Joint gap measurement in total knee arthroplasty using a tensor device with the same articulating surface as the prosthesis

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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Four-Millimeter Additional Bone Resection in the Distal Femur Does Not Result in an Equivalent Increase in the Extension Joint Gap in Total Knee Arthroplasty

The Journal of Arthroplasty ◽

10.1016/j.arth.2020.09.002 ◽

2020 ◽

Author(s):

Yukihide Minoda ◽

Ryo Sugama ◽

Yoichi Ohta ◽

Hideki Ueyama ◽

Susumu Takemura ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Distal Femur ◽

Bone Resection ◽

Joint Gap ◽

Total Knee

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Effects of four different surgical approaches on intra-operative joint gap in posterior-stabilized total knee arthroplasty

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-011-1813-5 ◽

2011 ◽

Vol 20 (10) ◽

pp. 2026-2031 ◽

Cited By ~ 9

Author(s):

Yasuo Niki ◽

Yuki Takeda ◽

Hiroya Kanagawa ◽

Wataru Iwamoto ◽

Hideo Matsumoto ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Surgical Approaches ◽

Posterior Stabilized ◽

Joint Gap ◽

Total Knee

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The Effect of Coronal and Axial Femoral Component Rotation on Midflexion Laxity and Patient Reported Outcomes in Total Knee Arthroplasty

10.29007/km58 ◽

2020 ◽

Author(s):

Edgar Wakelin ◽

Sami Shalhoub ◽

Jeffrey Lawrence ◽

John Keggi ◽

Amber Randall ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Axial Rotation ◽

Improved Outcomes ◽

Joint Gap ◽

Component Rotation ◽

Patient Reported ◽

Total Knee ◽

Multi Center Study ◽

Line P

Joint balance in total knee arthroplasty (TKA) has traditionally focused on achieving a tight symmetric extension gap and rectangular or trapezoidal gaps in flexion. This study sought to investigate the effect of femoral and tibial coronal rotation and femoral axial rotation on midflexion coronal joint balance and patient outcomes.A prospective multi-center study was performed with a mixture of tibia-first gap-balancing and femur-first approaches were performed using the Corin OMNIBotics robot-assisted TKA platform with APEX implant components. Coronal and axial femoral and tibial resections were recorded by the platform. Medial and lateral joint gaps were recorded while applying a computer-controlled load to the joint throughout flexion during trialing using the Corin BalanceBot device. In addition, 1-year Knee Injury and Osteoarthritis Outcome Score (KOOS) and PROMIS-10 global health scores were collected.231 surgeries were identified: 66.9±8.1 years, 31.4±4.8 kg/m2 and 57% female (121) with a mean pre-operative HKA angle of 4.5±5.2° varus. A significant correlation was found between the medio-lateral (ML) joint gap difference in midflexion and both extension and flexion joint line (p=0.003, r2=-0.20, p=0.001, r2=-0.22, respectively). A significant correlation was found between midflexion ML imbalance and KOOS stiffness questions at 3 M and 6 M post-op (r2=-0.15, p=0.036, r2=-0.18, p=0.013), in which a more balanced knee correlated with improved outcomes.Treating flexion and extension joint balance in isolation may not capture the effect on midflexion laxity. Component placement should take in to account the effect on joint gaps throughout flexion to target optimal joint balance.

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Flexion-extension joint gap changes after lateral structure release for valgus deformity correction in total knee arthroplasty: A cadaveric study

The Journal of Arthroplasty ◽

10.1016/s0883-5403(99)90016-5 ◽

1999 ◽

Vol 14 (8) ◽

pp. 994-1004 ◽

Cited By ~ 71

Author(s):

Kenneth A. Krackow ◽

William M. Mihalko

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Deformity Correction ◽

Valgus Deformity ◽

Cadaveric Study ◽

Joint Gap ◽

Flexion Extension ◽

Total Knee ◽

Lateral Structure

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Measurement of joint gap load in patella everted and reset position during total knee arthroplasty

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-008-0656-1 ◽

2008 ◽

Vol 17 (5) ◽

pp. 484-490 ◽

Cited By ~ 24

Author(s):

Nobuyuki Yoshino ◽

Nobuyoshi Watanabe ◽

Yoshinobu Watanabe ◽

Yukihisa Fukuda ◽

Shinro Takai

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Joint Gap ◽

Total Knee

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Gap measurement in posterior-stabilized total knee arthroplasty with or without a trial femoral component

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-014-1955-2 ◽

2014 ◽

Vol 134 (6) ◽

pp. 861-865 ◽

Cited By ~ 4

Author(s):

Seiju Hayashi ◽

Yuji Murakami ◽

Hiroyuki Inoue ◽

Hiroo Nobutou ◽

Koji Nishida ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Femoral Component ◽

Knee Arthroplasty ◽

Posterior Stabilized ◽

Gap Measurement ◽

Total Knee

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Does measuring the medial gap before bone resection in total knee arthroplasty provide optimum gap adjustment and prevent bone recutting?

10.21203/rs.3.rs-77483/v1 ◽

2020 ◽

Author(s):

Uğur Tiftikçi ◽

Sancar Serbest ◽

Hacı Bayram Tosun ◽

Seyyid İsa Keskinkılıç ◽

Cem Yalın Kılınc ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Bone Resection ◽

Tibial Bone ◽

Number Of Patients ◽

Joint Gap ◽

Measured Resection ◽

Total Knee ◽

Group 2 ◽

Group 1

Abstract PurposeThe aim of this study was to demonstrate that measuring the medial gap before bone resection during total knee arthroplasty (TKA) provides an optimum gap adjustment in varus knees.MethodsPatients were separated into two groups, Group 1 being those whose medial joint gap was measured prior to bone resection and Group 2 comprising those who underwent conventional measured resection technique without measuring. The medial joint gap was measured with a custom-made gap measuring device up to the point that the knee was corrected and aligned along its mechanical axis. Medial joint gap distances, distal medial femoral bone cut thicknesses, amounts of tibial resection calculated, gap internal distances measured after cutting, and the thicknesses of the trial inserts were recorded. A comparison was made between the groups in terms of the number of patients requiring an additional tibial bone cut and the distribution of insert thicknesses.ResultsExtra tibial bone resections performed in two (5.7%) patients in Group 1 and in 10 (28.6%) patients in Group 2. In Group 1, where the medial joint gap was measured, the need for an additional bone resection was statistically less. (p=0.018). In the comparison of distribution of insert size by group, the number of patients on whom an 8 mm insert had been used was significantly greater in Group 1 (p=0.024). ConclusionMeasuring the medial joint gap prior to bone resection in total knee arthroplasty may prevent repeated bone recutting and additional bone resections. Furthermore, we can use this method to avoid the disadvantages of the measured resection technique.

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