Coronal and sagittal laxity affects clinical outcomes in posterior-stabilized total knee arthroplasty: assessment of well-functioning knees. View Full Text


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Article Info

DATE

2019-04-12

AUTHORS

Toshifumi Watanabe, Hideyuki Koga, Koji Otabe, Yusuke Nakagawa, Takeshi Muneta, Ichiro Sekiya, Tetsuya Jinno

ABSTRACT

PURPOSE: Both coronal and sagittal laxity of well-functioning knees after total knee arthroplasty (TKA) was examined, and the correlations between the joint laxity and the clinical outcomes were analyzed to clarify the adequate joint laxity for the prosthesis, and the relationship between the laxity and the outcomes. METHODS: Forty well-functioning TKA knees with a high-flexion posterior-stabilized (PS) prosthesis were studied. All patients were diagnosed as having osteoarthritis with varus deformity and were followed up for 2 years or more. The coronal and sagittal laxity was assessed at extension and flexion, and the correlations between the joint laxity and the clinical outcomes were evaluated. RESULTS: The varus and valgus laxity averaged 5.6 ± 1.8° and 3.6 ± 1.2° at 10° knee flexion, and 7.4 ± 5.1° and 3.6 ± 2.7° at 80° knee flexion, respectively, and the AP laxity at 30° and 75° knee flexion averaged 8.7 ± 3.6 mm and 6.6 ± 2.3 mm, respectively. Knee flexion angle correlated with the joint laxity, while the other outcomes including patient-reported pain and instability were adversely affected by the greater laxity. CONCLUSIONS: This study exhibited the importance of consistent medial laxity both at extension and flexion, which averaged 3.6°. Care should be taken to maintain the medial stability and to obtain adequate laxity both at extension and flexion during surgery. A few degrees of medial tightness can be allowed to achieve excellent clinical results after TKA for preoperative varus knees. LEVEL OF EVIDENCE: Therapeutic study, Level III. More... »

References to SciGraph publications

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  • 2014-12. Extension gap needs more than 1-mm laxity after implantation to avoid post-operative flexion contracture in total knee arthroplasty in KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY
  • 2016-08. Assessing coronal laxity in extension and flexion at a minimum of 10 years after primary total knee arthroplasty in KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY
  • 2006-05. Asymmetry of mediolateral laxity of the normal knee in JOURNAL OF ORTHOPAEDIC SCIENCE
  • 2017-10. Varus–valgus stability at 90° flexion correlates with the stability at midflexion range more widely than that at 0° extension in posterior-stabilized total knee arthroplasty in ARCHIVES OF ORTHOPAEDIC AND TRAUMA SURGERY
  • 2016-11. In-vivo kinematics of high-flex posterior-stabilized total knee prosthesis designed for Asian populations in INTERNATIONAL ORTHOPAEDICS
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  • 2010-02. Comparing Patient Outcomes After THA and TKA: Is There a Difference? in CLINICAL ORTHOPAEDICS AND RELATED RESEARCH®
  • 2014-08. In vivo anteroposterior translation after meniscal-bearing total knee arthroplasty: effects of soft tissue conditions and flexion angle in EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY
  • 2013-04. Intraoperative Joint Gaps Affect Postoperative Range of Motion in TKAs With Posterior-stabilized Prostheses in CLINICAL ORTHOPAEDICS AND RELATED RESEARCH®
  • 2017-06. Changes in anteroposterior stability and proprioception after different types of knee arthroplasty in KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY
  • 2003-02. Influence of stability on range of motion after cruciate-retaining TKA in ARCHIVES OF ORTHOPAEDIC AND TRAUMA SURGERY
  • Identifiers

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    http://scigraph.springernature.com/pub.10.1007/s00167-019-05500-8

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    http://dx.doi.org/10.1007/s00167-019-05500-8

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    https://app.dimensions.ai/details/publication/pub.1113380440

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/30980120


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    32 schema:description PURPOSE: Both coronal and sagittal laxity of well-functioning knees after total knee arthroplasty (TKA) was examined, and the correlations between the joint laxity and the clinical outcomes were analyzed to clarify the adequate joint laxity for the prosthesis, and the relationship between the laxity and the outcomes. METHODS: Forty well-functioning TKA knees with a high-flexion posterior-stabilized (PS) prosthesis were studied. All patients were diagnosed as having osteoarthritis with varus deformity and were followed up for 2 years or more. The coronal and sagittal laxity was assessed at extension and flexion, and the correlations between the joint laxity and the clinical outcomes were evaluated. RESULTS: The varus and valgus laxity averaged 5.6 ± 1.8° and 3.6 ± 1.2° at 10° knee flexion, and 7.4 ± 5.1° and 3.6 ± 2.7° at 80° knee flexion, respectively, and the AP laxity at 30° and 75° knee flexion averaged 8.7 ± 3.6 mm and 6.6 ± 2.3 mm, respectively. Knee flexion angle correlated with the joint laxity, while the other outcomes including patient-reported pain and instability were adversely affected by the greater laxity. CONCLUSIONS: This study exhibited the importance of consistent medial laxity both at extension and flexion, which averaged 3.6°. Care should be taken to maintain the medial stability and to obtain adequate laxity both at extension and flexion during surgery. A few degrees of medial tightness can be allowed to achieve excellent clinical results after TKA for preoperative varus knees. LEVEL OF EVIDENCE: Therapeutic study, Level III.
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