Intraoperative posterior movement of the tibia at 90° of flexion predicts worse postoperative flexion angles in cruciate-substituting total knee arthroplasty View Full Text


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Article Info

DATE

2019-07-19

AUTHORS

Takao Inokuchi, Kazunari Ishida, Koji Takayama, Nao Shibanuma, Shinya Hayashi, Masahiro Kurosaka, Ryosuke Kuroda, Tomoyuki Matsumoto

ABSTRACT

PurposeTo investigate the correlation between intraoperative tibiofemoral anteroposterior changes at 90° of flexion and postoperative maximum flexion angles in navigated cruciate-substituting TKA. The hypothesis of this study was that intraoperative tibiofemoral anteroposterior changes at 90° of flexion indirectly reflect posterior cruciate ligament (PCL) function and associate with postoperative maximum flexion angles.MethodsFifty-five consecutive patients with varus osteoarthritis treated with primary TKA were retrospectively analysed. All patients received the same type of implant, placed with an image-free navigation system. The PCL was retained, and cruciate-substituting inserts were used in all cases. The mean follow-up was 44 ± 8 months. The preoperative and postoperative kinematics were measured intraoperatively with a navigation system, and the preoperative and postoperative tibiofemoral anteroposterior positions at 90° of flexion were determined. The correlation between intraoperative anteroposterior position changes and postoperative maximum flexion angles was investigated. The correlation between the change of anteroposterior position and tibiofemoral rotational angles was also assessed.ResultsThe intraoperative anteroposterior position change was −1.7 ± 3.4 mm (a positive value indicates tibial posterior shift). Flexion angle improvement was negatively correlated with intraoperative change of tibiofemoral anteroposterior position (R2 = 0.17, p < 0.005). Postoperative maximum flexion angles were also negatively correlated with intraoperative change of tibiofemoral anteroposterior position (R2 = 0.09, p < 0.05). The postoperative amount of tibial internal rotation was positively correlated with the preoperative amount (R2 = 0.60, p < 0.0001); however, the intraoperative anteroposterior position change was not correlated with the postoperative amount of tibial internal rotation (n.s.).ConclusionA navigation system may be able to indirectly evaluate PCL function and predict the postoperative flexion angles in cruciate-substituting TKA. Intraoperative posterior movement of the tibia at 90° of flexion predicts worse postoperative flexion angles in cruciate-substituting TKA.Level of evidenceLevel 3, retrospective comparative study. More... »

PAGES

2816-2822

References to SciGraph publications

  • 2014-08-26. Is the posterior cruciate ligament necessary for medial pivot knee prostheses with regard to postoperative kinematics? in KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY
  • 2011-11-05. Less femorotibial rotation and AP translation in deep-dished total knee arthroplasty. An intraoperative kinematic study using navigation in KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY
  • 2016-02-04. Navigation-based tibial rotation at 90° of flexion is associated with better range of motion in navigated total knee arthroplasty in KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY
  • 2014-02-12. Similar stability and range of motion between cruciate-retaining and cruciate-substituting ultracongruent insert total knee arthroplasty in KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY
  • 2018-02-23. Posterior tibial slope impacts intraoperatively measured mid-flexion anteroposterior kinematics during cruciate-retaining total knee arthroplasty in KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY
  • 2011-06-25. Is the effect of a posterior cruciate ligament resection in total knee arthroplasty predictable? in INTERNATIONAL ORTHOPAEDICS
  • 2016-08-02. Anteroposterior translation and range of motion after total knee arthroplasty using posterior cruciate ligament-retaining versus posterior cruciate ligament-substituting prostheses in KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY
  • 2014-09-27. Navigation-based femorotibial rotation pattern correlated with flexion angle after total knee arthroplasty in KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY
  • 2012-11-01. Preservation of the posterior cruciate ligament is not helpful in highly conforming mobile-bearing total knee arthroplasty: a randomized controlled study in KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY
  • 2013-03-05. Kinematic factors affecting postoperative knee flexion after cruciate-retaining total knee arthroplasty in INTERNATIONAL ORTHOPAEDICS
  • 2009-11. Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses in BEHAVIOR RESEARCH METHODS
  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1007/s00167-019-05624-x

    DOI

    http://dx.doi.org/10.1007/s00167-019-05624-x

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1118127870

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/31324963


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        "description": "PurposeTo investigate the correlation between intraoperative tibiofemoral anteroposterior changes at 90\u00b0 of flexion and postoperative maximum flexion angles in navigated cruciate-substituting TKA. The hypothesis of this study was that intraoperative tibiofemoral anteroposterior changes at 90\u00b0 of flexion indirectly reflect posterior cruciate ligament (PCL) function and associate with postoperative maximum flexion angles.MethodsFifty-five consecutive patients with varus osteoarthritis treated with primary TKA were retrospectively analysed. All patients received the same type of implant, placed with an image-free navigation system. The PCL was retained, and cruciate-substituting inserts were used in all cases. The mean follow-up was 44\u2009\u00b1\u20098\u00a0months. The preoperative and postoperative kinematics were measured intraoperatively with a navigation system, and the preoperative and postoperative tibiofemoral anteroposterior positions at 90\u00b0 of flexion were determined. The correlation between intraoperative anteroposterior position changes and postoperative maximum flexion angles was investigated. The correlation between the change of anteroposterior position and tibiofemoral rotational angles was also assessed.ResultsThe intraoperative anteroposterior position change was \u22121.7\u2009\u00b1\u20093.4\u00a0mm (a positive value indicates tibial posterior shift). Flexion angle improvement was negatively correlated with intraoperative change of tibiofemoral anteroposterior position (R2\u2009=\u20090.17, p\u2009<\u20090.005). Postoperative maximum flexion angles were also negatively correlated with intraoperative change of tibiofemoral anteroposterior position (R2\u2009=\u20090.09, p\u2009<\u20090.05). The postoperative amount of tibial internal rotation was positively correlated with the preoperative amount (R2\u2009=\u20090.60, p\u2009<\u20090.0001); however, the intraoperative anteroposterior position change was not correlated with the postoperative amount of tibial internal rotation (n.s.).ConclusionA navigation system may be able to indirectly evaluate PCL function and predict the postoperative flexion angles in cruciate-substituting TKA. Intraoperative posterior movement of the tibia at 90\u00b0 of flexion predicts worse postoperative flexion angles in cruciate-substituting TKA.Level of evidenceLevel 3, retrospective comparative study.", 
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    32 schema:description PurposeTo investigate the correlation between intraoperative tibiofemoral anteroposterior changes at 90° of flexion and postoperative maximum flexion angles in navigated cruciate-substituting TKA. The hypothesis of this study was that intraoperative tibiofemoral anteroposterior changes at 90° of flexion indirectly reflect posterior cruciate ligament (PCL) function and associate with postoperative maximum flexion angles.MethodsFifty-five consecutive patients with varus osteoarthritis treated with primary TKA were retrospectively analysed. All patients received the same type of implant, placed with an image-free navigation system. The PCL was retained, and cruciate-substituting inserts were used in all cases. The mean follow-up was 44 ± 8 months. The preoperative and postoperative kinematics were measured intraoperatively with a navigation system, and the preoperative and postoperative tibiofemoral anteroposterior positions at 90° of flexion were determined. The correlation between intraoperative anteroposterior position changes and postoperative maximum flexion angles was investigated. The correlation between the change of anteroposterior position and tibiofemoral rotational angles was also assessed.ResultsThe intraoperative anteroposterior position change was −1.7 ± 3.4 mm (a positive value indicates tibial posterior shift). Flexion angle improvement was negatively correlated with intraoperative change of tibiofemoral anteroposterior position (R2 = 0.17, p < 0.005). Postoperative maximum flexion angles were also negatively correlated with intraoperative change of tibiofemoral anteroposterior position (R2 = 0.09, p < 0.05). The postoperative amount of tibial internal rotation was positively correlated with the preoperative amount (R2 = 0.60, p < 0.0001); however, the intraoperative anteroposterior position change was not correlated with the postoperative amount of tibial internal rotation (n.s.).ConclusionA navigation system may be able to indirectly evaluate PCL function and predict the postoperative flexion angles in cruciate-substituting TKA. Intraoperative posterior movement of the tibia at 90° of flexion predicts worse postoperative flexion angles in cruciate-substituting TKA.Level of evidenceLevel 3, retrospective comparative study.
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    39 schema:keywords ConclusionA navigation system
    40 EvidenceLevel 3
    41 Flexion angle improvement
    42 Intraoperative posterior movement
    43 MethodsFifty-five consecutive patients
    44 PCL
    45 PCL function
    46 PurposeTo
    47 TKA
    48 amount
    49 angle
    50 angle improvement
    51 anteroposterior changes
    52 anteroposterior position
    53 anteroposterior position change
    54 arthroplasty
    55 cases
    56 changes
    57 comparative study
    58 consecutive patients
    59 correlation
    60 cruciate ligament (PCL) function
    61 cruciate-substituting TKA
    62 cruciate-substituting inserts
    63 cruciate-substituting total knee arthroplasty
    64 flexion
    65 flexion angle
    66 function
    67 hypothesis
    68 image-free navigation system
    69 improvement
    70 inserts
    71 internal rotation
    72 intraoperative anteroposterior position change
    73 intraoperative changes
    74 intraoperative tibiofemoral anteroposterior changes
    75 kinematics
    76 knee arthroplasty
    77 levels
    78 ligament function
    79 maximum flexion angle
    80 months
    81 movement
    82 navigation system
    83 osteoarthritis
    84 patients
    85 position
    86 position changes
    87 posterior cruciate ligament function
    88 posterior movement
    89 postoperative amount
    90 postoperative flexion angle
    91 postoperative kinematics
    92 postoperative maximum flexion angle
    93 postoperative tibiofemoral anteroposterior positions
    94 preoperative amount
    95 primary TKA
    96 retrospective comparative study
    97 rotation
    98 rotational angle
    99 same type
    100 study
    101 system
    102 tibia
    103 tibial internal rotation
    104 tibiofemoral anteroposterior changes
    105 tibiofemoral anteroposterior position
    106 tibiofemoral rotational angles
    107 total knee arthroplasty
    108 types
    109 varus osteoarthritis
    110 worse postoperative flexion angles
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