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Intraoperative physiological lateral laxity in extension and flexion for varus knees did not affect short-term clinical outcomes and patient satisfaction

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Abstract

Purpose

Medial release during total knee arthroplasty (TKA) is used to correct ligament imbalance in knees with varus deformity. However, questions remain on whether residual ligament imbalance would be related to inferior clinical results. The purposes of the present study were to measure the intraoperative joint gap and to evaluate the effect of intraoperative soft tissue condition on the new Knee Society Score (KSS 2011) at 2-year follow-up, without the maneuver of additional medial release to correct the asymmetrical gap balance.

Methods

Varus–valgus gap angle and joint gap were measured using a tensor device without medial release for 100 knees with preoperative varus deformity. The knees were categorized according to the varus–valgus gap angle and the laxity. The preoperative and postoperative clinical outcomes using KSS 2011 were compared between the groups.

Results

The average varus–valgus angles had a residual imbalance of 2.8° varus and 1.3° varus in extension and flexion, respectively. In comparison, according to varus–valgus joint gap angle and knee laxity in extension and flexion, no significant differences were found in postoperative range of motion and subscale of KSS 2011 among the groups.

Conclusion

Intraoperative asymmetrical joint gap and physiological laxity do not affect early clinical results after TKA.

Level of evidence

III.

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Abbreviations

TKA:

Total knee arthroplasty

KSS:

Knee Society Score

MCL:

Medial collateral ligament

SD:

Standard deviation

HKA:

Hip–knee–ankle

FMA:

Femoral mechanical angle

TMA:

Tibial mechanical angle

WOMAC:

Western Ontario and McMaster Universities Arthritis Index

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Author information

Correspondence to Shinichiro Nakamura.

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Conflict of interest

All authors declare that they have no conflict of interest.

Funding

One or more authors (SN and SM) received  research grant from Kyocera  outside the submitted work.

Ethical approval

The study design was approved by the institutional ethics review boards, and all procedures performed were in accordance with the ethical standards of the institutional research committee.

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Tanaka, Y., Nakamura, S., Kuriyama, S. et al. Intraoperative physiological lateral laxity in extension and flexion for varus knees did not affect short-term clinical outcomes and patient satisfaction. Knee Surg Sports Traumatol Arthrosc (2020). https://doi.org/10.1007/s00167-020-05862-4

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Keywords

  • Total knee replacement
  • Total knee arthroplasty
  • Genu varum
  • Collateral ligaments
  • Joint laxity