The effect of hamstring tightness on intraoperative extension gap in posterior stabilized total knee arthroplasty

AbstractThis study aimed to determine the factors related to intraoperative extension gap (EG) in patients who underwent posterior-stabilized total knee arthroplasty (TKA). A total of 106 TKAs in 84 patients were retrospectively reviewed. Only patients who underwent the same method of bone resection were included consecutively. Bilateral popliteal angle (BPA) was used as an indicator of hamstring tightness. EG and extension space angle were measured using an offset type tensor. The associations between patient variables and EG were analyzed using multivariable linear regression and Pearson's correlation coefficients. The average EG was 12.9 ± 2.1 mm, and the average extension space angle was 2.8° ± 3.2°. BPA was greater than flexion contracture in most cases (94.3%), and no difference was found in only six cases (5.7%). According to multivariable linear regression analysis which was conducted after modifying the BPA into a categorical variable by 5°, EG was correlated with BPA (p < 0.001). Pearson’s correlation coefficient between EG and BPA was − 0.674 (p < 0.001). No other factors were significantly correlated with intraoperative EG. The present study found that popliteal angle is a different entity from flexion contracture, and that it is a predictable factor for EG in osteoarthritis patients. Smaller BPAs led to larger EG in patients who underwent the same degree of bone resection.

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Capsular release around the intercondylar notch increases the extension gap in posterior-stabilized rotating-platform total knee arthroplasty

The Knee ◽

10.1016/j.knee.2015.11.022 ◽

2016 ◽

Vol 23 (4) ◽

pp. 730-735 ◽

Cited By ~ 5

Author(s):

Yoshinori Okamoto ◽

Mikio Nakajima ◽

Tsuyoshi Jotoku ◽

Shuhei Otsuki ◽

Masashi Neo

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Intercondylar Notch ◽

Posterior Stabilized ◽

Rotating Platform ◽

Capsular Release ◽

Total Knee ◽

Extension Gap

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Flexion-extension gap in cruciate-retaining versus posterior-stabilized total knee arthroplasty: A cadaveric study

Journal of Orthopaedic Research® ◽

10.1002/jor.22587 ◽

2014 ◽

Vol 32 (5) ◽

pp. 627-632 ◽

Cited By ~ 13

Author(s):

Joshua Matthews ◽

Alexander Chong ◽

David McQueen ◽

Justin O'Guinn ◽

Paul Wooley

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Cadaveric Study ◽

Posterior Stabilized ◽

Cruciate Retaining ◽

Flexion Extension ◽

Total Knee ◽

Extension Gap

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Extension gap needs more than 1-mm laxity after implantation to avoid post-operative flexion contracture in total knee arthroplasty

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-014-2858-z ◽

2014 ◽

Vol 22 (12) ◽

pp. 3174-3180 ◽

Cited By ~ 24

Author(s):

Shigetoshi Okamoto ◽

Ken Okazaki ◽

Hiroaki Mitsuyasu ◽

Shuichi Matsuda ◽

Hideki Mizu-uchi ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Flexion Contracture ◽

Total Knee ◽

Extension Gap

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Posteromedial vertical capsulotomy selectively increases the extension gap in posterior stabilized total knee arthroplasty

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-019-05511-5 ◽

2019 ◽

Vol 28 (5) ◽

pp. 1419-1424 ◽

Cited By ~ 1

Author(s):

Shin Masuda ◽

Shinichi Miyazawa ◽

Kodama Yuya ◽

Yusuke Kamatski ◽

Hino Tomohito ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Posterior Stabilized ◽

Total Knee ◽

Extension Gap

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Improvement of the Gap Adjustment in Total Knee Arthroplasty Using the Posterior Condylar Pre-cut Technique

The Journal of Knee Surgery ◽

10.1055/s-0038-1675420 ◽

2018 ◽

Vol 32 (10) ◽

pp. 1001-1007

Author(s):

Ryutaku Kaneyama ◽

Hidetaka Higashi ◽

Kazuhiro Oinuma ◽

Yoko Miura ◽

Tatsuya Tamaki ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Femoral Component ◽

Knee Arthroplasty ◽

Posterior Part ◽

Soft Tissue Release ◽

Bone Resection ◽

Posterior Condylar ◽

Total Knee ◽

Extension Gap ◽

Trial Setting

AbstractTo provide adequate gaps for knee extension and flexion during total knee arthroplasty, a femoral component placement decreases the extension gap because the posterior capsule tension increases against the protrusion of the posterior part of the femoral component. We thought that the influence of this component on the extension gap depends on the amount of posterior femoral bone resection and the thickness of the posterior femoral components. We hypothesized that less bone resection and a thinner posterior part of the femoral component might avoid these problems. To verify our hypothesis, a 4-mm posterior condylar pre-cut technique and temporary femoral components that were 8 and 4 mm thick in the distal and posterior parts, respectively, were made using the FINE Total Knee System (Teijin-Nakashima Medical Co., Okayama, Japan). After bone resection, the pre-cut trial component was set to the femur, and the bone and component setting gaps were estimated. Seventy-one patients (98 knees) were investigated. The average bone gaps were 17.2/15.0 mm (extension/flexion, after pre-cut), 18.3/16.3 mm (after soft tissue release), and 8.7/12.2 mm (after pre-cut trial setting). After pre-cut trial setting, the extension gap decreased significantly; the amount was 1.6 mm (0–4 mm) on average (p < 0.0001), whereas a change of 3 mm or more occurred in 15 knees (15.3%), which could be problematic. The degree of these changes after component setting could be reduced by using the posterior femoral condylar pre-cut technique. However, the problem of component setting on the extension gap was not completely resolved. To precisely project the intraoperative gap to the ultimate postoperative gap, a posterior small protrusion device such as a pre-cut trial with the pre-cut technique would be necessary.

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Additional distal femoral resection increases mid-flexion coronal laxity in posterior-stabilized total knee arthroplasty with flexion contracture

The Bone & Joint Journal ◽

10.1302/0301-620x.103b6.bjj-2020-2444.r1 ◽

2021 ◽

Vol 103-B (6 Supple A) ◽

pp. 87-93

Author(s):

Brian P. Chalmers ◽

Shady S. Elmasry ◽

Cynthia A. Kahlenberg ◽

David J. Mayman ◽

Timothy M. Wright ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Capsular Contracture ◽

Primary Total Knee Arthroplasty ◽

Flexion Contracture ◽

Joint Line ◽

In Vivo Studies ◽

Posterior Stabilized ◽

Coronal Laxity ◽

Total Knee

Aims Surgeons commonly resect additional distal femur during primary total knee arthroplasty (TKA) to correct a flexion contracture, which leads to femoral joint line elevation. There is a paucity of data describing the effect of joint line elevation on mid-flexion stability and knee kinematics. Thus, the goal of this study was to quantify the effect of joint line elevation on mid-flexion laxity. Methods Six computational knee models with cadaver-specific capsular and collateral ligament properties were implanted with a posterior-stabilized (PS) TKA. A 10° flexion contracture was created in each model to simulate a capsular contracture. Distal femoral resections of + 2 mm and + 4 mm were then simulated for each knee. The knee models were then extended under a standard moment. Subsequently, varus and valgus moments of 10 Nm were applied as the knee was flexed from 0° to 90° at baseline and repeated after each of the two distal resections. Coronal laxity (the sum of varus and valgus angulation with respective maximum moments) was measured throughout flexion. Results With + 2 mm resection at 30° and 45° of flexion, mean coronal laxity increased by a mean of 3.1° (SD 0.18°) (p < 0.001) and 2.7° (SD 0.30°) (p < 0.001), respectively. With + 4 mm resection at 30° and 45° of flexion, mean coronal laxity increased by 6.5° (SD 0.56°) (p < 0.001) and 5.5° (SD 0.72°) (p < 0.001), respectively. Maximum increased coronal laxity for a + 4 mm resection occurred at a mean 15.7° (11° to 33°) of flexion with a mean increase of 7.8° (SD 0.2°) from baseline. Conclusion With joint line elevation in primary PS TKA, coronal laxity peaks early (about 16°) with a maximum laxity of 8°. Surgeons should restore the joint line if possible; however, if joint line elevation is necessary, we recommend assessment of coronal laxity at 15° to 30° of knee flexion to assess for mid-flexion instability. Further in vivo studies are warranted to understand if this mid-flexion coronal laxity has negative clinical implications. Cite this article: Bone Joint J 2021;103-B(6 Supple A):87–93.

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