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Intraoperative soft tissue balance using novel medial preserving gap technique in posterior-stabilized total knee arthroplasty: comparison to measured resection technique

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To investigate intraoperative soft tissue balance with femoral component trial in place using a novel medial preserving gap technique, focusing on medial compartment stability and allowing lateral physiological laxity, with compared with using a measured resection technique in posterior-stabilized (PS) total knee arthroplasty (TKA).

Methods

Primary PS TKA, using either medial preserving gap technique (n = 127) or measured resection technique (n = 148), was performed in 275 subjects with varus knee osteoarthritis. Intraoperative soft tissue balance with femoral component in place was assessed using Offset Repo-Tensor with 40 lbs. of joint distraction force throughout the range of motion, and medial and lateral compartment gaps (mm) were calculated. Medial and lateral joint gap changes (mm) were calculated by subtracting the medial/lateral compartment gap at 0° from the medial/lateral compartment gap at each knee flexion angle, respectively.

Results

Medial and lateral joint gap changes in medial preserving gap technique were significantly smaller than measured resection technique respectively (mean difference between two procedures: medial; 0.9 ± 0.2 mm, lateral; 1.0 ± 0.3 mm). Medial and lateral joint gaps were significantly changed during knee flexion in measured resection technique, whereas medial and lateral joint gaps were not significantly changed during mid-to-deep knee flexion (30°–90° in medial, 30°–120° in lateral) in medial preserving gap technique.

Conclusions

Medial preserving gap technique provided more consistent intraoperative soft tissue balance during knee flexion than the measured resection technique, suggesting that this novel technique can be utilized to obtain a more stable joint gap in PS TKA.

Level of evidence

III.

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Abbreviations

TKA:

Total knee arthroplasty

PS:

Posterior-stabilized

OA:

Osteoarthritis

CR:

Cruciate-retaining

PCL:

Posterior cruciate ligament

MCL:

Medial collateral ligament

ICC:

Interclass correlation coefficient

CI:

Confidential interval

PF:

Patellofemoral

AP:

Anteroposterior

CT:

Computed tomography

ANOVA:

Analysis of variance

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Acknowledgements

The authors would like to thank Dr. Akihiro Maruo, MD, Steel Memorial Hirohata Hospital for collecting data, and Dr. Brandon Marshall, PhD, University of Pittsburgh, for his assistance in editing the manuscript. We also would like to thank Editage (http://www.editage.jp) for English language editing.

Funding

No external source of funding was used.

Author information

Authors and Affiliations

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

    Kanto Nagai, Hirotsugu Muratsu, Yutaro Kanda, Masanori Tsubosaka, Tomoyuki Kamenaga & Hidetoshi Miya

  2. Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan

    Kanto Nagai, Yutaro Kanda, Masanori Tsubosaka, Takehiko Matsushita, Takahiro Niikura, Ryosuke Kuroda & Tomoyuki Matsumoto

Authors
  1. Kanto Nagai
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  2. Hirotsugu Muratsu
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  4. Masanori Tsubosaka
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  5. Tomoyuki Kamenaga
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  7. Takehiko Matsushita
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  9. Ryosuke Kuroda
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  10. Tomoyuki Matsumoto
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Corresponding author

Correspondence to Hirotsugu Muratsu.

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Conflict of interest

The authors declare no conflicts of interest in association with the present study.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Institutional review board approval for the study was provided by Steel Memorial Hirohata Hospital (no. ZIMU H28-0082).

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

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Nagai, K., Muratsu, H., Kanda, Y. et al. Intraoperative soft tissue balance using novel medial preserving gap technique in posterior-stabilized total knee arthroplasty: comparison to measured resection technique. Knee Surg Sports Traumatol Arthrosc 26, 3474–3481 (2018). https://doi.org/10.1007/s00167-018-4945-z

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  • DOI: https://doi.org/10.1007/s00167-018-4945-z

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