Abstract
Purpose
Given the knee kinematics and soft tissue balance in unicompartmental knee arthroplasty (UKA), it was hypothesised that intraoperative medial compartment stability will result in good functional outcome. The purpose of this study was to test the influence of soft tissue balance on post-operative knee flexion in UKA.
Methods
The influence of soft tissue balance on post-operative knee flexion in UKA was first examined retrospectively by using a newly developed tensor device in 30 consecutive patients diagnosed with either isolated medial compartmental osteoarthritis or idiopathic necrosis. The intraoperative component gap of the medial compartment was measured by using the tensor while applying a 20-lb joint distraction force at 0°, 10°, 30°, 45°, 60°, 90°, 120°, and 135° of knee flexion, with calculation of the joint looseness. Correlations between the soft tissue parameters and post-operative knee flexion angles were analysed 1 year after surgery.
Results
The post-operative knee flexion angle was negatively correlated with the component gap at 45°, 60°, and 90° of flexion (R = −0.41, P < 0.05; R = −0.44, P < 0.05; and R = −0.44, P < 0.05, respectively). Furthermore, the post-operative knee flexion angle was negatively correlated with joint looseness at 45°, 60°, and 90° of flexion (R = −0.40, P < 0.05; R = −0.41, P < 0.05; and R = −0.36, P < 0.05, respectively).
Conclusions
The intraoperative medial compartment stability of knee flexion in midrange resulted in increasing post-operative knee flexion angle in UKA. Medial soft tissue release should be minimised, and assessment of soft tissue balance using a tensor can be performed to predict the post-operative knee flexion angle during surgery for UKA.
Level of evidence
III.
Similar content being viewed by others
References
Collier MB, Eickmann TH, Sukezaki F, McAuley JP, Engh GA (2006) Patient, implant, and alignment factors associated with revision of medial compartment unicondylar arthroplasty. J Arthroplasty 21:108–115
Dennis DA, Mahfouz MR, Komistek RD, Hoff W (2005) In vivo determination of normal and anterior cruciate ligament-deficient knee kinematics. J Biomech 38:241–253
Emerson RH Jr, Head WC, Peters PC Jr (1992) Soft-tissue balance and alignment in medial unicompartmental knee arthroplasty. J Bone Joint Surg Br 74:807–810
Faul F, Erdfelder E, Buchner A, Lang AG (2009) Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods 41:1149–1160
Hernigou P, Deschamps G (2004) Alignment influences wear in the knee after medial unicompartmental arthroplasty. Clin Orthop Relat Res 423:161–165
Kanekasu K, Banks SA, Honjo S, Nakata O, Kato H (2004) Fluoroscopic analysis of knee arthroplasty kinematics during deep flexion kneeling. J Arthroplasty 19:998–1003
Matsuda S, Kawahara S, Okazaki K, Tashiro Y, Iwamoto Y (2013) Postoperative alignment and ROM affect patient satisfaction after TKA. Clin Orthop Relat Res 471:127–133
Matsumoto T, Kuroda R, Kubo S, Muratsu H, Mizuno K, Kurosaka M (2009) The intra-operative joint gap in cruciate-retaining compared with posterior-stabilised total knee replacement. J Bone Joint Surg Br 91:475–480
Matsumoto T, Muratsu H, Kubo S, Kuroda R, Kurosaka M (2013) Intra-operative joint gap kinematics in unicompartmental knee arthroplasty. Clin Biomech (Bristol, Avon) 28:29–33
Matsumoto T, Muratsu H, Tsumura N, Mizuno K, Kuroda R, Yoshiya S, Kurosaka M (2006) Joint gap kinematics in posterior-stabilized total knee arthroplasty measured by a new tensor with the navigation system. J Biomech Eng 128:867–871
Matsuzaki T, Matsumoto T, Kubo S, Muratsu H, Matsushita T, Kawakami Y, Ishida K, Oka S, Kuroda R, Kurosaka M (2014) Tibial internal rotation is affected by lateral laxity in cruciate-retaining total knee arthroplasty: an intraoperative kinematic study using a navigation system and offset-type tensor. Knee Surg Sports Traumatol Arthrosc 22:615–620
Mochizuki T, Sato T, Tanifuji O, Kobayashi K, Koga Y, Yamagiwa H, Omori G, Endo N (2013) In vivo pre- and postoperative three-dimensional knee kinematics in unicompartmental knee arthroplasty. J Orthop Sci 18:54–60
Muratsu H, Matsumoto T, Kubo S, Maruo A, Miya H, Kurosaka M, Kuroda R (2010) Femoral component placement changes soft tissue balance in posterior-stabilized total knee arthroplasty. Clin Biomech (Bristol, Avon) 25:926–930
Nakamura E, Banks SA, Tanaka A, Sei A, Mizuta H (2009) Three-dimensional tibiofemoral kinematics during deep flexion kneeling in a mobile-bearing total knee arthroplasty. J Arthroplasty 24:1120–1124
Patil S, Colwell CW Jr, Ezzet KA, D’Lima DD (2005) Can normal knee kinematics be restored with unicompartmental knee replacement? J Bone Joint Surg Am 87:332–338
Takayama K, Matsumoto T, Muratsu H, Ishida K, Shibanuma N, Araki D, Matsushita T, Kuroda R, Kurosaka M (2014) The tibia first technique with tensor measurement is useful to predict the soft tissue tension after implantation in unicompartmental knee arthroplasty. Int Orthop. doi:10.1007/s00264-014-2531-7
Utzschneider S, Goettinger M, Weber P, Horng A, Glaser C, Jansson V, Muller PE (2011) Development and validation of a new method for the radiologic measurement of the tibial slope. Knee Surg Sports Traumatol Arthrosc 19:1643–1648
Vince KG, Cyran LT (2004) Unicompartmental knee arthroplasty: new indications, more complications? J Arthroplasty 19:9–16
Von Keudell A, Sodha S, Collins J, Minas T, Fitz W, Gomoll AH (2014) Patient satisfaction after primary total and unicompartmental knee arthroplasty: an age-dependent analysis. Knee 21:180–184
Weber P, Schroder C, Laubender RP, Baur-Melnyk A, von Schulze Pellengahr C, Jansson V, Muller PE (2013) Joint line reconstruction in medial unicompartmental knee arthroplasty: development and validation of a measurement method. Knee Surg Sports Traumatol Arthrosc 21:2468–2473
Whiteside LA (2005) Making your next unicompartmental knee arthroplasty last: three keys to success. J Arthroplasty 20:2–3
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Matsuzaki, T., Matsumoto, T., Muratsu, H. et al. The contribution of intraoperative medial compartment stability to post-operative knee flexion angle in unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 25, 272–276 (2017). https://doi.org/10.1007/s00167-014-3493-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00167-014-3493-4