scholarly journals Posteromedial Corner Release with the Knee in Figure‐of‐Four Position vs Conventional Position for Varus Knee Arthroplasty

2021 ◽  
Author(s):  
Quan‐bo Ji ◽  
Jun‐cheng Li ◽  
Qing‐yuan Zheng ◽  
Zong‐jie Geng ◽  
Ming Ni ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Varus Knee ◽  
Posteromedial Corner

scholarly journals Posteromedial Corner Release with the Knee in Figure-of-Four Position vs Conventional Position for Varus Knee Arthroplasty

2020 ◽  
Author(s):  
Quanbo Ji ◽  
Qingyuan Zheng ◽  
Juncheng Li ◽  
Zongjie Geng ◽  
Ming Ni ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Control Group ◽  
Varus Knee ◽  
Balance Test ◽  
Soft Tissue Balancing ◽  
Posteromedial Corner ◽  
The Mean ◽  
And Control ◽  
Experimental Group

Abstract Backgroud: The objective of this study is to introduce posteromedial corner release with the knee in the figure-of-four position versus the conventional position for varus knee arthroplasty. Methods : From March 2015 to September 2019, 123 patients (139 knees) with varus knee were randomly and blindly allocated to experimental group (60 patients; 68 knees) and control group (57 patients; 65 knees). Patients in experimental group underwent posteromedial corner release with the knee in the figure-of-four position; and patients in control group with the knee in the conventional position. Time for soft tissue balancing was defined as the time from the start of spacer test to the end of balance test. Length of release was defined as the distance from the osteotomy surface of the tibial plateau to the farthest structures released. The rating system of Hospital for Special Surgery (HSS) knee score was used to evaluate the clinical results. Differences were considered statistically significant at p < 0.05. Results: The mean time for soft tissue balancing was 8.4±3.3 minutes and 8.4±3.3 minutes in experimental and control group, respectively ( p <0.05). The mean length of releasing posteromedial corner structures was 35.5±13.4 mm and 27.3±9.7 mm in experimental and control group, respectively ( p <0.05). HSS scores 5 years after surgery were 95.1±16.9 and 94.8±17.2 respectively ( p >0.05). Conclusion: During varus knee arthroplasty, the posteromedial corner can be released more extensively and thoroughly when the knee is placed in the figure-of-four position.

scholarly journals Postoperative laxity of the lateral soft tissue is largely negligible in total knee arthroplasty for varus osteoarthritis

2021 ◽  
Vol 29 (1) ◽  
pp. 230949902110020
Author(s):  
Seikai Toyooka ◽  
Hironari Masuda ◽  
Nobuhiro Nishihara ◽  
Takashi Kobayashi ◽  
Wataru Miyamoto ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Mechanical Axis ◽  
Varus Deformity ◽  
Varus Knee ◽  
Before And After ◽  
Knee Deformity ◽  
Varus Stress ◽  
Total Knee

Purpose: To evaluate the integrity of lateral soft tissue in varus osteoarthritis knee by comparing the mechanical axis under varus stress during navigation-assisted total knee arthroplasty before and after compensating for a bone defect with the implant. Methods: Sixty-six knees that underwent total knee arthroplasty were investigated. The mechanical axis of the operated knee was evaluated under manual varus stress immediately after knee exposure and after navigation-assisted implantation. The correlation between each value of the mechanical axis and degree of preoperative varus deformity was compared by regression analysis. Results: The maximum mechanical axis under varus stress immediately after knee exposure increased in proportion to the degree of preoperative varus deformity. Moreover, the maximum mechanical axis under varus stress after implantation increased in proportion to the degree of preoperative varus deformity. Therefore, the severity of varus knee deformity leads to a progressive laxity of the lateral soft tissue. However, regression coefficients after implantation were much smaller than those measured immediately after knee exposure (0.99 vs 0.20). Based on the results of the regression formula, the postoperative laxity of the lateral soft tissue was negligible, provided that an appropriate thickness of the implant was compensated for the bone and cartilage defect in the medial compartment without changing the joint line. Conclusion: The severity of varus knee deformity leads to a progressive laxity of the lateral soft tissue. However, even if the degree of preoperative varus deformity is severe, most cases may not require additional procedures to address the residual lateral laxity.

Is Standing Coronal Long-Leg Alignment View Effective in Predicting the Extent of Medial Soft Tissue Release in Varus Deformity during Total Knee Arthroplasty?

2021 ◽  
Author(s):  
Mohammadreza Minator Sajjadi ◽  
Mohammad Ali Okhovatpour ◽  
Yaser Safaei ◽  
Behrooz Faramarzi ◽  
Reza Zandi
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Varus Deformity ◽  
Soft Tissue Release ◽  
Varus Knee ◽  
Significant Difference ◽  
Leg Alignment ◽  
Total Knee ◽  
Group 2

AbstractThe aim of this study was to assess the predictive value of the femoral intermechanical-anatomical angle (IMA), mechanical lateral distal femoral angle (mLDFA), medial proximal tibia angle (MPTA), femorotibial or varus angle (VA), and joint line convergence angle (CA) in predicting the stage of the medial collateral ligament (MCL) during total knee arthroplasty (TKA) of varus knee. We evaluated 229 patients with osteoarthritic varus knee who underwent primary TKA, prospectively. They were categorized in three groups based on the extent of medial soft tissue release that performed during TKA Group 1, osteophytes removal and release of the deep MCL and posteromedial capsule (stage 1); Group 2, the release of the semimembranosus (stage 2); and Group 3, release of the superficial MCL (stage 3) and/or the pes anserinus (stage 4). We evaluated the preoperative standing coronal hip-knee-ankle alignment view to assessing the possible correlations between the knee angles and extent of soft tissue release. A significant difference was observed between the three groups in terms of preoperative VA, CA, and MPTA by using the Kruskal–Wallis test. The extent of medial release increased with increasing VA and CA as well as decreasing MPTA in preoperative long-leg standing radiographs. Finally, a patient with a preoperative VA larger than 19, CA larger than 6, or MPTA smaller than 81 would need a stage 3 or 4 of MCL release. The overall results showed that the VA and MPTA could be useful in predicting the extent of medial soft tissue release during TKA of varus knee.

Differential Effect of Total Knee Arthroplasty on Valgus and Varus Knee Biomechanics During Gait

2016 ◽  
Vol 31 (9) ◽  
pp. 248-253 ◽  
Author(s):  
Jose A. Rodriguez ◽  
Marcel A. Bas ◽  
Karl F. Orishimo ◽  
Jonathan Robinson ◽  
Stephen J. Nicholas
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Differential Effect ◽  
Knee Biomechanics ◽  
Varus Knee ◽  
Total Knee

scholarly journals Association between changes in hip-knee-ankle angle and hindfoot alignment after total knee arthroplasty for varus knee osteoarthritis

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Naicheng Diao ◽  
Fei Yu ◽  
Bo Yang ◽  
Lifeng Ma ◽  
Heyong Yin ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Osteoarthritis ◽  
Knee Arthroplasty ◽  
Weight Bearing ◽  
Linear Regression Analysis ◽  
Varus Knee ◽  
Hindfoot Alignment ◽  
Total Knee ◽  
American Orthopaedic ◽  
The Relationship

Abstract Background The change in hip-knee-ankle (HKA) angle after total knee arthroplasty (TKA) may cause an adjustment in hindfoot alignment (HFA). However, the relationship between the changes in HKA angle and HFA is still not well studied. This study aimed to investigate the association between HKA angle and hindfoot alignment changes after TKA for varus knee osteoarthritis. Methods A prospective study was carried out in which 108 patients with varus knee deformities were radiographically and clinically evaluated before and 3 months after TKA. The relationship of change in HFA with correction in HKA angle was investigated. Results The results showed that the HFA was adjusted significantly by 3 months after TKA (p < 0.001), along with improved American Orthopaedic Foot and Ankle Society (AOFAS) ankle hindfoot score (p < 0.001). Next, a univariate correlation and linear regression analysis showed that the change in HFA was weakly correlated with the change in HKA angle (r=-0.262, β=-0.14, 95 % CI: -0.23 to -0.04, P = 0.006). Further stratified analysis and interaction tests revealed that age has a distinct effect on the correlation between the changes in HFA and HKA angle. The correlation was dramatically greater in the group under 65 years (r=-0.474, β=-0.26, 95 % CI: -0.41 to -0.12, P = 0.001), whilst, no correlation was observed in those above 65 years old (r=-0.036, β=-0.02, 95 % CI: -0.14 to 0.11, P = 0.779). Conclusions Our findings indicated that correction of HKA after TKA tend to promote adjustment in the hindfoot alignment toward re-balance of the whole lower limb weight-bearing axis. However, this mechanism obviously weakens in elderly patients. Therefore, if apparent hindfoot deformity exists in these patients before TKA, more perioperative intervention is required for hindfoot adjustment, and even HKA undercorrection may be considered.

scholarly journals Changes of mediolateral soft tissue gaps in total knee arthroplasty after suturing medial extensor in navigation

2018 ◽  
Vol 26 (3) ◽  
pp. 230949901880251
Author(s):  
Seung Bum Chae ◽  
Myung Rae Cho ◽  
Jae Bum Kwon ◽  
Jae Hyuk Lee ◽  
Won Kee Choi
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Knee Flexion ◽  
Computer Navigation ◽  
Varus Knee ◽  
Total Knee ◽  
The Difference ◽  
Lateral Gaps

Purpose: Aim is to investigate the changes of mediolateral soft tissue gaps in total knee arthroplasty (TKA) after suturing medial extensor. Methods and materials: We compared the differences of medial and lateral gap values that were shown by the computer navigation at 0°, 45°, 90°, and 120° knee flexion during patella in situ and during patella repaired by a towel clip on two constant sites. Fifty consecutive knees (43 patients) scheduled for TKA due to varus knee osteoarthritis, from February 2017 to May 2017, were enrolled in this prospective study. Results: The medial gaps with patella repaired were significantly lower ( p < 0.05) than the medial gaps with patella in situ at 45°, 90°, and 120° knee flexion. Differences in the medial gap were largest at 90, with the difference of 0.87 mm. Twenty-four of 50 cases (48%) showed medial gap differences of 1 mm or over, and 13 of 50 cases (26%) showed medial gap differences of 2 mm or over. The variation in the medial gap at 90° following patellar repair showed significant association (correlation coefficient = 0.78, p = 0.001) with the difference between medial and lateral gaps (medial gap − lateral gap) at 90° of patella in situ. At 90° knee flexion, when the medial and lateral gap difference in patella in situ was 1 mm or less, 73.5% (25/34) of the cases showed variation in the medial gap of less than 1 mm after patellar repair. Conclusion: During TKA, while measuring the medial gap with patella in situ, overestimation might occur, especially in the position of knee flexion. Thus, reevaluation using towel clips should be considered when the medial and lateral gap difference is 1 mm or larger when patella in situ during evaluation of the medial and lateral gaps at 90° knee flexion.

scholarly journals Medio-Lateral and Flexion-Extension Gap Imbalances in Mechanically Aligned Total Knee Arthroplasty Using Measured Resection Technique in Korean Patients: 3D Simulation

2021 ◽  
Vol 10 (4) ◽  
pp. 845
Author(s):  
Byung Woo Cho ◽  
Ji Hoon Nam ◽  
Yong Gon Koh ◽  
Kwan Kyu Park ◽  
Kyoung Tak Kang
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Valgus Knee ◽  
Varus Knee ◽  
Asian Patients ◽  
Measured Resection ◽  
Flexion Extension ◽  
Total Knee ◽  
Extension Gap ◽  
Flexion And Extension

Background: It is well known that the measured resection (MR) technique in mechanically aligned (MA) total knee arthroplasty (TKA) generates significant gap imbalances, but little is known about whether this applies to the knees of Asian patients. The aim of this study was to evaluate the medio-lateral and flexion-extension gap imbalances and to find the most optimal posterior femoral condyle resection method for operating on the knees of Asian patients. Methods: In total, 738 magnetic resonance imaging (MRI) scans of consecutive patients who underwent TKA were obtained. Four posterior femoral condylar resection methods were used: alignment by the surgical transepicondylar axis (TEA), Whiteside’s line (WSL), 3° external rotation to the posterior condylar axis (PCA), and flexion-extension axis (FEA). Results: For the medial compartments, there were significant differences between the flexion and extension gaps in the varus knee group in all four methods, but there were no differences between the flexion and extension gaps in the valgus knee group. For the lateral compartment, all the methods showed significant differences except for WSL of the valgus knee group and FEA of the varus knee group. Conclusions: In Asian patients, the use of the MA MR technique inevitably leads to medio-lateral or flexion-extension imbalances. Therefore, surgeons should consider which methods can minimize imbalances and choose the best method within the technically possible range.

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