scholarly journals Knee Stability following Posterior-Stabilized Total Knee Arthroplasty: Comparison of Medial Preserving Gap Technique and Measured Resection Technique

2021 ◽  
Author(s):  
Masanori Tsubosaka ◽  
Hirotsugu Muratsu ◽  
Naoki Nakano ◽  
Tomoyuki Kamenaga ◽  
Yuichi Kuroda ◽  
...  
Keyword(s):  
Rotation Angle ◽  
External Rotation ◽  
Surgical Techniques ◽  
Knee Stability ◽  
Posterior Stabilized ◽  
Medial Knee ◽  
Gap Technique ◽  
Measured Resection ◽  
Total Knee ◽  
Postoperative Knee

AbstractNovel medial preserving gap technique (MPGT) focuses on medial compartment stability and allows lateral physiological laxity. This study aimed to compare the MPGT with the measured resection technique (MRT) to determine which provides better postoperative knee stability after posterior-stabilized total knee arthroplasty (PS-TKA). Primary PS-TKA, using either MPGT (n = 65) or MRT (n = 65), was performed in 130 patients with varus knee osteoarthritis. Postoperative knee stabilities at extension and flexion were assessed using varus–valgus stress radiographs and stress epicondylar view, respectively (at 1 month, 6 months, 1 year, and 3 years postoperatively). The distance between the femoral prosthesis and polyethylene insert was measured on each medial and lateral side, defined as the medial joint opening (MJO) and lateral joint opening (LJO), respectively. Decreasing MJO or LJO translated to increasing postoperative stability. The femoral external rotation angle was compared between the two surgical techniques; postoperative knee stability was also compared between the medial and lateral compartments, as well as the surgical techniques. A significant difference was found in the femoral external rotation angle between MPGT (4.2 ± 0.2 degrees) and MRT (3.6 ± 0.1 degrees, p < 0.01). Postoperative MJOs both at extension and flexion were significantly smaller than LJOs using MPGT and MRT at all time points (p < 0.05). MJOs and LJOs at extension using MPGT were significantly smaller than those when using MRT, at 1 and 3 years postoperatively (p < 0.05). Furthermore, MJOs at flexion using MPGT were significantly smaller than those when using MRT at 6 months, 1 year, and 3 years postoperatively (p < 0.05). MPGT provided higher postoperative medial knee stability than MRT both at extension and flexion, even at 3 years after PS-TKA. This suggests that this newly developed surgical technique is a more feasible option than MRT for the preservation of postoperative medial knee stability.

The Effects of Resection Technique on Implant Migration in Single Radius Posterior-Stabilized Total Knee Replacement

2018 ◽  
Vol 33 (01) ◽  
pp. 078-083
Author(s):  
Matthew G. Teeter ◽  
Kevin Perry ◽  
Xunhua Yuan ◽  
James L. Howard ◽  
Brent A. Lanting
Keyword(s):  
Total Knee Replacement ◽  
Femoral Component ◽  
Knee Replacement ◽  
Tibial Component ◽  
Posterior Stabilized ◽  
Gap Balancing ◽  
Measured Resection ◽  
Total Knee ◽  
Single Radius ◽  
Component Migration

AbstractThe purpose of the present study was to measure the effects of gap balancing and resection techniques on migration of a single total knee replacement implant design. A total of 23 patients (24 knees) were recruited on referral to either a surgeon performing gap balancing or a surgeon performing measured resection and followed prospectively. All patients received a fixed bearing, posterior stabilized total knee replacement implant of a single radius femoral component design with cement fixation, and all aspects of care outside of resection technique were identical. Patients underwent radiostereometric analysis (RSA) at 2 weeks (baseline), 6 weeks, 3 months, 6 months, 1 year, and 2 years. Migration of the tibial and femoral components was compared between groups. Tibial component migration was greater at 2 years in the gap balancing group (mean difference = 0.336 mm, p = 0.036), but there was no difference at 1 year. One measured resection and three gap balancing tibial components demonstrated continuous migration > 0.2 mm between years 1 and 2. There was no difference in femoral component migration. Small differences in tibial component migration were found between the gap balancing and measured resection techniques. However, comparing the migration to established predictive thresholds for long-term loosening risk, implants performed with both techniques were found to have equally low revision risk.

The Influence of Postoperative Knee Stability on Patient Satisfaction in Cruciate-Retaining Total Knee Arthroplasty

2018 ◽  
Vol 33 (8) ◽  
pp. 2475-2479 ◽  
Author(s):  
Tomoyuki Kamenaga ◽  
Hirotsugu Muratsu ◽  
Yutaro Kanda ◽  
Hidetoshi Miya ◽  
Ryosuke Kuroda ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Patient Satisfaction ◽  
Knee Arthroplasty ◽  
Knee Stability ◽  
Cruciate Retaining ◽  
Total Knee ◽  
Postoperative Knee

The flexion gap preparation does not disturb the modified gap technique in posterior stabilized total knee arthroplasty

The Knee ◽  
2012 ◽  
Vol 19 (6) ◽  
pp. 832-835 ◽  
Author(s):  
Yukihide Minoda ◽  
Hiroyoshi Iwaki ◽  
Mitsuhiko Ikebuchi ◽  
Taku Yoshida ◽  
Hiroaki Nakamura
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Posterior Stabilized ◽  
Flexion Gap ◽  
Gap Technique ◽  
Total Knee

scholarly journals Comparison of Kinematics in Cruciate Retaining and Posterior Stabilized for Fixed and Rotating Platform Mobile-Bearing Total Knee Arthroplasty with respect to Different Posterior Tibial Slope

2018 ◽  
Vol 2018 ◽  
pp. 1-11 ◽  
Author(s):  
Kyoung-Tak Kang ◽  
Yong-Gon Koh ◽  
Juhyun Son ◽  
Oh-Ryong Kwon ◽  
Jun-Sang Lee ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
External Rotation ◽  
Mobile Bearing ◽  
Tibial Slope ◽  
Posterior Stabilized ◽  
Rotating Platform ◽  
Cruciate Retaining ◽  
Posterior Tibial ◽  
Total Knee

Reconstructed posterior tibial slope (PTS) plays a significant role in kinematics restoration after total knee arthroplasty (TKA). However, the effect of increased and decreased PTS on prosthetic type and design has not yet been investigated. We used a finite element model, validated using in vitro data, to evaluate the effect of PTS on knee kinematics in cruciate-retaining (CR) and posterior-stabilized (PS) fixed TKA and rotating platform mobile-bearing TKA. Anterior-posterior tibial translation and internal-external tibial rotation were investigated for PTS ranging from -3° to 15°, with increments of 1°, for three different designs of TKA. Tibial posterior translation and external rotation increased as the PTS increased in both CR and PS TKAs. In addition, there was no remarkable difference in external rotation between CR and PS TKAs. However, for the mobile-bearing TKA, PTS had less effect on the kinematics. Based on our computational simulation, PTS is the critical factor that influences kinematics in TKA, especially in the CR TKA. Therefore, the surgeon should be careful in choosing the PTS in CR TKAs.

scholarly journals Design and Cadaveric Validation of a Novel Device to Quantify Knee Stability During Total Knee Arthroplasty

2012 ◽  
Vol 134 (11) ◽  
Author(s):  
Robert A. Siston ◽  
Thomas L. Maack ◽  
Erin E. Hutter ◽  
Matthew D. Beal ◽  
Ajit M. W. Chaudhari
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Joint ◽  
Knee Arthroplasty ◽  
Surgical Techniques ◽  
Load Cell ◽  
Knee Stability ◽  
Joint Stability ◽  
Postoperative Function ◽  
New Device ◽  
Total Knee

The success of total knee arthroplasty depends, in part, on the ability of the surgeon to properly manage the soft tissues surrounding the joint, but an objective definition as to what constitutes acceptable postoperative joint stability does not exist. Such a definition may not exist due to lack of suitable instrumentation, as joint stability is currently assessed by visual inspection while the surgeon manipulates the joint. Having the ability to accurately and precisely measure knee stability at the time of surgery represents a key requirement in the process of objectively defining acceptable joint stability. Therefore, we created a novel sterilizable device to allow surgeons to measure varus-valgus, internal-external, or anterior-posterior stability of the knee during a total knee arthroplasty. The device can be quickly adjusted between 0 deg and 90 deg of knee flexion. The device interfaces with a custom surgical navigation system, which records the resultant rotations or translations of the knee while the surgeon applies known loads to a patient’s limb with a handle instrumented with a load cell. We validated the performance of the device by having volunteers use it to apply loads to a mechanical linkage that simulated a knee joint; we then compared the joint moments calculated by our stability device against those recorded by a load cell in the simulated knee joint. Validation of the device showed low mean errors (less than 0.21 ± 1.38 Nm and 0.98 ± 3.93 N) and low RMS errors (less than 1.5 Nm and 5 N). Preliminary studies from total knee arthroplasties performed on ten cadaveric specimens also demonstrate the utility of our new device. Eventually, the use of this device may help determine how intra-operative knee stability relates to postoperative function and could lead to an objective definition of knee stability and more efficacious surgical techniques.

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