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Does a Modified Gap-balancing Technique Result in Medial-pivot Knee Kinematics in Cruciate-retaining Total Knee Arthroplasty?: A Pilot Study

  • Symposium: Papers Presented at the Annual Meetings of The Knee Society
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Normal knee kinematics is characterized by posterior femorotibial rollback with tibial internal rotation and medial-pivot rotation in flexion. Cruciate-retaining TKAs (CR-TKAs) do not reproduce normal knee kinematics.

Questions/purposes

We hypothesized a more anatomic reconstruction of the medial femoral condyle, simultaneously preserving the tension of the PCL and medial collateral ligament, resulted in (1) medial-pivot rotation and tibial internal rotation, (2) lateral femoral rollback, and (3) reduced liftoff.

Patients and Methods

We compared 10 patients who underwent CR-TKA using the new technique at their 1-year followup to a matched control group of nine patients using a traditional gap-balancing technique at their 2- to 4-year followup. All patients received lateral radiographs in extension and flexion, which we utilized for three-dimensional implant matching to calculate tibial internal rotation, lateral rollback, and lateral liftoff in extension and flexion.

Results

The new gap-balancing technique resulted in a median of 3.5° tibial internal rotation with 2.7-mm rollback of the lateral femoral condyle relative to the medial condyle in flexion, which was different from the control group. We found no differences in liftoff between the groups.

Conclusions

The new technique resulted in tibial internal rotation with flexion and lateral rollback comparing the lateral to the medial condyle in flexion, but no differences in condylar liftoff. These preliminary results were comparable to published kinematic results of an asymmetric CR-TKA or medial-pivot CR-TKA but not to symmetric CR-TKA.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

The authors thank Scott Banks, PhD, for assistance in JointTrack and Karen Aneshansley for proofreading the manuscript.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Wolfgang Fitz MD, Sonal Sodha, William Reichmann & Tom Minas MD, MS

  2. Brigham and Women’s Orthopedic and Arthritis Center, Brigham and Women’s Cartilage Repair Center, 850 Boylston Street, Chestnut Hill, MA, 02467, USA

    Wolfgang Fitz MD & Tom Minas MD, MS

Authors
  1. Wolfgang Fitz MD
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  2. Sonal Sodha
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  3. William Reichmann
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  4. Tom Minas MD, MS
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Corresponding author

Correspondence to Wolfgang Fitz MD.

Additional information

The institution of one or more of the authors (WF, TM) has received funding from Conformis Inc, Burlington, MA, USA. Drs. Fitz and Minas are members of the scientific advisory board, hold consultancies, have stock and stock option ownership, and receive royalties for intellectual property from Conformis Inc. Dr. Fitz has received research support from Oped Inc (Framingham, MA, USA) and iGetBetter Inc (Waltham, MA, USA). Dr. Minas is a consultant for Genzyme Corp (Cambridge, MA, USA). Each author certifies that he or she, or a member of their immediate family, has no commercial associations that might pose a conflict of interest in connection with the submitted article.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Fitz, W., Sodha, S., Reichmann, W. et al. Does a Modified Gap-balancing Technique Result in Medial-pivot Knee Kinematics in Cruciate-retaining Total Knee Arthroplasty?: A Pilot Study. Clin Orthop Relat Res 470, 91–98 (2012). https://doi.org/10.1007/s11999-011-2121-6

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  • DOI: https://doi.org/10.1007/s11999-011-2121-6

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