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Soft-tissue balancing in total knee arthroplasty: cruciate-retaining versus posterior-stabilised, and measured-resection versus gap technique

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Abstract

Purpose

The purpose of this study was to prove the hypothesis that soft tissues are well balanced using the gap technique with a navigation system in cruciate-retaining (CR) and posterior-stabilised (PS) total knee arthroplasty (TKA), leading to better clinical outcomes compared with the measured-resection technique.

Methods

One hundred and thirty-five TKAs (90 CR and 45 PS) were performed in patients with varus-type osteoarthritis using the gap technique guided by the offset-type tensor and a navigation system. Soft-tissue balance (joint-component gap and ligament balance) were intraoperatively assessed with the tensor under 40 lb of joint-distraction force. The achievement in the equalised rectangular gap at extension and flexion was assessed and retrospectively compared with the previous series in which the measured-resection technique was used (20 CR and 100 PS TKAs). In addition, clinical outcomes, including range of motion and Knee Society Score were assessed at a minimum two year follow-up.

Results

In achieving equalised rectangular gaps at extension and flexion, CR TKAs met criteria in more cases [66.7 % (64/90) vs. 44.4 % (20/45) of PS TKA] with the gap technique, which was superior to that with the measured-resection technique [50.0 % (10/20) of CR TKA and 28.0 % (28/100) of PS TKA]. However, clinical outcomes showed no significant differences among groups at minimum two year follow-up.

Conclusions

The superiority of CR TKA with the gap technique in achieving equalised rectangular gaps at extension and flexion does not directly reflect two year postoperative clinical outcomes.

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References

  1. Muratsu H, Tsumura N, Yamaguchi M, Mizuno K, Kuroda R, Kurosaka M (2003) Patellar eversion affects soft tissue balance in total knee arthroplasty. Trans Orthop Res 28:242

    Google Scholar 

  2. Matsumoto T, Muratsu H, Tsumura N, Mizuno K, Kuroda R, Yoshiya S, Kurosaka M (2006) Joint gap kinematics in posterior-stabilized total knee arthroplasty measured by a new tensor with the navigation system. J Biomech Eng 128(6):867–871. doi:10.1115/1.2354201

    Article  PubMed  Google Scholar 

  3. Matsumoto T, Kuroda R, Kubo S, Muratsu H, Mizuno K, Kurosaka M (2009) The intra-operative joint gap in cruciate-retaining compared with posterior-stabilised total knee replacement. J Bone Joint Surg Br 91(4):475–480. doi:10.1302/0301-620X.91B4.21862

    Article  CAS  PubMed  Google Scholar 

  4. Matsumoto T, Muratsu H, Kubo S, Matsushita T, Kurosaka M, Kuroda R (2011) Soft tissue tension in cruciate-retaining and posterior-stabilized total knee arthroplasty. J Arthroplasty 26(5):788–795. doi:10.1016/j.arth.2010.06.006

    Article  PubMed  Google Scholar 

  5. Matsumoto T, Muratsu H, Kubo S, Matsushita T, Kurosaka M, Kuroda R (2012) Intraoperative soft tissue balance reflects minimum 5-year midterm outcomes in cruciate-retaining and posterior-stabilized total knee arthroplasty. J Arthroplasty 27(9):1723–1730. doi:10.1016/j.arth.2012.02.020

    Article  PubMed  Google Scholar 

  6. Matsumoto T, Muratsu H, Tsumura N, Mizuno K, Kurosaka M, Kuroda R (2009) Soft tissue balance measurement in posterior-stabilized total knee arthroplasty with a navigation system. J Arthroplasty 24(3):358–364. doi:10.1016/j.arth.2008.01.001

    Article  PubMed  Google Scholar 

  7. Muratsu H, Matsumoto T, Kubo S, Maruo A, Miya H, Kurosaka M, Kuroda R (2010) Femoral component placement changes soft tissue balance in posterior-stabilized total knee arthroplasty. Clin Biomech (Bristol, Avon) 25(9):926–930. doi:10.1016/j.clinbiomech.2010.06.020

    Article  Google Scholar 

  8. Berger RA, Rubash HE, Seel MJ, Thompson WH, Crossett LS (1993) Determining the rotational alignment of the femoral component in total knee arthroplasty using the epicondylar axis. Clin Orthop Relat Res (286):40–47

  9. Dennis DA (2008) Measured resection: an outdated technique in total knee arthroplasty. Orthopedics 31(9):940, 943–944

    Article  PubMed  Google Scholar 

  10. Fehring TK (2000) Rotational malalignment of the femoral component in total knee arthroplasty. Clin Orthop Relat Res (380):72–79

  11. Griffin FM, Math K, Scuderi GR, Insall JN, Poilvache PL (2000) Anatomy of the epicondyles of the distal femur: MRI analysis of normal knees. J Arthroplasty 15(3):354–359

    Article  CAS  PubMed  Google Scholar 

  12. Whiteside LA, Arima J (1995) The anteroposterior axis for femoral rotational alignment in valgus total knee arthroplasty. Clin Orthop Relat Res (321):168–172

  13. Mantas JP, Bloebaum RD, Skedros JG, Hofmann AA (1992) Implications of reference axes used for rotational alignment of the femoral component in primary and revision knee arthroplasty. J Arthroplasty 7(4):531–535

    Article  CAS  PubMed  Google Scholar 

  14. Poilvache PL, Insall JN, Scuderi GR, Font-Rodriguez DE (1996) Rotational landmarks and sizing of the distal femur in total knee arthroplasty. Clin Orthop Relat Res (331):35–46

  15. Schnurr C, Nessler J, Konig DP (2009) Is referencing the posterior condyles sufficient to achieve a rectangular flexion gap in total knee arthroplasty? Int Orthop 33(6):1561–1565. doi:10.1007/s00264-008-0656-2

    Article  PubMed Central  PubMed  Google Scholar 

  16. Katz MA, Beck TD, Silber JS, Seldes RM, Lotke PA (2001) Determining femoral rotational alignment in total knee arthroplasty: reliability of techniques. J Arthroplasty 16(3):301–305

    Article  CAS  PubMed  Google Scholar 

  17. Matsumoto T, Muratsu H, Kubo S, Matsushita T, Ishida K, Sasaki H, Oka S, Kurosaka M, Kuroda R (2012) Soft tissue balance using the tibia first gap technique with navigation system in cruciate-retaining total knee arthroplasty. Int Orthop 36(5):975–980. doi:10.1007/s00264-011-1377-5

    Article  PubMed Central  PubMed  Google Scholar 

  18. Matsuzaki T, Matsumoto T, Muratsu H, Kubo S, Matsushita T, Kawakami Y, Ishida K, Oka S, Kuroda R, Kurosaka M (2013) Kinematic factors affecting postoperative knee flexion after cruciate-retaining total knee arthroplasty. Int Orthop 37(5):803–808. doi:10.1007/s00264-013-1803-y

    Article  PubMed  Google Scholar 

  19. Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res (248):13–14

  20. The Knee Society (2007) http://www.kneesociety.org/web/outcom

  21. Matsuda S, Kawahara S, Okazaki K, Tashiro Y, Iwamoto Y (2013) Postoperative alignment and ROM affect patient satisfaction after TKA. Clin Orthop Relat Res 471(1):127–133. doi:10.1007/s11999-012-2533-y

    Article  PubMed Central  PubMed  Google Scholar 

  22. Maruyama S, Yoshiya S, Matsui N, Kuroda R, Kurosaka M (2004) Functional comparison of posterior cruciate-retaining versus posterior stabilized total knee arthroplasty. J Arthroplasty 19(3):349–353

    Article  PubMed  Google Scholar 

  23. Wunschel M, Leasure JM, Dalheimer P, Kraft N, Wulker N, Muller O (2013) Differences in knee joint kinematics and forces after posterior cruciate retaining and stabilized total knee arthroplasty. Knee. doi:10.1016/j.knee.2013.03.005

    PubMed  Google Scholar 

  24. Seon JK, Park JK, Shin YJ, Seo HY, Lee KB, Song EK (2011) Comparisons of kinematics and range of motion in high-flexion total knee arthroplasty: cruciate retaining vs. substituting designs. Knee Surg Sports Traumatol Arthrosc 19(12):2016–2022. doi:10.1007/s00167-011-1434-z

    Article  PubMed  Google Scholar 

  25. McCalden RW, MacDonald SJ, Charron KD, Bourne RB, Naudie DD (2010) The role of polyethylene design on postoperative TKA flexion: an analysis of 1534 cases. Clin Orthop Relat Res 468(1):108–114. doi:10.1007/s11999-009-1127-9

    Article  PubMed Central  PubMed  Google Scholar 

  26. Kadoya Y, Kobayashi A, Komatsu T, Nakagawa S, Yamano Y (2001) Effects of posterior cruciate ligament resection on the tibiofemoral joint gap. Clin Orthop Relat Res (391):210–217

  27. Lee HJ, Lee JS, Jung HJ, Song KS, Yang JJ, Park CW (2011) Comparison of joint line position changes after primary bilateral total knee arthroplasty performed using the navigation-assisted measured gap resection or gap balancing techniques. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-011-1468-2

    Google Scholar 

  28. Tigani D, Sabbioni G, Ben Ayad R, Filanti M, Rani N, Del Piccolo N (2010) Comparison between two computer-assisted total knee arthroplasty: gap-balancing versus measured resection technique. Knee Surg Sports Traumatol Arthrosc 18(10):1304–1310. doi:10.1007/s00167-010-1124-2

    Article  PubMed  Google Scholar 

  29. Lotke PA (2003) Primary total knees: standard principles and technique. Knee Arthroplasty. Lippincott Williams & Wilkins, Philadelphia

    Google Scholar 

  30. Sculco TP (1991) Soft tisseu balancing in total knee arthroplasty. Controversies of Total Knee Replacement. Ranven Press, New York

    Google Scholar 

  31. Sekiya H, Takatoku K, Takada H, Sasanuma H, Sugimoto N (2009) Postoperative lateral ligamentous laxity diminishes with time after TKA in the varus knee. Clin Orthop Relat Res 467(6):1582–1586. doi:10.1007/s11999-008-0588-6

    Article  PubMed Central  PubMed  Google Scholar 

  32. Lee DH, Padhy D, Park JH, Jeong WK, Park JH, Han SB (2011) The impact of a rectangular or trapezoidal flexion gap on the femoral component rotation in TKA. Knee Surg Sports Traumatol Arthrosc 19(7):1141–1147. doi:10.1007/s00167-011-1422-3

    Article  PubMed  Google Scholar 

  33. Lee DH, Park JH, Song DI, Padhy D, Jeong WK, Han SB (2010) Accuracy of soft tissue balancing in TKA: comparison between navigation-assisted gap balancing and conventional measured resection. Knee Surg Sports Traumatol Arthrosc 18(3):381–387. doi:10.1007/s00167-009-0983-x

    Article  CAS  PubMed  Google Scholar 

  34. Seon JK, Song EK, Park SJ, Lee DS (2011) The use of navigation to obtain rectangular flexion and extension gaps during primary total knee arthroplasty and midterm clinical results. J Arthroplasty 26(4):582–590. doi:10.1016/j.arth.2010.04.030

    Article  PubMed  Google Scholar 

  35. Luyckx T, Peeters T, Vandenneucker H, Victor J, Bellemans J (2012) Is adapted measured resection superior to gap-balancing in determining femoral component rotation in total knee replacement? J Bone Joint Surg Br 94(9):1271–1276. doi:10.1302/0301-620X.94B9.28670

    Article  CAS  PubMed  Google Scholar 

  36. Fujimoto E, Sasashige Y, Masuda Y, Hisatome T, Eguchi A, Masuda T, Sawa M, Nagata Y (2012) Significant effect of the posterior tibial slope and medial/lateral ligament balance on knee flexion in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-012-2059-6

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan

    Tomoyuki Matsumoto, Yohei Kawakami, Koji Takayama, Takehiko Matsushita, Toshihiro Akisue, Kotaro Nishida, Ryosuke Kuroda & Masahiro Kurosaka

  2. Department of Orthopaedic Surgery, Steel Memorial Hirohata Hospital, Himeji, Japan

    Hirotsugu Muratsu

  3. Department of Orthopaedic Surgery, Kobe Kaisei Hospital, Kobe, Japan

    Kazunari Ishida

Authors
  1. Tomoyuki Matsumoto
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  2. Hirotsugu Muratsu
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  3. Yohei Kawakami
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Correspondence to Tomoyuki Matsumoto.

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Matsumoto, T., Muratsu, H., Kawakami, Y. et al. Soft-tissue balancing in total knee arthroplasty: cruciate-retaining versus posterior-stabilised, and measured-resection versus gap technique. International Orthopaedics (SICOT) 38, 531–537 (2014). https://doi.org/10.1007/s00264-013-2133-9

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  • DOI: https://doi.org/10.1007/s00264-013-2133-9

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