Decreasing Posterior Femoral Condyle Offset Improves Intraoperative Correction of Flexion Contracture in Total Knee Arthroplasty

2020 ◽  
Author(s):  
Murilo Anderson Leie ◽  
Antonio Klasan ◽  
Wei Wang Yeo ◽  
Dylan Misso ◽  
Myles Coolican
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Femoral Condyle ◽  
Knee Extension ◽  
Flexion Contracture ◽  
Level Of Evidence ◽  
Full Extension ◽  
Time Of Surgery ◽  
Posterior Femoral Condyle ◽  
Total Knee

AbstractMultiple intraoperative strategies are described to achieve full extension in total knee arthroplasty, but only a few studies have assessed the effect of the flexion gap on intraoperative improvement in flexion contracture. The aim of this study was to determine whether posterior condylar offset, in isolation, independently affects extension at the time of total knee arthroplasty.Two hundred and seventy-eight patients who underwent total knee arthroplasty for knee osteoarthritis and flexion contracture ≥ 5 degrees between January 2008 and July 2018 were included in this study. Patients with other factors that could affect knee extension at the time of surgery were excluded. We recorded the thickness of posterior femoral condyle bone resected as well as the thickness of the posterior femoral component chosen for each patient. Patients' knee extension was recorded under anesthetic, prior to resection and intraoperatively after total knee replacement.Average thickness of bone resection for the posteromedial femur was 12.64  ± 1.65 mm and for the posterolateral femur was 10.38  ± 1.52 mm. Using a linear regression model, we found that changes in posterior offset and implant downsizing influenced correction of fixed flexion deformity at the time of surgery. When patients had a combined posteromedial and posterolateral offset 2 mm thinner than the thickness of bone resected, there was an average correction of 3.5 degrees of flexion contracture.Our study demonstrated that posterior femoral condyle offset is an independent variable affecting correction of flexion contracture at the time of surgery in a gap balanced cruciate-retaining total knee arthroplasty. Level of evidence Level IV evidence

scholarly journals Large osteophyte removal from the posterior femoral condyle significantly improves extension at the time of surgery in a total knee arthroplasty

2020 ◽  
Vol 19 ◽  
pp. 76-83
Author(s):  
Murilo Anderson Leie ◽  
Antonio Klasan ◽  
Takeshi Oshima ◽  
Sven Edwards Putnis ◽  
Wai Weng Yeo ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Femoral Condyle ◽  
Time Of Surgery ◽  
Posterior Femoral Condyle ◽  
Total Knee

scholarly journals Component gap control during posterior-stabilised total knee arthroplasty using the posterior condylar pre-cut technique

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Makoto Kawasaki ◽  
Ryutaku Kaneyama ◽  
Hitoshi Suzuki ◽  
Teruaki Fujitani ◽  
Manabu Tsukamoto ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Knee Flexion ◽  
Femoral Condyle ◽  
Posterior Part ◽  
Case Series ◽  
Knee Extension ◽  
Level Of Evidence ◽  
Gap Control ◽  
Total Knee

Abstract Purpose Adjusting the gap lengths to ensure equal lengths in both extension and flexion during total knee arthroplasty (TKA) is important for achieving successful outcomes. We designed a new pre-cut trial component (PCT) for posterior-stabilised (PS) TKA and aimed to determine whether the pre-cut technique is useful for component gap (CG) control in PS TKA. Methods A total of 70 knees were included. The PS PCT for PS TKA is composed of a 9-mm-thick distal part and 5-mm-thick posterior part with a cam structure. First, the distal femur and proximal tibia were cut to create an extension gap. Next, a 4-mm pre-cut was made from the posterior femoral condylar line; then, the PS PCT was attached, and the CGs were checked and compared at 0° and 90° knee flexion. Final CGs with the trial femoral components were compared with gaps in PS PCT at 0° and 90° knee flexion. Results CGs using PS PCTs were 10.2 mm at 0° and 13.6 mm at 90° knee flexion. According to the release of the posterior capsule at intercondylar notch and the adjustment of the cutting level of posterior femoral condyle, the final CG on knee extension was 11.3 mm; it did not significantly differ from CGs with PS PCT. The final CG at 90° knee flexion was 12.7 mm; it did not significantly differ from the estimated gap (12.4 mm) in PS PCT after flexion gap control. Conclusion CG control using PS PCT is a useful technique during PS TKA. Level of evidence Level IV: Case series.

scholarly journals Gender-specific difference in the recurrence of flexion contracture after total knee arthroplasty

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Tomofumi Kinoshita ◽  
Kazunori Hino ◽  
Tatsuhiko Kutsuna ◽  
Kunihiko Watamori ◽  
Takashi Tsuda ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Extension ◽  
Flexion Contracture ◽  
Specific Difference ◽  
Full Extension ◽  
Before And After ◽  
Total Knee ◽  
The Mean ◽  
Postoperative Knee ◽  
Gender Specific

Abstract Background Range of motion after total knee arthroplasty (TKA) can impact patients’ daily lives. Nevertheless, flexion contracture (FC) often recurs after TKA, even upon achieving full extension intraoperatively. This study aimed to evaluate the relationship among preoperative, intraoperative, and postoperative knee extension angles, and clarify the risk factor for postoperative FC. Methods One hundred forty-seven knees undergoing TKA using a navigation system were evaluated. We measured the pre- and postoperative (6 months after TKA) extension angles using a goniometer, and intraoperative (before and after TKA) extension angle using a navigation system; the correlation between these angles at each time point was evaluated. Results The mean preoperative, intraoperative (before and after TKA) and postoperative extension angles were -9.9°, -6.8°, -0.1°, and -2.0°. Regarding intraoperative extension angle after TKA, 58 knees showed ≤ 5° hyperextension and six knees showed > 5° hyperextension. At 6 months, no cases showed hyperextension and 105 knees showed full extension. The mean intraoperative extension angle after TKA in the postoperative full extension group was 0.4°. A significant correlation was found among extension angles at each point (p<0.01, respectively). However, the intraoperative extension angle after TKA correlated with the postoperative extension angle only in females. Contrarily, the recurrence rate of FC was significantly higher in males than in females (p<0.01). Conclusion Intraoperative extension angles significantly correlated with pre- and postoperative extension angles in TKA. Moreover, intraoperative mild (≤ 5°) hyperextension is acceptable for postoperative full extension. There was a gender-specific difference in correlation between intra- and postoperative knee extension angles. Level of evidence III.

scholarly journals Severity and Location of Lumbar Spine Stenosis Affects the Outcome of Total Knee Arthroplasty

2021 ◽  
Author(s):  
William Sheppard ◽  
Kevin M McKay ◽  
Alexander Upfill-Brown ◽  
Gideon Blumstein ◽  
Howard Park ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Lumbar Spine ◽  
Knee Arthroplasty ◽  
Flexion Contracture ◽  
Lumbar Spine Surgery ◽  
Level Of Evidence ◽  
Dural Sac ◽  
Targeted Analysis ◽  
Postoperative Flexion ◽  
Total Knee

Abstract BackgroundRecent studies have noted that patients with pre-existing lumbar spinal stenosis (LSS) have lower functional outcomes after total knee arthroplasty (TKA). Given that LSS manifests heterogeneously in location and severity, its influence on knee replacement merits a radiographically targeted analysis. We hypothesize that patients with more severe LSS will have diminished knee mobility following TKA. MethodsThis retrospective study assessed all TKAs performed at our institution for primary osteoarthritis from 2017-2020. Preoperative lumbar magnetic resonance image (MRI) with no prior lumbar spine surgery were necessary for inclusion. Stenosis severity was demonstrated by (1) anterior-posterior (AP) diameter of the dural sac and (2) morphological grade. TKA outcomes in 103 cases (94 patients) were assessed by measuring preoperative and postoperative arc of motion (AOM), postoperative flexion contracture, and need for manipulation under anesthesia. ResultsPatients with mild stenosis did significantly better in terms of postoperative knee AOM. As AP diameter decreased at levels L1-2, L2-3, L3-4, and L4-5, there was a significant reduction in preoperative-AOM (p<0.001 for each), with a 16 degree decrease when using patients’ most stenotic level (p<0.001). The same was noted with respect to increased morphological grade (p<0.001), with a 5 degree decrease for patients’ most stenotic level (p<0.001). ConclusionSevere LSS, which is readily demonstrated by a reduction in the AP diameter of the dural sac or increased morphological grade on MRI, correlated with a significant reduction in preoperative-AOM that was not improved after TKA. Persistent postoperative reductions in AOM may contribute to reduced patient satisfaction and recovery. Level of Evidence: Level 4

A dynamic knee extension device improves flexion contracture before total knee arthroplasty: a randomized controlled trial

2020 ◽  
Vol 31 (4) ◽  
pp. 347-351 ◽  
Author(s):  
Andrea H. Stone ◽  
Justin J. Turcotte ◽  
M. Brook Fowler ◽  
James H. MacDonald ◽  
Marc F. Brassard ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Randomized Controlled Trial ◽  
Knee Arthroplasty ◽  
Controlled Trial ◽  
Knee Extension ◽  
Flexion Contracture ◽  
Randomized Controlled ◽  
Total Knee

scholarly journals Range of Motion Comparison Following Total Knee Arthroplasty with and without Patella Resurfacing

2021 ◽  
Vol 11 ◽  
Author(s):  
Melissa Jackels ◽  
Samantha Andrews ◽  
Maya Matsumoto ◽  
Kristin Mathews ◽  
Cass Nakasone
Keyword(s):  
Total Knee Arthroplasty ◽  
Range Of Motion ◽  
Knee Arthroplasty ◽  
Knee Flexion ◽  
Knee Extension ◽  
Implant Design ◽  
Tourniquet Time ◽  
Full Extension ◽  
Total Knee ◽  
Low Incidence

Background: Despite significant evaluation, no consensus has been reach for best clinical practice for resurfacing the patella during total knee arthroplasty. Further complicating the ability to reach a conclusion is the inclusion of several different implant types used in previous research. Questions/Purpose: The purpose of this study was to compare post-TKA outcomes between two cruciate retaining implants with or without patella resurfacing. Methods: This retrospective review included 289 patients (380 knees) with a minimum six-month follow-up. All patients received a CR implant, with either a symmetric or an asymmetric tibial baseplate. Post-TKA knee flexion was categorized as <120° and ≥120° and knee extension classified as 0° or >0° and required knee manipulations were noted. Descriptive, nonparametric statistics were performed and a multivariate logistic regression was performed to determine risk of poor range of motion and manipulations. Results: Age was significantly lower in the resurfaced group (p=0.001) and the resurfaced group had longer tourniquet time (p=0.003). The symmetric-resurfaced group had ≥120° of flexion and full extension in 72% and 98.7% of patients, respectively. Compared to symmetric-resurfaced, all other groups had a significantly greater risk of not reaching 120° of knee flexion (p<0.05). There were no significant differences in the risk of requiring a MUA between groups (p>0.06). Conclusions: The effect of resurfacing the patella on post-TKA outcomes may be influenced by tibial implant design. Compared to all other combinations, a symmetric tibial baseplate and resurfaced patella resulted in the highest percentage of patients reaching ≥120°, with a low incidence of manipulations.

scholarly journals Severity and location of lumbar spine stenosis affects the outcome of total knee arthroplasty

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
William L. Sheppard ◽  
Kevin M. McKay ◽  
Alexander Upfill-Brown ◽  
Gideon Blumstein ◽  
Howard Y. Park ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Lumbar Spine ◽  
Knee Arthroplasty ◽  
Case Series ◽  
Flexion Contracture ◽  
Lumbar Spine Surgery ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Targeted Analysis ◽  
Total Knee

Abstract Background Recent studies have noted that patients with pre-existing lumbar spinal stenosis (LSS) have lower functional outcomes after total knee arthroplasty (TKA). Given that LSS manifests heterogeneously in location and severity, its influence on knee replacement merits a radiographically targeted analysis. We hypothesize that patients with more severe LSS will have diminished knee mobility before and after TKA. Methods This retrospective case series assessed all TKAs performed at our institution for primary osteoarthritis from 2017–2020. Preoperative lumbar magnetic resonance image (MRI) with no prior lumbar spine surgery was necessary for inclusion. Stenosis severity was demonstrated by (1) anterior–posterior (AP) diameter of the thecal sac and (2) morphological grade. TKA outcomes in 103 cases (94 patients) were assessed by measuring preoperative and postoperative arc of motion (AOM), postoperative flexion contracture, and need for manipulation under anesthesia. Results Patients with mild stenosis did significantly better in terms of postoperative knee AOM. As AP diameter decreased at levels L1–2, L2–3, L3–4, and L4–5, there was a significant reduction in preoperative-AOM (p < 0.001 for each), with a 16 degree decrease when using patients’ most stenotic level (p < 0.001). The same was noted with respect to increased morphological grade (p < 0.001), with a 5 degree decrease for patients’ most stenotic level (p < 0.001). Conclusion Severe LSS, which is readily demonstrated by a reduction in the AP diameter of the thecal sac or increased morphological grade on MRI, correlated with a significant reduction in preoperative AOM that was not improved after TKA. Persistent postoperative reductions in AOM may contribute to reduced patient satisfaction and recovery. Level of evidence: Level 4

scholarly journals Over-constrained kinematic of the medial compartment leads to lower clinical outcomes after total knee arthroplasty

2021 ◽  
Author(s):  
Nicola Pizza ◽  
Stefano Di Paolo ◽  
Raffaele Zinno ◽  
Giulio Maria Marcheggiani Muccioli ◽  
Piero Agostinone ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Clinical Outcomes ◽  
Knee Arthroplasty ◽  
Motor Task ◽  
Medial Compartment ◽  
Level Of Evidence ◽  
Contact Points ◽  
Sit To Stand ◽  
Medial Pivot ◽  
Total Knee

Abstract Purpose To investigate if postoperative clinical outcomes correlate with specific kinematic patterns after total knee arthroplasty (TKA) surgery. The hypothesis was that the group of patients with higher clinical outcomes would have shown postoperative medial pivot kinematics, while the group of patients with lower clinical outcomes would have not. Methods 52 patients undergoing TKA surgery were prospectively evaluated at least a year of follow-up (13.5 ± 6.8 months) through clinical and functional Knee Society Score (KSS), and kinematically through dynamic radiostereometric analysis (RSA) during a sit-to-stand motor task. Patients received posterior-stabilized TKA design. Based on the result of the KSS, patients were divided into two groups: “KSS > 70 group”, patients with a good-to-excellent score (93.1 ± 6.8 points, n = 44); “KSS < 70 group”, patients with a fair-to-poor score (53.3 ± 18.3 points, n = 8). The anteroposterior (AP) low point (lowest femorotibial contact points) translation of medial and lateral femoral compartments was compared through Student’s t test (p < 0.05). Results Low point AP translation of the medial compartment was significantly lower (p < 0.05) than the lateral one in both the KSS > 70 (6.1 mm ± 4.4 mm vs 10.7 mm ± 4.6 mm) and the KSS < 70 groups (2.7 mm ± 3.5 mm vs 11.0 mm ± 5.6 mm). Furthermore, the AP translation of the lateral femoral compartment was not significantly different (p > 0.05) between the two groups, while the AP translation of the medial femoral compartment was significantly higher for the KSS > 70 group (p = 0.0442). Conclusion In the group of patients with a postoperative KSS < 70, the medial compartment translation was almost one-fourth of the lateral one. Surgeons should be aware that an over-constrained kinematic of the medial compartment might lead to lower clinical outcomes. Level of evidence II.

scholarly journals Intraoperative manipulation for flexion contracture during total knee arthroplasty

2019 ◽  
Vol 27 (1) ◽  
pp. 230949901982557
Author(s):  
Yoshio Matsui ◽  
Masanori Matsuura ◽  
Yukihide Minoda ◽  
Sigeru Nakagawa ◽  
Yoshiaki Okajima ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Flexion Contracture ◽  
Total Knee

An imaging measurement study of normal knee parameters in southeast China

2021 ◽  
Vol 17 ◽  
Author(s):  
Huitong Liu ◽  
Bingqiang Xu ◽  
Eryou Feng ◽  
Shizhang Liu ◽  
Wei Zhang ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Tibial Plateau ◽  
Femoral Condyle ◽  
Age Groups ◽  
Young Group ◽  
Normal Female ◽  
Valgus Angle ◽  
Significant Difference ◽  
Total Knee

Background: Imaging measurement of distal femur and proximal tibia has been the hot point in the research of total knee arthroplasty and prosthesis development, which is an important treatment for patients with advanced knee joint disease. This study retrospectively investigated the digital imaging measurement of normal knee parameters in southeast China and evaluated their clinical value. Methods: From February 2010 to May 2014, and in accordance with the inclusion criteria, a total of 677 knees (334 female knees and 343 male knees) were categorized into 3 age groups. Clinical and digital imaging data, including the distal femoral condyle diameter (FCD), tibial plateau diameter (TPD), the distance between the medial tibial plateau and fibular head (DPF), tibiofemoral valgus angle, distal femoral valgus angle, proximal tibia (PT) varus angle and the angle from femoral condyle to tibial perpendicular (FT), were measured by using AutoCAD 10.0 software. All measured variables were statistically analyzed by SPSS statistical software (version 18.0). Results: Data are presented as the mean ± standard deviation. The normal female and male femoral condyle diameter was (7.69 ± 0.46) cm and (8.68 ± 0.55) cm, while the normal female and male tibial plateau diameter was (7.66 ± 0.46) cm and (8.60 ± 0.55) cm, respectively. The normal female and male DPF was (0.76 ± 0.36) cm and (0.79 ± 0.36) cm. For females and males, the tibiofemoral valgus angle and distal femoral valgus angle were (3.89 ± 2.20) ° and (3.29 ± 2.12) °, (9.03 ± 2.18) ° and (8.25 ± 2.20) °. As the two methods to measure tibial plateau varus angle, PT angle of normal female and male was (4.29 ± 1.86) ° and (4.84 ± 2.23) °, while the normal female and male FT angle was (5.34 ± 1.95) ° and (5.52 ± 2.07) °. Based on the data obtained, we found significant differences between the two genders in terms of the femoral condyle diameter and tibial plateau diameter in all age groups (P < 0.01). The DPF parameter showed an obvious difference between the young group and the middle-aged group (P < 0.05), and no significant difference was observed between the sides and genders (P > 0.05). The distal femoral valgus angle showed statistical differences between genders in the left side of the young group and middle-aged group (P < 0.05), while angle PT and FT showed no significant difference (P > 0.05). Conclusion: A large number of knee measurements was obtained, and a local knee database was developed in this study. Imaging measurement prior to total knee arthroplasty is clinically important for increasing the accuracy and long-term efficacy of total knee arthroplasty. These data can also provide useful information for knee surgery and sports medicine as well as prosthesis development.

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