of arthroplasty》2017,32(6):1845-1849
Background
We hypothesized that postoperative anteroposterior (AP) stability of the knee correlates with patient-reported clinical outcome and knee function after total knee arthroplasty (TKA).Methods
This study enrolled 110 knees in 81 patients after TKA. AP laxity was measured with a KS Measure Arthrometer at 30°, 60°, and 90° flexion, which was confirmed with a goniometer. We assessed knee pain and function by using the Knee Society Function Score (KSS) and Knee Injury and Osteoarthritis Outcome Score (KOOS). Correlations among AP translation values and KOOS subscale scores (pain symptom, activities of daily living, and knee-related quality of life), KSS, and range of motion (ROM) were analyzed.Results
The mean follow-up period for the assessment of the KOOS was 4.4 ± 2.2 years (range, 1.1-11.5 years). Twenty-five knees had posterior-stabilized fixed-bearing TKA, and 85 knees had posterior-stabilized mobile-bearing TKA. The mean KSS functional score and mean ROM were 96.3 ± 5.7 (range, 75-100) and 121.6° ± 14.4° (range, 90°-145°), respectively. The mean AP laxity was 4.5 ± 2.2 mm, 3.6 ± 1.9 mm, and 3.0 ± 1.9 mm at 30°, 60°, and 90° knee flexion, respectively. A significant inverse association was observed between AP laxity at 60° knee flexion and KOOS pain (P = .021, R2 = 0.05), but no significant association was found between AP laxity and other KOOS subscale score, KSS, and ROM.Conclusion
We found that the AP laxity at 60° knee flexion in this study significantly correlated with patient-reported pain. The observed AP laxity can be considered as a register of normal AP translations after arthroplasty. 相似文献15.
Seung-Suk Seo Chang-Wan Kim Jin-Hyuk Seo Do-Hun Kim Ok-Gul Kim Chang-Rack Lee 《The Journal of arthroplasty》2017,32(6):1819-1823
Background
When evaluating the effects of the preparation of the flexion gap on the extension gap in total knee arthroplasty (TKA), the effects of posterior condylar resection and osteophyte removal on the extension gap should be differentiated. Although the amount of osteophytes differs between patients, posterior condylar resection is a procedure that is routinely implemented in TKA. The aim of this study was to assess the effects of the resection of the posterior condyle of the femur on the extension gap in posterior-stabilized (PS) TKA.Methods
We enrolled 40 knees that underwent PS TKA between July 2010 and February 2011 with no or minimal osteophytes in the posterior compartment and a varus deformity of <15°. We measured the extension gap before and after the resection of the posterior condyle of the femur using a tensor under 20 and 40 lb of distraction force.Results
Under 20 lb of distraction force, the average extension gap was 13.3 mm (standard deviation [SD], 1.6) before and 13.8 mm (SD, 1.6) after posterior condylar resection. Under 40 lb of distraction force, the average extension gap was 15.1 mm (SD, 1.5) before and 16.1 mm (SD, 1.7) after posterior condylar resection.Conclusion
The resection of the posterior condyle of the femur in PS TKA increased the extension gap. However, this increase was only by approximately 1 mm. In conclusion, posterior condylar resection does increase the extension gap by approximately 1 mm. However, in most case, this change in unlikely to be clinically important. 相似文献16.
Background
Total knee arthroplasty (TKA) is a highly successful surgery shown to improve quality of life. One of the more common known complications of TKA is early arthrofibrosis requiring manipulation under anesthesia (MUA). This investigation evaluates the incidence of arthrofibrosis before and after the implementation of an electronic sensor device used to assist with ligament balancing.Methods
Six hundred ninety TKAs performed without sensor use were compared to a cohort of 252 TKAs performed with sensor usage.Results
Prior to usage, there was a 5% rate of MUA after TKA, while after implementation, the MUA rate went down to 1.6% (P = .004). Ligament balancing using sensor assistance led to a statistically significant decrease in MUA in this cohort of patients. An odds ratio analysis also demonstrated that non-sensor patients had a 3.2× higher likelihood of requiring MUA than the sensor patients.Conclusion
The use of an electronic sensor device during trialing of TKA with resultant improved ligamentous balancing led to a statistically significant reduction in the rate of MUA in this cohort of patients. This type of approach to ligamentous balancing may continue to show evidence of improved clinical outcomes. 相似文献17.
Background
This study was performed to assess the impact of soft tissue imbalance on the knee flexion angle 2 years after posterior stabilized total knee arthroplasty (TKA).Methods
A total of 329 consecutive varus knees were included to assess the association of knee flexion angle 2 years after TKA with preoperative, intraoperative, and postoperative variables. All intraoperative soft tissue measurements were performed by a single surgeon under spinal anesthesia in a standardized manner including the subvastus approach, reduced patella, and without use of a pneumonic tourniquet.Results
Multiple linear regression analysis showed no significant correlations in terms of intraoperative valgus imbalance at 90-degree flexion or the difference in soft tissue tension between 90-degree flexion and 0-degree extension (β = ?0.039; 95% confidence interval [CI], ?0.88 to 0.80; P = .93 and β = 0.015; 95% CI, ?0.29 to 0.32; P = .92, respectively). Preoperative flexion angle was significantly correlated with knee flexion angle 2 years after TKA (β = 0.42; 95% CI, 0.33 to 0.51; P < .0001).Conclusion
Avoiding valgus imbalance at 90-degree flexion and aiming for strictly equal soft tissue tension between 90-degree flexion and 0-degree extension had little practical value with regard to knee flexion angle 2 years after posterior stabilized TKA. 相似文献18.
Intraoperative Load-Sensing Variability During Cemented,Posterior-Stabilized Total Knee Arthroplasty
Scott R. Nodzo Vincenzo Franceschini Alejandro Gonzalez Della Valle 《The Journal of arthroplasty》2017,32(1):66-70
Background
Load-sensing technology during total knee arthroplasty (TKA) provides objective measurements of ligamentous balance. The purpose of this study is to assess its intraoperative validity and reliability during TKA.Methods
Fifty-four patients underwent TKA using the OrthoSensor VERASENSE tibial insert to assist with ligament balance. The transepicondylar axis (TEA) was used to determine femoral component rotation, and the posterior condylar angle (PCA) was measured. Load measurements were documented at 10°, 45°, and 90° of flexion with the trial (TRIAL) components and with the definitive (FINAL) cemented implants. Adequate balance was defined as a load differential ≤15 pounds between compartments.Results
Adequate balanced with TRIAL and FINAL implants was observed in 89% TKAs. There was a significant linear correlation of the TRIAL and FINAL loads in the medial compartment throughout range of motion. No correlation between the TRIAL and FINAL loads was identified in the lateral compartment. There was no relationship between an increasing PCA and medial compartment loads at 45° (R2 = 0.0006, Y = ?0.10X + 7.3 ± 2.3; P = .86) and 90° (R2 = 0.004, Y = ?0.25X + 6.3 ± 2.1; P = .62) of flexion, suggesting that the compartment loads were not significantly altered with femoral rotation parallel to the TEA. A similar finding was observed in the lateral compartment at all poses.Conclusion
Variability between the TRIAL and FINAL implant measurements was higher in the lateral compartment as compared to the medial compartment. Using the TEA and not the posterior condylar line as a landmark to guide femoral component rotation, the flexion gap is frequently balanced without the need for additional ligament releases. 相似文献19.
Trevor F. Grieco Adrija Sharma Garett M. Dessinger Harold E. Cates Richard D. Komistek 《The Journal of arthroplasty》2018,33(2):565-571
Background
The bicruciate stabilized (BCS) total knee arthroplasty (TKA) features asymmetrical bearing geometry and dual substitution for the anterior cruciate ligament and posterior cruciate ligament (PCL). Previous TKA designs have not fully replicated normal knee motion, and they are characterized by lower magnitudes of overall rollback and axial rotation than the normal knee.Methods
In vivo kinematics were derived for 10 normal knees and 40-second generation BCS TKAs all implanted by a single surgeon. Mobile fluoroscopy and three-dimensional-to-two-dimensional registration was used to analyze anterior-posterior motion of the femoral condyles and femorotibial axial rotation during weight-bearing flexion. Statistical analysis was conducted at the 95% confidence level.Results
From 0° to 30° of knee flexion, the BCS subjects exhibited similar patterns of femoral rollback and axial rotation compared to normal knee subjects. From 30° to 60° of knee flexion, BCS subjects experienced negligible anterior-posterior motions and axial rotation while normal knees continued to rollback and externally rotate. Between 60° and 90° the BCS resumed posterior motion and, after 90°, axial rotation increased in a normal-like fashion.Conclusion
Similarities in early flexion kinematics suggest that the anterior cam-post is supporting normal-like anterior-posterior motion in the BCS subjects. Likewise, lateral femoral rollback and external rotation of the femur in later flexion provides evidence for appropriate substitution of the PCL via the posterior cam-post. Being discrete in nature, the dual cam-post mechanism does not lend itself to adequate substitution of the cruciate ligaments in mid-flexion during which anterior cruciate ligament tension is decreasing and PCL tension is increasing in the normal knee. 相似文献20.
Matthew G. Teeter Kevin I. Perry Xunhua Yuan James L. Howard Brent A. Lanting 《The Journal of arthroplasty》2017,32(6):1834-1838