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Archives of Orthopaedic and Trauma Surgery

, Volume 138, Issue 8, pp 1143–1150 | Cite as

Intraoperative medial joint laxity in flexion decreases patient satisfaction after total knee arthroplasty

  • Masayuki Azukizawa
  • Shinichi Kuriyama
  • Shinichiro Nakamura
  • Kohei Nishitani
  • Stephen Lyman
  • Yugo Morita
  • Moritoshi Furu
  • Hiromu Ito
  • Shuichi Matsuda
Knee Arthroplasty
  • 217 Downloads

Abstract

Introduction

The relationship between postoperative tibiofemoral ligament balance and patient satisfaction in total knee arthroplasty (TKA) has been explored previously. However, the optimal intraoperative medial–lateral ligament balance during knee flexion in terms of postoperative patient satisfaction remains unknown. We evaluated the effect of intraoperative flexion instability on patient satisfaction after TKA.

Materials and methods

This study consisted of 46 knees with varus osteoarthritis undergoing TKA. Medial–lateral component gaps at 0° knee extension and 90° flexion were measured intraoperatively using a knee balancer. Differences in postoperative patient outcomes at 3 weeks and 1 year were compared between medially tight knees in 90° flexion with a medial component gap of < 4 mm and medially loose knees in 90° flexion with a gap of ≥ 4 mm. Outcomes were measured using the 2011 Knee Society Scoring System (2011 KS).

Results

The median total 2011 KS score at 1 year postoperatively in the medially loose knees [median 97; interquartile range (IQR) 75–117] was significantly lower than that in the medially tight knees (median 128; IQR 104–139, P < 0.01), while preoperative and 3-week postoperative scores were similar. In addition, medial flexion gaps were not significantly associated with total 2011 KS scores before surgery or at 3 weeks postoperatively. However, at 1 year after surgery, medial component flexion gaps were negatively associated with the total 2011 KS score (R = − 0.42; P < 0.01) and the 2011 KS satisfaction subscale score (R = − 0.36; P = 0.01).

Conclusions

Excessive intraoperative medial joint laxity of ≥ 4 mm at 90° flexion progressively decreased patient satisfaction for 1 year. Since intraoperative medial laxity in flexion is likely to interfere with functional recovery after TKA, medial stabilization during TKA is important throughout knee flexion.

Level of evidence

Therapeutic study, Level III.

Keywords

Total knee arthroplasty Patient satisfaction Intraoperative medial joint laxity Joint gap Knee flexion 

Notes

Funding

No funds were received for this study.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interests.

Ethical approval

An institutional review board approved this study.

Informed consent

Informed consent to participate in the study was obtained for all patients prior to the surgical procedure.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Orthopaedic Surgery, Graduate School of MedicineKyoto UniversityKyotoJapan
  2. 2.Healthcare Research InstituteHospital for Special SurgeryNew YorkUSA
  3. 3.Department of Orthopaedic SurgeryFuru ClinicKogaJapan

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