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Gap balance difference of unicompartmental knee arthroplasty between hanging leg and supine leg position: a prospective cohort study

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Abstract

Purpose

Gap balance is critical in Oxford unicompartmental knee arthroplasty (OUKA) surgery; the effect of lower limb positioning on gap balance judgements has not been reported. There are two mean operative positions for OUKA patients, the hanging leg (HL) and the supine leg (SL) position. This study aimed to investigate the gap balance achieved by current UKA surgical techniques by using a force sensor, to compare the differences in gap balance between the two different positions, and to test whether the difference in gap balance leads to different outcomes in terms of component alignment and early post-operative clinical outcomes.

Methods

This prospective study included 97 knees (76 patients), who underwent OUKA from June 1, 2020, to July 31, 2021, of which 67 knees underwent UKA in the supine leg position and the other 30 in the hanging leg position. When the operator was satisfied with the gap balance, the contact forces between the trial and the spacer block were measured at 90° of knee flexion (flexion gap) and 20° of knee flexion (extension gap) using a pre-developed matrix flexible force sensor. X-rays were reviewed three to five days after surgery. Knee Society Scores (KSS) were obtained at the six month follow-up.

Results

Compared to the HL group, the contact force at the flexion gap was higher in the SL group: 55.15N (SD 43.36N) vs. 34.25N (SD 27.56N) (p < 0.05), whereas in the extension gap, there was no significant difference, 90.19 N (SD 43.36N) in the SL group and 86.72N (SD 43.08N) in the HL group (ns.). The contact force was greater in the extension gap than in the flexion gap in both groups (p < 0.01). The gap balance difference in the HL group was 52.46N (SD 31.33N), which was greater than that of the SL group at 35.03N (SD 19.50N) (p < 0.05). There were no significant differences in component alignment or lower limb mechanical alignment between the two groups. There was no significant difference in pre-operative and post-operative KSS between the two groups, while post-operative KSS was significantly higher in both groups compared to the pre-operative period.

Conclusion

The intra-operative contact forces between the flexion and extension gaps differed in the two groups; the hanging leg position appeared to produce a greater difference in the judgement of gap balance than the supine leg position, but this difference did not adversely affect the alignment of the component or the early post-operative clinical outcome.

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Data availability

All of the data are available in contact with the correspondence author.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China

    Juncheng Ge & Wanshou Guo

  2. Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China

    Juncheng Ge, Changquan Liu, Xiaowei Sun, Qidong Zhang & Wanshou Guo

  3. China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China

    Changquan Liu & Xiaowei Sun

  4. Department of Orthopedics, Shanxi Huajin Orthopedic Hospital, Taiyuan, China

    Binping Ji

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Contributions

Juncheng Ge and Wanshou Guo designed the study. Binping Ji and Wanshou Guo operated the UKA procedure. Juncheng Ge, Xiaowei Sun, Qidong Zhang, and Changquan Liu did the data collection. Juncheng Ge and Changquan Liu did the data analysis. Juncheng Ge wrote the article. Qidong Zhang,Binping Ji and Wanshou Guo revised the article. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Binping Ji or Wanshou Guo.

Ethics declarations

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the institutional review board of China-Japan Friendship Hospital (approval number 2020–50-k28).

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Informed consent was obtained from all individual participants included in the study.

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The authors declare no competing interests.

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Juncheng Ge and Changquan Liu are co-first authors.

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Ge, J., Liu, C., Sun, X. et al. Gap balance difference of unicompartmental knee arthroplasty between hanging leg and supine leg position: a prospective cohort study. International Orthopaedics (SICOT) 47, 745–753 (2023). https://doi.org/10.1007/s00264-022-05680-y

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  • DOI: https://doi.org/10.1007/s00264-022-05680-y

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