Soft-Tissue Reconstruction in Exposed Total Knee Arthroplasty

AbstractDeep soft tissue defects after complicated primary or revision total knee arthroplasty (TKA) can be devastating to the patient and technically challenging. The purpose of this review was to (1) discuss different methods used to provide coverage for deep defects of the knee following TKA, as well as to (2) report on their success rates. A comprehensive literature search was performed. Reports were only included if they (1) were case series, (2) were level III studies or above (including retrospective cohort studies and meta-analyses), (3) were in English, and (4) discussed the outcome of graft or flap coverage of soft tissue defects after total knee arthroplasty. A total of 28 case series and four retrospective comparative studies were retrieved. In 16 studies, 195 out of 241 patients who received gastrocnemius flaps (81%) experienced successful outcomes. In seven studies including 84 patients that underwent fasciocutaneous flap coverage, over 90% of patients experienced successful outcomes. In the four studies examining 144 patients with delayed versus prophylactic soft tissue reconstruction, up to 81% of patients experienced a successful outcome. Various factors must be taken into consideration when assessing full-thickness defects over a TKA and collaboration between plastic and orthopaedic surgeons is required to select the optimal approach.

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Soft Tissue Reconstruction and Flap Coverage for Revision Total Knee Arthroplasty

The Journal of Arthroplasty ◽

10.1016/j.arth.2015.12.054 ◽

2016 ◽

Vol 31 (7) ◽

pp. 1529-1538 ◽

Cited By ~ 21

Author(s):

Allison J. Rao ◽

Steven J. Kempton ◽

Brandon J. Erickson ◽

Brett R. Levine ◽

Venkat K. Rao

Keyword(s):

Total Knee Arthroplasty ◽

Soft Tissue ◽

Knee Arthroplasty ◽

Revision Total Knee Arthroplasty ◽

Soft Tissue Reconstruction ◽

Flap Coverage ◽

Tissue Reconstruction ◽

Total Knee

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Erratum to: An in vitro analysis of medial structures and a medial soft tissue reconstruction in a constrained condylar total knee arthroplasty

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-017-4583-x ◽

2017 ◽

Vol 25 (8) ◽

pp. 2656-2656

Author(s):

Kiron K. Athwal ◽

Hadi El Daou ◽

Eivind Inderhaug ◽

William Manning ◽

Andrew J. Davies ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Soft Tissue ◽

Knee Arthroplasty ◽

Soft Tissue Reconstruction ◽

Tissue Reconstruction ◽

Total Knee ◽

Vitro Analysis ◽

In Vitro Analysis

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Is Soft Tissue Laxity Associated with Tissue Metal Concentrations after Total Knee Arthroplasty?

Journal of Long-Term Effects of Medical Implants ◽

10.1615/jlongtermeffmedimplants.2018025386 ◽

2018 ◽

Vol 28 (2) ◽

pp. 79-85

Author(s):

Meredith Perkins ◽

Julie Lowell ◽

Christina Arnholt ◽

Daniel MacDonald ◽

Anita L. Kerkhof ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Soft Tissue ◽

Knee Arthroplasty ◽

Metal Concentrations ◽

Soft Tissue Laxity ◽

Total Knee

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Postoperative laxity of the lateral soft tissue is largely negligible in total knee arthroplasty for varus osteoarthritis

Journal of Orthopaedic Surgery ◽

10.1177/23094990211002002 ◽

2021 ◽

Vol 29 (1) ◽

pp. 230949902110020

Author(s):

Seikai Toyooka ◽

Hironari Masuda ◽

Nobuhiro Nishihara ◽

Takashi Kobayashi ◽

Wataru Miyamoto ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Soft Tissue ◽

Knee Arthroplasty ◽

Mechanical Axis ◽

Varus Deformity ◽

Varus Knee ◽

Before And After ◽

Knee Deformity ◽

Varus Stress ◽

Total Knee

Purpose: To evaluate the integrity of lateral soft tissue in varus osteoarthritis knee by comparing the mechanical axis under varus stress during navigation-assisted total knee arthroplasty before and after compensating for a bone defect with the implant. Methods: Sixty-six knees that underwent total knee arthroplasty were investigated. The mechanical axis of the operated knee was evaluated under manual varus stress immediately after knee exposure and after navigation-assisted implantation. The correlation between each value of the mechanical axis and degree of preoperative varus deformity was compared by regression analysis. Results: The maximum mechanical axis under varus stress immediately after knee exposure increased in proportion to the degree of preoperative varus deformity. Moreover, the maximum mechanical axis under varus stress after implantation increased in proportion to the degree of preoperative varus deformity. Therefore, the severity of varus knee deformity leads to a progressive laxity of the lateral soft tissue. However, regression coefficients after implantation were much smaller than those measured immediately after knee exposure (0.99 vs 0.20). Based on the results of the regression formula, the postoperative laxity of the lateral soft tissue was negligible, provided that an appropriate thickness of the implant was compensated for the bone and cartilage defect in the medial compartment without changing the joint line. Conclusion: The severity of varus knee deformity leads to a progressive laxity of the lateral soft tissue. However, even if the degree of preoperative varus deformity is severe, most cases may not require additional procedures to address the residual lateral laxity.

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Accuracy of soft tissue balancing in total knee arthroplasty using surgeon-defined assessment versus a gap-balancer or electronic sensor

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02439-w ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Ran Zhao ◽

Yanqing Liu ◽

Hua Tian

Keyword(s):

Total Knee Arthroplasty ◽

Soft Tissue ◽

Knee Arthroplasty ◽

Sensor Data ◽

Soft Tissue Balancing ◽

Electronic Sensor ◽

Prior Performance ◽

Cumulative Summation ◽

Total Knee ◽

Sensitivity Specificity

Abstract Background Soft tissue balancing is essential for the success of total knee arthroplasty (TKA) and is mainly dependent on surgeon-defined assessment (SDA) or a gap-balancer (GB). However, an electronic sensor has been developed to objectively measure the gap pressure. This study aimed to evaluate the accuracy of soft tissue balancing using SDA and GB compared with a sensor. Methods Forty-eight patients undergoing TKA (60 knees) were prospectively enrolled. Soft tissue balancing was sequentially performed using SDA, a GB, and an electronic sensor. We compared the SDA, GB, and sensor data to calculate the sensitivity, specificity, and accuracy at 0°, 45°, 90°, and 120° flexion. Cumulative summation (CUSUM) analysis was performed to assess the surgeon’s performance during the sensor introductory phase. Results The sensitivity of SDA was 63.3%, 68.3%, 80.0%, and 80.0% at 0°, 45°, 90°, and 120°, respectively. The accuracy of the GB compared with sensor data was 76.7% and 71.7% at 0° and 90°, respectively. Cohen’s kappa coefficient for the accuracy of the GB was 0.406 at 0° (moderate agreement) and 0.227 at 90° (fair agreement). The CUSUM 0° line achieved good prior performance at case 45, CUSUM 90° and 120° showed a trend toward good prior performance, while CUSUM 45° reached poor prior performance at case 8. Conclusion SDA was a poor predictor of knee balance. GB improved the accuracy of soft tissue balancing, but was still less accurate than the sensor, particularly for unbalanced knees. SDA improved with ongoing use of the sensor, except at 45° flexion.

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Accuracy of total knee arthroplasty using the modified gap technique based on the bone gap: an evaluation of the bone gap with a distal femoral trial component

Arthroplasty ◽

10.1186/s42836-021-00072-w ◽

2021 ◽

Vol 3 (1) ◽

Author(s):

Goki Kamei ◽

Shigeki Ishibashi ◽

Koki Yoshioka ◽

Satoru Sakurai ◽

Hiroyuki Inoue ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Soft Tissue ◽

Knee Arthroplasty ◽

Distal Femur ◽

Gap Size ◽

Flexion Gap ◽

Gap Technique ◽

Joint Gap ◽

Total Knee ◽

The Mean

Abstract Background In total knee arthroplasty (TKA) using the modified gap technique, the soft-tissue balance is measured after osteotomy of the distal femur and proximal tibia (conventional bone gap). However, after osteotomy, the flexion gap size during 90° knee flexion may be larger than that observed after implantation. The tension of the lateral compartment during 90° flexion may also be reduced after osteotomy of the distal femur. We manufactured a distal femoral trial component to reproduce the condition after implantation and prior to posterior condyle osteotomy. This study aimed to evaluate the effect of the trial component on the flexion gap. Methods This prospective study included 21 consecutive patients aged 78 years with medial osteoarthritis who underwent cruciate-retaining TKA between February 2017 and March 2018. The postoperative flexion gap size and inclination during 90° flexion were compared between cases with and without the trial component. Results The mean joint gap size with the trial component (13.4 ± 0.80 mm) was significantly smaller than that without the trial component (14.7 ± 0.84 mm). The mean gap inclination angle with the trial component (3.7° ± 0.62°) was significantly smaller than that without the trial component (5.5° ± 0.78°). Conclusions In the present study, the joint gap size and medial tension were significantly reduced after the trial component had been set. Accurate measurement of the soft-tissue balance is an important factor in the modified gap technique, and this method using a distal femoral trial component can offer better outcomes than those achieved with conventional methods.

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