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Component gap measurement reflects the planned gap balance during total knee arthroplasty more accurately and reliably than bone surface gap measurement

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

This study aimed to compare the reliability of two gap assessment methods (component and bone surface gap measurement vs. planned gap balance) and identify the contributors to component gaps other than planned gaps.

Methods

The prospectively collected data for 122 consecutive primary total knee arthroplasties (TKAs; 114 patients). After femoral planning for gap balancing, the medial and lateral planned gaps were calculated (planned gap). The established medial extension and flexion gaps (MEG and MFG, respectively) and lateral extension and flexion gaps (LEG and LFG, respectively) were measured with and without the TKA components (bone surface and component gaps) at 0° and 90° flexion. The intraclass and Pearson correlation coefficients for each gap measurement method were assessed using planned gap values, and multiple linear regression analyses were performed to identify the contributors to component gaps.

Results

Compared with the bone surface gap measurement, the component gap measurement showed higher reliability and stronger correlation with the planned gap balance for each gap. The changes in the medial posterior femoral offset contributed to the MEG and LEG, whereas those in the joint line height contributed to the LEG. The changes in the hip–knee–ankle angle and lateral posterior femoral offset contributed to the LFG.

Conclusion

Component gap measurements of the established gap more accurately and reliably reflect the planned gap balance than do bone surface gap measurements. The established gaps are affected by several factors other than femoral planning.

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Abbreviations

HKA:

Hip–knee–ankle

ICC:

Intraclass correlation coefficient

JLH:

Joint line height

KSKS:

Knee Society Knee Score

KSFS:

Knee Society Function Score

LEG:

Lateral extension gap

LFG:

Lateral flexion gap

LPFO:

Lateral posterior femoral offset

MCL:

Medial collateral ligament

MEG:

Medial extension gap

MFG:

Medial flexion gap

MPFO:

Medial posterior femoral offset

ROM:

Range of motion

TKA:

Total knee arthroplasty

WOMAC:

Western Ontario and McMaster Universities Osteoarthritis index

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, 73 Inchon-ro, Sungbuk-gu, Seoul, 02841, South Korea

    Kyun-Ho Shin, Ki-Mo Jang & Seung-Beom Han

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Contributions

Conception and design: SB Han and KH Shin; data collection: KH Shin and KM Jang; analysis and interpretation: KH Shin; writing the article: KH Shin; critical revision of the article for intellectual content: SB Han and KH Shin; final approval of the article: SB Han; statistical analysis: KH Shin; obtained funding: not applicable; overall responsibility: KH Shin, KM Jang and SB Han.

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Correspondence to Seung-Beom Han.

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Conflict of interest

All authors declare no conflict of interest regarding the preparation of the manuscript. No funding source is applicable to any part of this study.

Ethical approval

This study was approved by the institutional review board of Anam Hospital of Korea University Medical Center.

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Shin, KH., Jang, KM. & Han, SB. Component gap measurement reflects the planned gap balance during total knee arthroplasty more accurately and reliably than bone surface gap measurement. Knee Surg Sports Traumatol Arthrosc 30, 584–592 (2022). https://doi.org/10.1007/s00167-020-06324-7

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