Skip to main content
SpringerLink
Log in

Pre-operative frontal plane malalignment predicts the extension gap asymmetry in knee osteoarthritis

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

In contrast to bone cuts, soft-tissue releases cannot be planned sufficiently prior to total knee arthroplasty (TKA). Intra-operative evaluation of the extension gap after tibial or femoral resection may result in an unnecessarily excessive bone resection. The present study examines whether extension gap asymmetry can be calculated from the pre-operative long standing X-ray.

Methods

In this retrospective study, 32 patients with navigated unconstrained TKA were included. The pre-operative malalignment was measured on long standing X-rays and compared with the extension gap asymmetry that was documented by the navigation system intra-operatively.

Results

The mean pre-operative malalignment was 9.8° (20° valgus to 14.8° varus). The intra-operatively measured extension gap showed a mean asymmetry of 3.4 ± 2.4 mm. Both correlated following the equation: asymmetry [mm] = 0.35 * malalignment [°] (R = 0.855, P < 0.001).

Conclusions

We recommend planning the intra-operative release and tibial bone cut using long standing X-rays.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Asano H, Muneta T, Sekiya I (2008) Soft tissue tension in extension in total knee arthroplasty affects postoperative knee extension and stability. Knee Surg Sports Traumatol Arthrosc 16:999–1003

    Article  PubMed  Google Scholar 

  2. Whiteside LA (2002) Soft tissue balancing: the knee. J Arthroplasty 17:23–27

    Article  PubMed  Google Scholar 

  3. Peters CL (2006) Soft-tissue balancing in primary total knee arthroplasty. Instr Course Lect 55:413–417

    PubMed  Google Scholar 

  4. Bottros J, Gad B, Krebs V, Barsoum WK (2006) Gap balancing in total knee arthroplasty. J Arthroplasty 21:11–15

    Article  PubMed  Google Scholar 

  5. Unitt L, Sambatakakis A, Johnstone D, Briggs TW (2008) Short-term outcome in total knee replacement after soft-tissue release and balancing. J Bone Joint Surg Br 90:159–165

    Article  PubMed  CAS  Google Scholar 

  6. Insall JN, Binazzi R, Soudry M, Mestriner LA (1985) Total knee arthroplasty. Clin Orthop Relat Res 192:13–22

    PubMed  Google Scholar 

  7. Higuchi H, Hatayama K, Shimizu M, Kobayashi A, Kobayashi T, Takagishi K (2009) Relationship between joint gap difference and range of motion in total knee arthroplasty: a prospective randomised study between different platforms. Int Orthop 33(4):997–1000

    Article  PubMed  Google Scholar 

  8. Schnurr C, Nessler J, König DP (2009) Is referencing the posterior condyles sufficient to achieve a rectangular flexion gap in total knee arthroplasty? Int Orthop 33(6):1561–1565

    Article  PubMed  Google Scholar 

  9. Sumino T, Gadikota HR, Varadarajan KM, Kwon YM, Rubash HE, Li G (2011) Do high flexion posterior stabilised total knee arthroplasty designs increase knee flexion? A meta analysis. Int Orthop. March 16. [Epub ahead of print]

  10. Moynihan AL, Varadarajan KM, Hanson GR, Park SE, Nha KW, Suggs JF, Johnson T, Li G (2010) In vivo knee kinematics during high flexion after a posterior-substituting total knee arthroplasty. Int Orthop 34(4):497–503

    Article  PubMed  Google Scholar 

  11. Schnurr C, Csécsei G, Nessler J, Eysel P, König DP (2010) How much tibial resection is required in total knee arthroplasty? Int Orthop. May 9. [Epub ahead of print]

  12. Ishii Y, Noguchi H, Matsuda Y, Kiga H, Takeda M, Toyabe S (2009) Preoperative laxity in osteoarthritis patients undergoing total knee arthroplasty. Int Orthop 33:105–109

    Article  PubMed  Google Scholar 

  13. Song EK, Seon JK, Yoon TR, Park SJ, Cho SG, Yim JH (2007) Comparative study of stability after total knee arthroplasties between navigation system and conventional techniques. J Arthroplasty 22:1107–1111

    Article  PubMed  Google Scholar 

  14. Sailer J, Scharitzer M, Peloschek P, Giurea A, Imhof H, Grampp S (2005) Quantification of axial alignment of the lower extremity on conventional and digital total leg radiographs. Eur Radiol 15:170–173

    Article  PubMed  CAS  Google Scholar 

  15. Heyse TJ, Decking R, Davis J, Boettner F, Laskin RS (2009) Varus gonarthrosis predisposes to varus malalignment in TKA. HSS J 5:143–148

    Article  PubMed  Google Scholar 

  16. Rauh MA, Boyle J, Mihalko WM, Phillips MJ, Bayers-Thering M, Krackow KA (2007) Reliability of measuring long-standing lower extremity radiographs. Orthopedics 30:299–303

    PubMed  Google Scholar 

  17. Fishkin Z, Miller D, Ritter C, Ziv I (2002) Changes in human knee ligament stiffness secondary to osteoarthritis. J Orthop Res 20:204–207

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Orthopedic Department, Center for Musculoskeletal Surgery, Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany

    Georg Matziolis, Doerte Matziolis & Carsten Perka

Authors
  1. Georg Matziolis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Doerte Matziolis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Carsten Perka
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Georg Matziolis.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Matziolis, G., Matziolis, D. & Perka, C. Pre-operative frontal plane malalignment predicts the extension gap asymmetry in knee osteoarthritis. International Orthopaedics (SICOT) 36, 79–82 (2012). https://doi.org/10.1007/s00264-011-1294-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-011-1294-7

Keywords

Search

Navigation