RSS-Feed abonnieren
DOI: 10.1055/s-0041-1739200
Intraoperative Assessment of Gap Balancing in Total Knee Arthroplasty Using Navigation with Joint Stability Graphs
![](https://www.thieme-connect.de/media/jks/202305/lookinside/thumbnails/10-1055-s-0041-1739200_210173oa-1.jpg)
Abstract
The purpose of this study was to assess continuous gaps in the replaced knee throughout the full range of motion (ROM) after total knee arthroplasty (TKA) using a joint stability graph, and to analyze the gap laxity in the mid-flexion range. Ninety-three TKAs were performed using imageless navigation with a joint stability graph. While positioning guides for each respective cut, the surgeon can safely preview the resection's impact for the resulting joint gaps and control the soft tissue balance at the knee flexion of 0° (extension) and 90° (flexion). The gaps between the femoral component and insert were evaluated throughout the full ROM using the joint stability graph. The mechanical axis (MA) and change of joint line height were radiographically evaluated. Posthoc power analyses using a significant α value of 0.05 were performed on the proportion of the mid-flexion instability as a primary outcome to determine whether the sample had sufficient power. The power was determined to be sufficient (100%). The flexion–extension gap differences in each medial and lateral compartment and the mediolateral gap differences in flexion and extension were all ≤3 mm. None of the knees had mid-flexion instability, which is defined by a peak mid-flexion gap that is 3 mm greater than the smaller value of flexion or extension gap. The average MA was well corrected from varus 11.4° to varus 1.0° postoperatively. The proportion of postoperative well-aligned knees (MA ≤ 3°) was 87.1%. The joint line height was well preserved (14.7 vs. 14.8 mm, p = 0.751). The joint stability graph in TKA using the navigation can effectively evaluate the continuous gap throughout the ROM, including the mid-flexion range. Mid-flexion instability was uncommon in primary TKAs with appropriate alignment and proper preservation of the joint line. The Level of evidence for the study is IV.
Publikationsverlauf
Eingereicht: 03. Mai 2021
Angenommen: 21. September 2021
Artikel online veröffentlicht:
18. November 2021
© 2021. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 Goto K, Katsuragawa Y, Miyamoto Y. Outcomes and component-positioning in total knee arthroplasty may be comparable between supervised trained surgeons and their supervisor. Knee Surg Relat Res 2020; 32 (01) 3
- 2 Lee QJ, Chang WYE, Wong YC. Forgotten Joint Score for early outcome assessment after total knee arthroplasty: is it really useful?. Knee Surg Relat Res 2020; 32 (01) 37
- 3 Sikorski JM. Alignment in total knee replacement. J Bone Joint Surg Br 2008; 90 (09) 1121-1127
- 4 Song SJ, Kim KI, Bae DK, Park CH. Mid-term lifetime survivals of octogenarians following primary and revision total knee arthroplasties were satisfactory: a retrospective single center study in contemporary period. Knee Surg Relat Res 2020; 32 (01) 50
- 5 Shalhoub S, Moschetti WE, Dabuzhsky L, Jevsevar DS, Keggi JM, Plaskos C. Laxity profiles in the native and replaced knee-application to robotic-assisted gap-balancing total knee arthroplasty. J Arthroplasty 2018; 33 (09) 3043-3048
- 6 Yoon JR, Jeong HI, Oh KJ, Yang JH. In vivo gap analysis in various knee flexion angles during navigation-assisted total knee arthroplasty. J Arthroplasty 2013; 28 (10) 1796-1800
- 7 Aunan E, Kibsgård T, Clarke-Jenssen J, Röhrl SM. A new method to measure ligament balancing in total knee arthroplasty: laxity measurements in 100 knees. Arch Orthop Trauma Surg 2012; 132 (08) 1173-1181
- 8 Martin JW, Whiteside LA. The influence of joint line position on knee stability after condylar knee arthroplasty. Clin Orthop Relat Res 1990; (259) 146-156
- 9 Minoda Y, Sugama R, Ohta Y, Ueyama H, Takemura S, Nakamura H. Joint line elevation is not associated with mid-flexion laxity in patients with varus osteoarthritis after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2020; 28 (10) 3226-3231
- 10 Song SJ, Kang SG, Lee YJ, Kim KI, Park CH. An intraoperative load sensor did not improve the early postoperative results of posterior-stabilized TKA for osteoarthritis with varus deformities. Knee Surg Sports Traumatol Arthrosc 2019; 27 (05) 1671-1679
- 11 Bae DK, Song SJ, Park CH, Ko YW, Lee H. A comparison of the medium-term results of total knee arthroplasty using computer-assisted and conventional techniques to treat patients with extraarticular femoral deformities. J Arthroplasty 2017; 32 (01) 71-78
- 12 Lequesne M. Indices of severity and disease activity for osteoarthritis. Semin Arthritis Rheum 1991; 20 (6, Suppl 2): 48-54
- 13 Song SJ, Lee HW, Park CH. A current prosthesis with a 1-mm thickness increment for polyethylene insert could result in fewer adjustments of posterior tibial slope in cruciate-retaining total knee arthroplasty. J Arthroplasty 2020; 35 (11) 3172-3179
- 14 Lee HW, Song SJ, Bae DK, Park CH. The influence of computer-assisted surgery experience on the accuracy and precision of the postoperative mechanical axis during computer-assisted lateral closing-wedge high tibial osteotomy. Knee Surg Relat Res 2019; 31 (01) 15
- 15 Ewald FC. The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res 1989; (248) 9-12
- 16 Çabuk H, İmren Y, Tekin AC, Dedeoğlu SS, Gürbüz H. High varus angle and lower posterior tibial slope associated with PCL injury in cruciate retaining total knee arthroplasty: an MRI study. J Knee Surg 2018; 31 (03) 277-283
- 17 Martin A, Wohlgenannt O, Prenn M, Oelsch C, von Strempel A. Imageless navigation for TKA increases implantation accuracy. Clin Orthop Relat Res 2007; 460 (460) 178-184
- 18 Mullaji A, Kanna R, Marawar S, Kohli A, Sharma A. Comparison of limb and component alignment using computer-assisted navigation versus image intensifier-guided conventional total knee arthroplasty: a prospective, randomized, single-surgeon study of 467 knees. J Arthroplasty 2007; 22 (07) 953-959
- 19 Parratte S, Pagnano MW, Trousdale RT, Berry DJ. Effect of postoperative mechanical axis alignment on the fifteen-year survival of modern, cemented total knee replacements. J Bone Joint Surg Am 2010; 92 (12) 2143-2149
- 20 Kamei G, Murakami Y, Kazusa H. et al. Is patella eversion during total knee arthroplasty crucial for gap adjustment and soft-tissue balancing?. Orthop Traumatol Surg Res 2011; 97 (03) 287-291
- 21 Luyckx T, Vandenneucker H, Ing LS, Vereecke E, Ing AV, Victor J. Raising the joint line in TKA is associated with mid-flexion laxity: a study in cadaver knees. Clin Orthop Relat Res 2018; 476 (03) 601-611
- 22 Victor J, Wong P, Witvrouw E, Sloten JV, Bellemans J. How isometric are the medial patellofemoral, superficial medial collateral, and lateral collateral ligaments of the knee?. Am J Sports Med 2009; 37 (10) 2028-2036
- 23 Martin JR, Jennings JM, Watters TS, Levy DL, McNabb DC, Dennis DA. Femoral implant design modification decreases the incidence of patellar crepitus in total knee arthroplasty. J Arthroplasty 2017; 32 (04) 1310-1313
- 24 Ranawat CS, White PB, West S, Ranawat AS. Clinical and radiographic results of attune and PFC sigma knee designs at 2-year follow-up: a prospective matched-pair analysis. J Arthroplasty 2017; 32 (02) 431-436
- 25 DePuy Synthes. ATTUNE® Knee System. 2017; Accessed 22 May, 2017 at: https://www.depuysynthes.com/hcp/knee/products/qs/ATTUNE-Knee-System
- 26 Webb JE, Yang HY, Collins JE, Losina E, Thornhill TS, Katz JN. The evolution of implant design decreases the incidence of lateral release in primary total knee arthroplasty. J Arthroplasty 2017; 32 (05) 1505-1509
- 27 Vajapey SP, Pettit RJ, Li M, Chen AF, Spitzer AI, Glassman AH. Risk factors for mid-flexion instability after total knee arthroplasty: a systematic review. J Arthroplasty 2020; 35 (10) 3046-3054
- 28 Longo UG, Candela V, Pirato F, Hirschmann MT, Becker R, Denaro V. Midflexion instability in total knee arthroplasty: a systematic review. Knee Surg Sports Traumatol Arthrosc 2021; 29 (02) 370-380
- 29 Vince K. Mid-flexion instability after total knee arthroplasty: woolly thinking or a real concern?. Bone Joint J 2016; 98-B (1, Suppl A): 84-88
- 30 Te Molder MEM, Wymenga AB, Heesterbeek PJC. Mid-flexion laxity in the asymptomatic native knee is predominantly present on the lateral side. Knee Surg Sports Traumatol Arthrosc 2019; 27 (11) 3614-3625