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The influence of patella height on soft tissue balance in cruciate-retaining and posterior-stabilised total knee arthroplasty

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Abstract

Purpose

Although the patella reduced or everted position has recently been recognised as an important factor influencing soft tissue balance during assessment in total knee arthroplasty (TKA), the influence of patella height on soft tissue balance has not been well addressed. Therefore, the relationship between soft tissue balance and patella height was investigated and differences between cruciate-retaining (CR) and posterior-stabilised (PS) TKA were compared.

Methods

Forty consecutive patients blinded to the type of implant received, were randomised prospectively. Using lateral radiographs, pre-operative patella height was measured. Using an offset-type tensor designed to measure the soft tissue balance with a reduced patellofemoral (PF) joint and femoral component in place, soft tissue balance was intra-operatively assessed in CR TKA (n = 20) and PS TKA (n = 20) in osteoarthritic patients. The joint component gap and varus ligament balance at zero, ten, 45, 90 and 135° of knee flexion with the patella reduced were measured.

Results

In PS TKA, the joint component gap positively correlated with patella height at 90 and 135° of knee flexion. However, there was no correlation between joint component gap and patella height at other flexion angles in PS TKA and any flexion angle in CR TKA. Varus ligament balance showed no significant correlation with patella height in either CR or PS TKA.

Conclusion

Analysis of soft tissue balance and patella height only showed a positive correlation in joint component gap at a high flexion angle (90 and 135°) in PS TKA but not in other parameters examined. Pre-operative measurement of patella height may be an important factor for predicting an intra-operative flexion gap in PS TKA.

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References

  1. Barrington JW, Sah A, Malchau H, Burke DW (2009) Contemporary cruciate-retaining total knee arthroplasty with a pegged tibial baseplate. Results at a minimum of 10 years. J Bone Joint Surg Am 91(4):874–878. doi:10.2106/JBJS.G.01609

    Article  PubMed  Google Scholar 

  2. Dixon MC, Brown RR, Parsch D, Scott RD (2005) Modular fixed-bearing total knee arthroplasty with retention of the posterior cruciate ligament. A study of patients followed for a minimum of 15 years. J Bone Joint Surg Am 87(3):598–603. doi:10.2106/JBJS.C.00591

    Article  PubMed  Google Scholar 

  3. Gioe TJ, Stroemer ES, Santos ER (2007) All-polyethylene and metal-backed tibias have similar outcomes at 10 years: a randomized level I [corrected] evidence study. Clin Orthop Relat Res 455:212–218. doi:10.1097/01.blo.0000238863.69486.97

    Article  PubMed  Google Scholar 

  4. Dorr LD, Boiardo RA (1986) Technical considerations in total knee arthroplasty. Clin Orthop Relat Res 205:5–11

    PubMed  Google Scholar 

  5. Insall J, Scott WN, Ranawat CS (1979) The total condylar knee prosthesis. A report of two hundred and twenty cases. J Bone Joint Surg Am 61(2):173–180

    PubMed  CAS  Google Scholar 

  6. Insall JN, Binazzi R, Soudry M, Mestriner LA (1985) Total knee arthroplasty. Clin Orthop Relat Res 192:13–22

    PubMed  Google Scholar 

  7. Takayama K, Matsumoto T, Kubo S, Muratsu H, Ishida K, Matsushita T, Kurosaka M, Kuroda R (2012) Influence of intra-operative joint gaps on post-operative flexion angle in posterior cruciate-retaining total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 20(3):532–537. doi:10.1007/s00167-011-1594-x

    Article  PubMed  Google Scholar 

  8. 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(6):867–871. doi:10.1115/1.2354201

    Article  PubMed  Google Scholar 

  9. 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 25(9):926–930. doi:10.1016/j.clinbiomech.2010.06.020

    Article  Google Scholar 

  10. 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(4):475–480. doi:10.1302/0301-620X.91B4.21862

    Article  PubMed  CAS  Google Scholar 

  11. Matsumoto T, Mizuno K, Muratsu H, Tsumura N, Fukase N, Kubo S, Yoshiya S, Kurosaka M, Kuroda R (2007) Influence of intra-operative joint gap on post-operative flexion angle in osteoarthritis patients undergoing posterior-stabilized total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 15(8):1013–1018. doi:10.1007/s00167-007-0331-y

    Article  Google Scholar 

  12. Matsumoto T, Muratsu H, Tsumura N, Mizuno K, Kurosaka M, Kuroda R (2009) Soft tissue balance measurement in posterior-stabilized total knee arthroplasty with a navigation system. J Arthroplast 24(3):358–364. doi:10.1016/j.arth.2008.01.001

    Article  Google Scholar 

  13. Lee TQ, Gerken AP, Glaser FE, Kim WC, Anzel SH (1997) Patellofemoral joint kinematics and contact pressures in total knee arthroplasty. Clin Orthop Relat Res 340:257–266

    Article  PubMed  Google Scholar 

  14. Insall J, Salvati E (1971) Patella position in the normal knee joint. Radiology 101(1):101–104

    PubMed  CAS  Google Scholar 

  15. Portner O, Pakzad H (2011) The evaluation of patellar height: a simple method. J Bone Joint Surg Am 93(1):73–80. doi:10.2106/JBJS.I.01689

    Article  PubMed  Google Scholar 

  16. Bergfeld JA, McAllister DR, Parker RD, Valdevit AD, Kambic H (2001) The effects of tibial rotation on posterior translation in knees in which the posterior cruciate ligament has been cut. J Bone Joint Surg Am 83-A(9):1339–1343

    PubMed  CAS  Google Scholar 

  17. Gollehon DL, Torzilli PA, Warren RF (1987) The role of the posterolateral and cruciate ligaments in the stability of the human knee. A biomechanical study. J Bone Joint Surg Am 69(2):233–242

    PubMed  CAS  Google Scholar 

  18. Li G, Gill TJ, DeFrate LE, Zayontz S, Glatt V, Zarins B (2002) Biomechanical consequences of PCL deficiency in the knee under simulated muscle loads—an in vitro experimental study. J Orthop Res 20(4):887–892. doi:10.1016/S0736-0266(01)00184-X

    Article  PubMed  Google Scholar 

  19. Kadoya Y, Kobayashi A, Komatsu T, Nakagawa S, Yamano Y (2001) Effects of posterior cruciate ligament resection on the tibiofemoral joint gap. Clin Orthop Relat Res 391:210–217

    Article  PubMed  Google Scholar 

  20. Mihalko W, Fishkin Z, Krackow K (2006) Patellofemoral overstuff and its relationship to flexion after total knee arthroplasty. Clin Orthop Relat Res 449:283–287. doi:10.1097/01.blo.0000218756.89439.06

    Article  PubMed  Google Scholar 

  21. Komatsu T, Kadoya Y, Nakagawa S, Yoshida G, Takaoka K (2005) Movement of the posterior cruciate ligament during knee flexion—MRI analysis. J Orthop Res 23(2):334–339. doi:10.1016/j.orthres.2004.08.001

    Article  PubMed  Google Scholar 

  22. Gejo R, Morita Y, Matsushita I, Sugimori K, Kimura T (2008) Joint gap changes with patellar tendon strain and patellar position during TKA. Clin Orthop Relat Res 466(4):946–951. doi:10.1007/s11999-008-0154-2

    Article  PubMed  Google Scholar 

  23. Matsumoto T, Muratsu H, Kubo S, Matsushita T, Kurosaka M, Kuroda R (2011) Soft tissue tension in cruciate-retaining and posterior-stabilized total knee arthroplasty. J Arthroplast 26(5):788–795. doi:10.1016/j.arth.2010.06.006

    Article  Google Scholar 

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Acknowledgments

The authors acknowledge Mrs. Janina Tubby for her assistance in preparation of this manuscript.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, chuo-ku, Kobe, 650-0017, Japan

    Yuichiro Nishizawa, Tomoyuki Matsumoto, Seiji Kubo, Takehiko Matsushita, Shinya Oka, Kazunari Ishida, Tokio Matsuzaki, Kotaro Nishida, Toshihiro Akisue, Ryosuke Kuroda & Masahiro Kurosaka

  2. Department of Orthopaedic Surgery, Nippon Steel Hirohata Hospital, 3-1, Yumesaki-cho, Hirohata-ku, Himeji, 671-1122, Japan

    Hirotsugu Muratsu

Authors
  1. Yuichiro Nishizawa
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  2. Tomoyuki Matsumoto
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  3. Seiji Kubo
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  4. Hirotsugu Muratsu
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  5. Takehiko Matsushita
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  6. Shinya Oka
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  7. Kazunari Ishida
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  8. Tokio Matsuzaki
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  9. Kotaro Nishida
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  11. Ryosuke Kuroda
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  12. Masahiro Kurosaka
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Correspondence to Tomoyuki Matsumoto.

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Nishizawa, Y., Matsumoto, T., Kubo, S. et al. The influence of patella height on soft tissue balance in cruciate-retaining and posterior-stabilised total knee arthroplasty. International Orthopaedics (SICOT) 37, 421–425 (2013). https://doi.org/10.1007/s00264-012-1749-5

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  • DOI: https://doi.org/10.1007/s00264-012-1749-5

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