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Limited medial posterior capsular release increases the intraoperative medial component gap while maintaining the joint varus angle at extension in posterior-stabilized total knee arthroplasty

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

There is a lack of robust evidence for the magnitude of the effects of posterior capsular release (PCR) on intraoperative component gaps during total knee arthroplasty (TKA). The purpose of the present study was to quantify and compare the effects of partial versus full PCR on the intraoperative component gaps at various degrees of flexion during posterior-stabilized TKA.

Methods

Full PCR was performed on 39 consecutive cases (full PCR group), and partial PCR (the medial side up to and including the intercondylar notch) was performed on the subsequent 39 consecutive cases (partial PCR group) during posterior-stabilized TKA using the measured resection technique for varus knee osteoarthritis. Medial component gaps and varus angles at 0°, 10°, 45°, 90°, and a maximum of flexion were measured with a tensor device before and after the PCR. Differences between the two groups in post-release medial component gap increase and post-release joint varus angle increase were assessed using a t test. Pre- to post-release medial component gaps and joint varus angles in each group were compared using a paired samples t test.

Results

In both groups at 0° and 10° of flexion, post-release medial compartment gaps were significantly greater than pre-release gaps (all P < 0.001). At 45°, 90° and maximum flexion, the medial compartment gap increase did not exceed the minimal detectable change in either group. At 0° and 10° of flexion, there was no significant difference in post-release medial compartment gap change between the two groups. In the full PCR group, post-release joint varus angles at 0° of flexion were significantly greater than pre-release angles (P < 0.001), while there was no significant pre- and post-release difference in the partial PCR group. The change in post-release joint varus angles at 0° of flexion was significantly greater in the full PCR group than in the partial PCR group.

Conclusion

Both full and partial PCR show similar clinical usefulness for increasing the medial component gap at extension and reducing component gap mismatch. A partial PCR can be used to avoid increasing joint varus angles at 0° of flexion.

Level of evidence

Level 2 (prospective comparative study).

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Acknowledgements

Midori Tanabe for data registration; Vern Fischer for English language editing.

Funding

This study received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minamikoshigaya, Koshigaya, Saitama, Japan

    Hiroki Katagiri, Ryusuke Saito, Mikio Shioda, Tetsuya Jinno & Toshifumi Watanabe

  2. Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan

    Hiroki Katagiri

Authors
  1. Hiroki Katagiri
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  2. Ryusuke Saito
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  3. Mikio Shioda
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  4. Tetsuya Jinno
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  5. Toshifumi Watanabe
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Contributions

HK designed the initial plan, conducted the study, and completed the final manuscript. RS and TJ analyzed the data and drafted the manuscript. MS collected the data. TW designed the initial plan, conducted the study, and edited the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Toshifumi Watanabe.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the Institutional Review Board in Dokkyo Medical University Saitama Medical Center (research protocol identification number: 21071).

Informed consent

All the study participants provided their full written informed consent for participation in this clinical research prior to the operative procedure.

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Katagiri, H., Saito, R., Shioda, M. et al. Limited medial posterior capsular release increases the intraoperative medial component gap while maintaining the joint varus angle at extension in posterior-stabilized total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 31, 4187–4194 (2023). https://doi.org/10.1007/s00167-023-07425-9

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  • DOI: https://doi.org/10.1007/s00167-023-07425-9

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