scholarly journals 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 ◽  
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.

The Impact of Intraoperative Gap Difference Between Extension and Flexion on Perception of Joint Function After Total Knee Arthroplasty: a Comparative Retrospective Study

2021 ◽  
Author(s):  
Tomohiro Okayoshi ◽  
Yoshinori Okamoto ◽  
Hitoshi Wakama ◽  
Shuhei Otsuki ◽  
Masashi Neo
Keyword(s):  
Total Knee Arthroplasty ◽  
Retrospective Study ◽  
Soft Tissue ◽  
Knee Joint ◽  
Predictive Factors ◽  
Knee Arthroplasty ◽  
Difference Threshold ◽  
Joint Function ◽  
Flexion Gap ◽  
Total Knee

Abstract Background: The argument presupposes that intra-operative soft tissue balance is associated with patient-reported outcome measures after total knee arthroplasty (TKA). Our aim was to assess the association between the extension-to-flexion gap and patients’ reported perception of knee joint function.Methods: This was a retrospective study of 60 cases of primary cruciate-retaining TKAs performed for the treatment of medial-compartment knee osteoarthritis, at a mean follow-up of 2.6 (range, 2.0–5.2) years. Knee perception was evaluated by asking patients whether they considered their knee joint as “natural” (grade I) or “artificial”, with or without restrictions (grades II–V). The following factors were compared between the two groups: age, sex, and the extension-to-flexion gap difference. A multiple logistic regression analysis was used to identify predictive factors of an artificial knee joint perception. A receiver operating characteristic curve analysis was used to identify cut-off values of predictive factors. Result: Compared to a natural knee joint perception (26 knees, 43%), an artificial perception (34 knees, 57%) was associated with a smaller gap difference at the distraction force of 20 lbf (p < .001), 30 lbf (p = .022), and 40 lbf (p = .038), a lower EuroQol 5-Dimension score (p = .029), and self-reported joint health (Knee injury and Osteoarthritis Outcome Score-Joint Replacement [KOOS-JR], p = .032). A gap difference <1.0 mm was a predictive of an artificial perception (odds ratio, 1.63; 95% confidence interval, 1.33–4.54; p < .001). A cut-off gap difference of 0.99 mm at 20 lbf predicted an artificial perception with a sensitivity of 81.5% and a specificity of 87.9%. Post-operative satisfaction (p < .001), KOOS-JR (p < .001), patient’s joint perception (p = .006), pain (p = .015), and EuroQol 5-Dimension (p = .032) differed between the two groups when the gap difference threshold was set to 1.0 mm.Conclusion: Careful balancing of soft tissue during TKA to achieve an extension-to-flexion gap ≥ 1.0 mm can improve patients’ perception of knee joint function and quality of life.

Posterior cruciate ligament resection in total knee arthroplasty

2019 ◽  
Vol 101-B (10) ◽  
pp. 1230-1237 ◽  
Author(s):  
Babar Kayani ◽  
Sujith Konan ◽  
Saman Horriat ◽  
Mazin S. Ibrahim ◽  
Fares S. Haddad
Keyword(s):  
Total Knee Arthroplasty ◽  
Posterior Cruciate Ligament ◽  
Knee Arthroplasty ◽  
Cruciate Ligament ◽  
Limb Alignment ◽  
Flexion Gap ◽  
Flexion Extension ◽  
Total Knee ◽  
The Mean ◽  
Extension Gap

Aims The aim of this study was to assess the effect of posterior cruciate ligament (PCL) resection on flexion-extension gaps, mediolateral soft-tissue laxity, fixed flexion deformity (FFD), and limb alignment during posterior-stabilized (PS) total knee arthroplasty (TKA). Patients and Methods This prospective study included 110 patients with symptomatic osteoarthritis of the knee undergoing primary robot-assisted PS TKA. All operations were performed by a single surgeon using a standard medial parapatellar approach. Optical motion capture technology with fixed femoral and tibial registration pins was used to assess gaps before and after PCL resection in extension and 90° knee flexion. Measurements were made after excision of the anterior cruciate ligament and prior to bone resection. There were 54 men (49.1%) and 56 women (50.9%) with a mean age of 68 years (sd 6.2) at the time of surgery. The mean preoperative hip-knee-ankle deformity was 4.1° varus (sd 3.4). Results PCL resection increased the mean flexion gap significantly more than the extension gap in the medial (2.4 mm (sd 1.5) vs 1.3 mm (sd 1.0); p < 0.001) and lateral (3.3 mm (sd 1.6) vs 1.2 mm (sd 0.9); p < 0.01) compartments. The mean gap differences after PCL resection created significant mediolateral laxity in flexion (gap difference: 1.1 mm (sd 2.5); p < 0.001) but not in extension (gap difference: 0.1 mm (sd 2.1); p = 0.51). PCL resection significantly improved the mean FFD (6.3° (sd 4.4) preoperatively vs 3.1° (sd 1.5) postoperatively; p < 0.001). There was a strong positive correlation between the preoperative FFD and change in FFD following PCL resection (Pearson’s correlation coefficient = 0.81; p < 0.001). PCL resection did not significantly affect limb alignment (mean change in alignment: 0.2° valgus (sd 1.2); p = 0.60). Conclusion PCL resection creates flexion-extension mismatch by increasing the flexion gap more than the extension gap. The increase in the lateral flexion gap is greater than the increase in the medial flexion gap, which creates mediolateral laxity in flexion. Improvements in FFD following PCL resection are dependent on the degree of deformity before PCL resection. Cite this article: Bone Joint J 2019;101-B:1230–1237

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

Balancing of total knee arthroplasty by bone cuts achieves accurately balanced soft tissues without the need for soft tissue releases

2018 ◽  
Vol 3 (5) ◽  
pp. 263-268 ◽  
Author(s):  
Ponky Firer ◽  
Brad Gelbart
Keyword(s):  
Total Knee Arthroplasty ◽  
Patient Satisfaction ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Soft Tissues ◽  
Size Difference ◽  
Gap Size ◽  
X Rays ◽  
Coronal Alignment ◽  
Total Knee

IntroductionPatient satisfaction, after mechanically aligned Total Knee Arthroplasty (TKA) is only 80%-85%. There is an inabilty to consistently get perfect soft tissue balance with this technique. It is postulated that soft tissue balance within 2° can be achieved by the boney cuts (Bone Balancing) without soft tissue releases, accepting whatever coronal mechanical alignment (CMA) this produces; that the alignment produced would be similar to natural (constitutional) alignment and that balanced knees would improve patient satisfaction.MethodsWe report on 914 consecutive TKAs using Bone Balancing: the femoral rotation for the flexion gap; the distal femoral cut and valgus angle for the extension gap are adjusted to give equal gap sizes with soft tissue balanced within 2° of medio-lateral laxity. Long leg X-rays were used to measure post-operative coronal alignment. Satisfaction beyond 1 year post operation was assessed by an independent researcher, using a question on satisfaction and a VAS score.Results782(85.5%) TKAs with satisfactory x-rays were available at 2-7 years follow up. Their CMA had a similar distribution profile to reported natural alignment studies. Of these, 672 (86%) had a CMA of 0°±3° (’aligned' group). Overall patient satisfaction was 92.8%, with satisfied patients having a mean (range) VAS score of 9.53 (7.3-10.0) and the dissatisfied patients 3.78 (0.0-6.3) (p<0.0001). There was no difference in satisfaction between ’aligned' knees (92.7%) and those ’outliers', whose CMA was >±3° (93.6%) (p=0.853). All balance measurements were within 3° with 92.2% being ≤2°. Gap size difference between extension and 90° flexion was ≤2mm in 98.7% of cases. Midflexion (45° flexion) balance was within 3° in all cases and the gap size difference was ≤2mm in 89%.ConclusionBalancing by bone cuts is able to achieve accurately balanced soft tissues without the need for soft tissue releases. The coronal alignment profile produced matches that of the normal population. This technique improves satisfaction compared to the literature for mechanically aligned TKAs. Acurate and measured soft tissue balancing needs further consideration in TKAs.Level of EvidenceLevel IV.

scholarly journals Changes in Joint Gap Balances between Intra- and Postoperation in Total Knee Arthroplasty

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Arata Nakajima ◽  
Yasuchika Aoki ◽  
Masazumi Murakami ◽  
Koichi Nakagawa
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Cruciate Ligament ◽  
Flexion Gap ◽  
Joint Gap ◽  
Significant Difference ◽  
Posterior Cruciate Ligament Retaining ◽  
Postoperative Flexion ◽  
Total Knee ◽  
Extension Gap

Achieving correct soft tissue balance and preparing equal and rectangular extension and flexion joint gaps are crucial goals of TKA. Intraoperative gap balances would change postoperatively; however, changes in joint gap balances between pre- and postoperation remain unclear. To explore these changes associated with TKA, we prospectively investigated 21 posterior cruciate ligament retaining TKAs for varus knees. Intraoperative extension gap balance (iEGB) was 2.6 ± 2.0° varus versus postoperative extension gap balance (pEGB) of 0.77 ± 1.8° valgus (P<0.01), while no significant difference between intraoperative flexion gap balance (iFGB) and postoperative flexion gap balance (pFGB) was observed. We also explored correlations between intraoperative and postoperative gap balances but found no significant correlations. These observations indicate that (i) surgeons should avoid excessive release of the medial soft tissue during TKA for varus knees and (ii) intraoperative gap balance may not be necessarily reflected on postoperative gap balance.

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