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Medial soft tissue contracture does not always exist in varus osteoarthritis knees in total knee arthroplasty

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To evaluate preoperative soft tissue balance for total knee arthroplasty (TKA), varus/valgus stress radiographs has been used in previous studies. While the joint line of femur and tibia is almost parallel in healthy and postoperative knees, osteoarthritis (OA) knees exhibit articular cartilage wear that causes the joint line tilting even in a non-stress condition. Therefore, the exact angle of the joint line might mislead to understand the joint laxity in OA knees. The purpose of this study was to evaluate soft tissue balance in varus OA knees using preoperative stress radiographs under three different constant loads, taking the articular cartilage wear into consideration.

Methods

One hundred and eighteen varus-deformed OA knees in 102 patients were investigated before primary TKA. Preoperative knee radiographs were obtained in the anteroposterior view with no stress (defined as the neutral condition) and with varus and valgus stresses (5, 10, and 15 kg) in extension. Two different types of joint line angle (JLA), the absolute JLA (an exact angle of joint line) and the relative JLA (the absolute JLA minus the JLA in the neutral condition), were compared for the same load with the paired t test.

Results

The absolute JLA was 7.9 ± 1.2°/− 1.5 ± 2.2° under varus/valgus 15 kg stress, 6.7 ± 2.4°/− 0.3 ± 2.1° under varus/valgus 10 kg stress, and 4.7 ± 2.4°/1.1 ± 2.2° under varus/valgus 5 kg stress. Significant differences in the numerical values of the absolute JLA were observed between varus and valgus stresses for each load. The neutral JLA was 3.2 ± 2.0°. The relative JLA was 4.8 ± 2.1°/− 4.7 ± 1.8° under varus/valgus 15 kg stress, 3.5 ± 2.0°/− 3.5 ± 1.8° under varus/valgus 10 kg stress, and 1.5 ± 1.9°/− 2.1 ± 1.8° under varus/valgus 5 kg stress. No significant differences in the numerical values of the relative JLA were observed between varus and valgus stresses for each load.

Conclusions

Consideration of cartilage wear allowed knee laxity to be evaluated more precisely in this study than in previous reports. It was shown that medial soft tissue contracture did not always exist, even in varus OA knees. Regarding clinical relevance, surgeons should be aware that underestimating medial soft tissue laxity due to reliance on the absolute JLA might lead to excessive medial tissue release and result in postoperative instability and lower patient satisfaction.

Level of evidence

IV.

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Abbreviations

TKA:

Total knee arthroplasty

OA:

Osteoarthritis

JLA:

Joint line angle

AP:

Anteroposterior

FTA:

Femorotibial angle

HKA:

Hip–knee–ankle

MPTA:

Medial proximal tibia angle

PTA:

Posterior tibial slope

OARSI:

Osteoarthritis Research Society International

K–L:

Kellgren–Lawrence

ICC:

Intraclass correlation coefficients

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Funding

There was no funding for this study.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, Fukuoka, 812-8582, Japan

    Tetsuro Ushio, Hideki Mizu-uchi, Kazuki Miyama, Yukio Akasaki, Yuan Ma & Yasuharu Nakashima

  2. Department of Orthopaedic Surgery, Tokyo Women’s Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan

    Ken Okazaki

Authors
  1. Tetsuro Ushio
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  2. Hideki Mizu-uchi
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  3. Ken Okazaki
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  4. Kazuki Miyama
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  5. Yukio Akasaki
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  6. Yuan Ma
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  7. Yasuharu Nakashima
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Contributions

TU collected and analyzed the data and drafted the manuscript. HM is the corresponding author, and conceived of the study, participated in its design, collected and analyzed the data, and helped to draft the manuscript. KO collected and analyzed the data and assisted in drafting the manuscript. KM and YM collected and analyzed the data. YA assisted in drafting the manuscript. YN gave final approval to the manuscript.

Corresponding author

Correspondence to Hideki Mizu-uchi.

Ethics declarations

Conflict of interest

HM: Zimmer Biomet, paid presenter or speaker. KO: Zimmer Biomet, paid presenter or speaker; Smith & Nephew, paid presenter or speaker.

Ethical approval

The study protocol was approved by the Institutional Review Board of Kyushu University (IRB number 28-366).

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Ushio, T., Mizu-uchi, H., Okazaki, K. et al. Medial soft tissue contracture does not always exist in varus osteoarthritis knees in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 27, 1642–1650 (2019). https://doi.org/10.1007/s00167-018-5276-9

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  • DOI: https://doi.org/10.1007/s00167-018-5276-9

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