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Extra-articular factors of the femur and tibia affecting knee balance in mechanically aligned total knee arthroplasty - 25/11/22

Doi : 10.1016/j.otsr.2022.103297 
Hiroyasu Ogawa a, b, , Masaya Sengoku a, Tetsuya Shimokawa a, Yutaka Nakamura a, Kazuichiro Ohnishi a, Kazu Matsumoto b, Haruhiko Akiyama b
a Department of Orthopaedic Surgery, Ogaki-Tokushukai Hospital, Hayashi-machi 6-85-1, 503-0015 Ogaki, Gifu, Japan 
b Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Yanagido 1-1, 501-1194 Gifu, Japan 

Corresponding author.

Highlights

Forty-three patients who underwent MA-TKA were analyzed about the relationship between mediolateral differentials in compartment pressure and lower limb alignment parameters.
Extra-articular bone shape affects knee balance in mechanically aligned total knee arthroplasty.
Balanced knees with maintaining medial stability are limited in mechanically aligned total knee arthroplasty.

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Abstract

Purpose

Although the joint gap distance and compartment loading of the knee are different parameters for obtaining balanced knees in patients with total knee arthroplasty (TKA), the extent to which a balanced knee is achieved in patients with mechanically aligned TKA (MA-TKA) is unclear. This study aimed to investigate the anatomical factors that affect the ligament balancing in MA-TKA according to a gap balancing technique by measured resection technique.

Methods

The relationship between compartment loading, gap distance, and lower limb alignment was analysed in forty-three patients who underwent navigation-assisted MA-TKA with the minimum soft-tissue release. Radiographic parameters included hip-knee-ankle (HKA) angle, femorotibial angle, mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle, posterior tibial slope, varus and valgus joint line convergence angle, femoral valgus angle, femoral shaft curve, and tibial shaft curve (TSC).

Results

The postoperative HKA angle was 0.4±1.5°, with one coronal alignment outlier (2.3%). The gap distance showed four unbalanced knees for extension (9.3%) and flexion (9.3%), whereas the compartment loading identified 17 unbalanced knees (39.5%) at extension, 8 (18.6%) at 45° flexion, 7 (16.2%) at 90° flexion, and 10 (23.2%) at full flexion in MA-TKA. Mediolateral differentials of compartment loading correlated with femoral valgus angle (0°, 45°, and 90° flexion), mLDFA (45° and 90° flexion), and TSC (45° and 90° flexion). Femoral valgus angle and TSC were risk factors of the mediolateral differentials of compartment loading.

Conclusion

Extra-articular factors of femoral valgus angle, mLDFA, and TSC were associated with the mediolateral imbalance of compartmental loading, suggesting there is a limit to obtaining balanced knees in MA-TKA due to these unadjustable extra-articular factors.

Level of evidence

IV, therapeutic case series.

Le texte complet de cet article est disponible en PDF.

Keywords : Total knee arthroplasty, Mechanical alignment, Compartment loading, Balanced knee, Kinematic alignment, Gap distance


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Vol 108 - N° 8

Article 103297- décembre 2022 Retour au numéro
Article précédent Article précédent
  • Similar outcomes of constrained condylar knee and rotating hinge prosthesis in revision surgery for extension instability after primary total knee arthroplasty
  • Francisco A. Miralles-Muñoz, Manuel Pineda-Salazar, Marta Rubio-Morales, Santiago González-Parreño, Matías Ruiz-Lozano, Alejandro Lizaur-Utrilla
| Article suivant Article suivant
  • Tibiofemoral lift-off and resulting laxity following total knee arthroplasty: Frequency in a series of 906 continuous cases and functional consequences at 4 years’ follow-up in a case-control study
  • Benoît de Saint Vincent, Pierre Martinot, Julien Dartus, Gilles Pasquier, Julien Girard, Henri Migaud

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