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Dynamic gap analysis of valgus knees shows large inter-individual variability of gaps

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was to investigate the dynamic gap widths of valgus knees in extension and flexion to evaluate the influence of deformity on gap differences and to find out whether different ligamentous subtypes in valgus knees exist.

Methods

Dynamic gap widths of 1000 consecutive total knee arthroplasty (TKA) patients were measured at different flexion angles by applying a computer-assisted surgery (CAS) technique. 198 knees showed a valgus deformity and were assessed regarding its degree of fulfillment of the following criteria of valgus knee: 1. Medial extension gap greater than lateral; 2. Medial flexion gap greater than lateral; 3. Flexion gap greater than extension gap. A single-factor ANOVA subgroup analysis was performed, based on the amount of deformity. The effect of other patient factors (age, gender, weight) on gap differences was investigated.

Results

The medial extension gap (3.7 ± 2.2 mm) was significantly (p < 0.01) larger than the lateral extension gap (1.1 ± 2.9 mm). The amount of deformity correlated highly with gap difference in extension (r2 = 0.67) but not in flexion. In 92.4% (183), the flexion gap (6.2 ± 3.1 mm) was significantly (p < 0.01) larger than the extension gap (2.4 ± 2.3 mm). Only 29.3% (58) of patients met all three criteria, this was mainly due to the fact that in flexion the medial gap was larger than the lateral in only 35.4% (70). Patient factors showed no significant influences (NS) on the gap widths.

Conclusion

Valgus knees show large variability in terms of gap widths. The extent of deformity correlates highly with gap difference in extension, but not in other flexion angles. Vast majority of valgus knees were valgus in extension only. Because of this variability, it should be aimed for an individualized balancing technique based on intraoperative gap sizes.

Level of Evidence

Level III.

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References

  1. Ranawat AS, Ranawat CS, Elkus M, Rasquinha VJ, Rossi R, Babhulkar S (2005) Total knee arthroplasty for severe valgus deformity. J Bone Joint Surg Am 87(1):271–284

    Article  PubMed  Google Scholar 

  2. Rossi R, Rosso F, Cottino U, Dettoni F, Bonasia DE, Bruzzone M (2014) Total knee arthroplasty in the valgus knee. Int Orthop 38(2):273–283

    Article  PubMed  Google Scholar 

  3. Lange J, Haas SB (2017) Correcting severe valgus deformity: taking out the knock. Bone Joint J 99(1):60–64

    Article  PubMed  Google Scholar 

  4. Lombardi AV Jr, Dodds KL, Berend KR, Mallory TH, Adams JB (2004) An algorithmic approach to total knee arthroplasty in the valgus knee. J Bone Joint Surg Am 86(2):62–71

    Article  PubMed  Google Scholar 

  5. McAuliffe MJ, Roe J, Garg G, Whitehouse SL, Crawford R (2017) The varus osteoarthritic knee has no coronal contractures in 90 degrees of flexion. J Knee Surg 30(4):297–303

    PubMed  Google Scholar 

  6. Nikolopoulos D, Michos I, Safos G, Safos P (2015) Current surgical strategies for total arthroplasty in valgus knee. World J Orthop 6(6):469–482

    Article  PubMed  PubMed Central  Google Scholar 

  7. van der List JP, Chawla H, Joskowicz L, Pearle AD (2016) Current state of computer navigation and robotics in unicompartmental and total knee arthroplasty: a systematic review with meta-analysis. Knee Surg Sports Traumatol Arthrosc 24(11):3482–3495

    Article  PubMed  Google Scholar 

  8. Hirschmann MT, Moser LB, Amsler F, Behrend H, Leclerq V, Hess S (2019) Functional knee phenotypes: a novel classification for phenotyping the coronal lower limb alignment based on the native alignment in young non-osteoarthritic patients. Knee Surg Sports Traumatol Arthrosc 27(5):1394–1402

    Article  PubMed  Google Scholar 

  9. Deep K, Shankar S, Mahendra A (2017) Computer assisted navigation in total knee and hip arthroplasty. SICOT J 3(50):1–6

    Google Scholar 

  10. Pertusson G, Fentad AM, Gothesen O, Dyrhovden GS, Hallan G, Röhrl SM et al (2018) Computer-assisted compared with conventional total knee replacement. J Bone Joint Surg Am 100(15):1265–1274

    Article  Google Scholar 

  11. Graichen H, Lekkreusuwan K, Eller K, Grau T, Hirschmann MT, Scior W (2021) A single type of varus knee does not exist: morphotyping and gap analysis in varus OA. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-021-06688-4

    Article  PubMed  PubMed Central  Google Scholar 

  12. Hohman DW Jr, Nodzo SR, Phillips M, Fitz W (2015) The implications of mechanical alignment on soft tissue balancing in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 23(12):3632–3636

    Article  PubMed  Google Scholar 

  13. Springer B, Bechler U, Waldstein W, Rueckl K, Boettner CS, Boettner F (2020) The influence of femoral and tibial bony anatomy on valgus OA of the knee. Knee Surg Sports Traumatol Arthrosc 28(9):2998–3006

    Article  PubMed  Google Scholar 

  14. McAuliffe MJ, Garg G, Orschulok T, Roe J, Whitehouse SL, Crawford R (2019) Coronal plane laxity of valgus osteoarthritic knee. J Orthop Surg 27(1):2309499019833058. https://doi.org/10.1177/2309499019833058

    Article  Google Scholar 

  15. Mehliß V, Strauch Leira M, Serrano Olaizola A, Scior W, Graichen H (2019) Proven accuracy for a new dynamic gap measurement in navigated TKA. Knee Surg Sports Traumatol Arthrosc 27(4):1189–1195

    Article  PubMed  Google Scholar 

  16. Brilhault J, Burdin P, Canciani JP, Courage O, Hulet C, Letenneur J (2004) Les prothèses totales de genou dans les grandes de ́viations axiales. Ann Orthop Ouest 36:253–288

    Google Scholar 

  17. Matziolis G, Matziolis D, Perka C (2012) Pre-operative frontal plane malalignment predicts the extension gap asymmetry in knee osteoarthritis. Int Orthop 36:79–82

    Article  PubMed  Google Scholar 

  18. Goltzer O, Mroz TP, Temkit M, Clarke HD, Spangehl MJ (2017) Preoperative radiographic valgus alignment predicts the extent of lateral soft tissue release and need for constraint in valgus total knee arthroplasty. Arthroplasty Today 3(4):303–308

    Article  PubMed  PubMed Central  Google Scholar 

  19. Xie K, Lyons ST (2017) Soft tissue releases in total knee arthroplasty for valgus deformities. J Arthroplasty 32(6):1814–1818

    Article  PubMed  Google Scholar 

  20. Bellemans J, Vandenneucker H, Vanlauwe J, Victor J (2010) The influence of coronal plane deformity on mediolateral ligament status: an observational study in varus knees. Knee Surg Sports Traumatol Arthrosc 18:152–156

    Article  PubMed  Google Scholar 

  21. Roth JD, Howell SM, Hull ML (2015) Native knee laxities at 0°, 45°, and 90° of flexion and their relationship to the goal of the gap-balancing alignment method of total knee arthroplasty. J Bone Joint Surg Am 97:1678–1684

    Article  PubMed  Google Scholar 

  22. Tokuhara Y, Kadoya Y, Nakagawa S, Kobayashi A, Takaoka K (2004) The flexion gap in normal knees An MRI study. J Bone Joint Surg Br 86(8):1133–1136

    Article  CAS  PubMed  Google Scholar 

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Funding

No grants or other funding were received for this study.

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Authors and Affiliations

  1. Department for Arthroplasty, Sports-Traumatology and General Orthopaedics, Asklepios Orthopaedic Hospital Lindenlohe, Lindenlohe 18, 92421, Schwandorf, Germany

    Kim Eller, Wolfgang Scior & Heiko Graichen

Authors
  1. Kim Eller
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  2. Wolfgang Scior
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  3. Heiko Graichen
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Contributions

HG conceived and planned the study. HG and WS planned and performed operations. KE contributed to the processing and analysis of the data. KE and HG took the lead in writing the manuscript. KE, WS and HG were responsible for corrections and revisions. All authors provided critical feedback and helped design the study, analyze the data, and write the manuscript.

Corresponding author

Correspondence to Kim Eller.

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Conflict of interest

Each author (Kim Eller, Wolfgang Scior, Heiko Graichen) confirms that he or she has no commercial affiliations that could constitute a conflict of interest in connection with the submitted article.

Ethical approval

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and its later amendments. Our evaluations were written exclusively in anonymized form and applicable data protection regulations were observed.

Informed consent

Written consent of all patients for data collection was obtained prior to Hospital entry.

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Eller, K., Scior, W. & Graichen, H. Dynamic gap analysis of valgus knees shows large inter-individual variability of gaps. Knee Surg Sports Traumatol Arthrosc 31, 1398–1404 (2023). https://doi.org/10.1007/s00167-022-07088-y

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  • DOI: https://doi.org/10.1007/s00167-022-07088-y

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