A quantitative method of effective soft tissue management for varus knees in total knee replacement surgery using navigational techniques

Total knee replacement (TKR) has become the standard procedure in management of degenerative joint disease with its success depending mainly on two factors: three-dimensional alignment and soft-tissue balancing. The aim of this work was to develop and validate an algorithm to indicate appropriate medial soft tissue release during TKR for varus knees using initial kinematics quantified via navigation techniques. Kinematic data were collected intra-operatively for 46 patients with primary end-stage osteoarthritis undergoing TKR surgery using a computer-tomography-free navigation system. All patients had preoperative varus knees and medial release was made using the surgeon's experience. Based on these data an algorithm was developed. This algorithm was validated on a further set of 35 patients where it was used to define the medial release based on the kinematic data. The post-operative valgus stress angles for the two groups were compared. These results showed that the algorithm was a suitable tool to indicate the type of medial release required in varus knees based on intra-operatively measured pre-implant valgus stress and extension deficit angles. It reduced the percentage of releases made and the results were more appropriate than the decisions made by an experienced surgeon.

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Can the need for soft tissue release in total knee replacement be predicted pre-operatively? A study based on surgical navigation

International Orthopaedics ◽

10.1007/s00264-021-05263-3 ◽

2021 ◽

Author(s):

Daniel Hernandez-Vaquero ◽

Alfonso Noriega-Fernandez ◽

Sergio Roncero-Gonzalez ◽

Gorka Luis Ruete-Gil ◽

Jose Manuel Fernandez-Carreira

Keyword(s):

Soft Tissue ◽

Total Knee Replacement ◽

Knee Replacement ◽

Surgical Navigation ◽

Lateral Release ◽

Soft Tissue Release ◽

Computer Assisted ◽

Lateral Side ◽

Valgus Stress ◽

Total Knee

Abstract Introduction In complex and deformed knees, soft tissue release (STR) is required to obtain symmetry in the femorotibial gap. The objective of this study was to attempt to predict the need for soft tissue release using surgical navigation in total knee replacement (TKR). Methods Prospective and non-randomized study. One hundred thirty knees. At the start of navigation, an attempt was made to correct the femorotibial mechanical axis by applying force to the medial or lateral side of the knee (varus-valgus stress angle test). A gap balanced technique with computer-assisted surgery (CAS) was performed in all cases. The ligaments were tensioned, and using CAS visualization and control, progressive STR was performed in the medial or lateral side until a symmetry of the femorotibial gap was achieved. Results Eighty-two patients had a varus axis ≥ 3° and 38 had a valgus axis (P < 0.001). STR was performed under navigation control in 38.5% of cases, lateral release (LR) in 12 cases, and medial release (MR) in 38 cases. After performing the varus-valgus stress angle test (VVSAT), the axis of 0° could be restored at some point during the manoeuvre in 28 cases. STR was required in 44.6% of varus cases and 27% of valgus cases (P = 0.05). A significant relationship was found between the previous deformity and the need for MR (P < 0.001) or LR (P = 0.001). STR was more common in male patients (P = 0.002) and as obesity increased. Conclusion This study shows that pre-operative factors favouring the need to perform STR in a TKR implant can be defined.

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Collateral soft tissue release in primary total knee replacement

Computer Aided Surgery ◽

10.3109/10929088.2014.889212 ◽

2014 ◽

Vol 19 (1-3) ◽

pp. 29-33 ◽

Cited By ~ 10

Author(s):

Stuart Goudie ◽

Kamal Deep

Keyword(s):

Soft Tissue ◽

Total Knee Replacement ◽

Knee Replacement ◽

Soft Tissue Release ◽

Primary Total Knee Replacement ◽

Total Knee ◽

Primary Total Knee

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Short-term outcome in total knee replacement after soft-tissue release and balancing

Journal of Bone and Joint Surgery - British Volume ◽

10.1302/0301-620x.90b2.19327 ◽

2008 ◽

Vol 90-B (2) ◽

pp. 159-165 ◽

Cited By ~ 56

Author(s):

L. Unitt ◽

A. Sambatakakis ◽

D. Johnstone ◽

T. W. R. Briggs

Keyword(s):

Soft Tissue ◽

Total Knee Replacement ◽

Knee Replacement ◽

Soft Tissue Release ◽

Short Term ◽

Term Outcome ◽

Short Term Outcome ◽

Total Knee

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Assessing the Role of Minimal Medial Tissue Release during Navigation-Assisted Varus Total Knee Arthroplasty Based on the Degree of Preoperative Varus Deformity

The Journal of Knee Surgery ◽

10.1055/s-0040-1722658 ◽

2021 ◽

Author(s):

Seikai Toyooka ◽

Hironari Masuda ◽

Nobuhiro Nishihara ◽

Wataru Miyamoto ◽

Takashi Kobayashi ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Soft Tissue ◽

Knee Arthroplasty ◽

Varus Deformity ◽

Soft Tissue Release ◽

Neutral Position ◽

Valgus Stress ◽

Total Knee ◽

Neutral Alignment ◽

Medial Release

AbstractWe assessed the impact of a minimal medial soft-tissue release with complete peripheral osteophyte removal on the ability to attain manual preresection deformity correction during navigation-assisted total knee arthroplasty (TKA) for varus osteoarthritis. We included 131 TKAs for 109 patients with medial compartment predominant osteoarthritis. The steps for achieving minimal medial soft-tissue release were performed as follows: (1) elevation of a periosteal sleeve to 5-mm distal to the joint line and (2) complete removal of peripheral osteophytes. The evaluation criteria of this study were as follows: (1) age, (2) height, (3) weight, (4) body mass index (BMI), (5) sex, (6) the preoperative femorotibial mechanical angle in the neutral position before medial release and (7) the mechanical angle in maximum manual valgus stress after the two-step medial-release procedure (measured on the navigation screens). Multiple regression analysis of the criteria was performed to determine the degree of varus deformity that allowed neutral alignment but required extensive medial release. The femorotibial mechanical angle in the neutral position before medial release and sex correlated with the mechanical angle in maximum manual valgus stress on the navigation screen after medial release (r = 0.72, p < 0.001). Based on the regression formula, the maximum degree of preoperative varus deformity that allowed neutral alignment by the minimum medial-release procedure was 5.3 degrees for males and 9.1 degrees for females. The magnitude of deformity which has an impact on the ability to correct varus deformity (by minimal soft-tissue release and complete osteophyte removal) was clarified. If the preoperative degree of varus deformity was within 5.3 degrees for males and 9.1 degrees for females, an extensive medial release was not required to obtain neutral alignment.

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