Skip to main content
Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy 3/2012

01.03.2012 | Knee

Influence of intra-operative joint gaps on post-operative flexion angle in posterior cruciate-retaining total knee arthroplasty

verfasst von: Koji Takayama, Tomoyuki Matsumoto, Seiji Kubo, Hirotsugu Muratsu, Kazunari Ishida, Takehiko Matsushita, Masahiro Kurosaka, Ryosuke Kuroda

Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy | Ausgabe 3/2012

Einloggen, um Zugang zu erhalten

Abstract

Purpose

The purpose of this study is to examine the joint component gap and its relationship with post-operative flexion angles in posterior cruciate-retaining (CR) total knee arthroplasty (TKA). In posterior-stabilized (PS) TKA, an inverse correlation between the joint component gap and the post-operative flexion angle was reported. However, the kinematics of the joint component gap has a different pattern in PS and CR TKA. It was hypothesised that CR TKA has a different correlation between the joint component gap and the post-operative flexion angle compared to PS TKA.

Methods

The joint component gap was measured with an offset-type tensor. The joint component gaps were measured at 0°, 10°, 30°, 60°, 90° and 120° knee flexion angle and various values of the change in the joint component gap were calculated; 10°–0°, 30°–0°, 60°–0°, 90°–0° and 120°–0°. Multivariate regression analysis was used to determine the influencing of these parameters to post-operative knee flexion angle.

Results

The post-operative flexion angle was positively correlated with a joint component gap of 90° and 120° and the values of the change in the joint component gap of 90°–0° and 120°–0°. Multivariate regression analysis demonstrated pre-operative knee flexion angle, and the values of the change in the joint component gap of 90°–0° had a significant independent factor of post-operative knee flexion angle.

Conclusions

Post-operative flexion angle is multi-factorial. However, it is important to avoid flexion component gap tightness as well as excessive flexion component gap looseness for acquisition of better flexion angle in CR TKA.

Level of evidence

IV.
Literatur
1.
Zurück zum Zitat Anouchi YS, McShane M, Kelly F Jr, Elting J, Stiehl J (1996) Range of motion in total knee replacement. Clin Orthop Relat Res 331:87–92PubMedCrossRef Anouchi YS, McShane M, Kelly F Jr, Elting J, Stiehl J (1996) Range of motion in total knee replacement. Clin Orthop Relat Res 331:87–92PubMedCrossRef
2.
Zurück zum Zitat Arima J, Whiteside LA, Martin JW, Miura H, White SE, McCarthy DS (1998) Effect of partial release of the posterior cruciate ligament in total knee arthroplasty. Clin Orthop Relat Res 353:194–202PubMedCrossRef Arima J, Whiteside LA, Martin JW, Miura H, White SE, McCarthy DS (1998) Effect of partial release of the posterior cruciate ligament in total knee arthroplasty. Clin Orthop Relat Res 353:194–202PubMedCrossRef
3.
Zurück zum Zitat Banks SA, Markovich GD, Hodge WA (1997) In vivo kinematics of cruciate-retaining and -substituting knee arthroplasties. J Arthroplasty 12:297–304PubMedCrossRef Banks SA, Markovich GD, Hodge WA (1997) In vivo kinematics of cruciate-retaining and -substituting knee arthroplasties. J Arthroplasty 12:297–304PubMedCrossRef
4.
Zurück zum Zitat Bellemans J, Banks S, Victor J, Vandenneucker H, Moemans A (2002) Fluoroscopic analysis of the kinematics of deep flexion in total knee arthroplasty. Influence of posterior condylar offset. J Bone Joint Surg Br 84:50–53PubMedCrossRef Bellemans J, Banks S, Victor J, Vandenneucker H, Moemans A (2002) Fluoroscopic analysis of the kinematics of deep flexion in total knee arthroplasty. Influence of posterior condylar offset. J Bone Joint Surg Br 84:50–53PubMedCrossRef
5.
Zurück zum Zitat Dennis DA (2001) The stiff total knee arthroplasty: causes and cures. Orthopedics 24:901–902PubMed Dennis DA (2001) The stiff total knee arthroplasty: causes and cures. Orthopedics 24:901–902PubMed
6.
Zurück zum Zitat Dennis DA, Komistek RD, Colwell CE Jr, Ranawat CS, Scott RD, Thornhill TS, Lapp MA (1998) In vivo anteroposterior femorotibial translation of total knee arthroplasty: a multicenter analysis. Clin Orthop Relat Res 356:47–57PubMedCrossRef Dennis DA, Komistek RD, Colwell CE Jr, Ranawat CS, Scott RD, Thornhill TS, Lapp MA (1998) In vivo anteroposterior femorotibial translation of total knee arthroplasty: a multicenter analysis. Clin Orthop Relat Res 356:47–57PubMedCrossRef
7.
Zurück zum Zitat Dennis DA, Komistek RD, Stiehl JB, Walker SA, Dennis KN (1998) Range of motion after total knee arthroplasty: the effect of implant design and weight-bearing conditions. J Arthroplasty 13:748–752PubMedCrossRef Dennis DA, Komistek RD, Stiehl JB, Walker SA, Dennis KN (1998) Range of motion after total knee arthroplasty: the effect of implant design and weight-bearing conditions. J Arthroplasty 13:748–752PubMedCrossRef
8.
Zurück zum Zitat Fehring TK, Odum S, Griffin WL, Mason JB, Nadaud M (2001) Early failures in total knee arthroplasty. Clin Orthop Relat Res 392:315–318PubMedCrossRef Fehring TK, Odum S, Griffin WL, Mason JB, Nadaud M (2001) Early failures in total knee arthroplasty. Clin Orthop Relat Res 392:315–318PubMedCrossRef
9.
Zurück zum Zitat Goldstein WM, Raab DJ, Gleason TF, Branson JJ, Berland K (2006) Why posterior cruciate-retaining and substituting total knee replacements have similar ranges of motion. The importance of posterior condylar offset and cleanout of posterior condylar space. J Bone Joint Surg Am 88(4):182–188PubMedCrossRef Goldstein WM, Raab DJ, Gleason TF, Branson JJ, Berland K (2006) Why posterior cruciate-retaining and substituting total knee replacements have similar ranges of motion. The importance of posterior condylar offset and cleanout of posterior condylar space. J Bone Joint Surg Am 88(4):182–188PubMedCrossRef
10.
Zurück zum Zitat Harvey IA, Barry K, Kirby SP, Johnson R, Elloy MA (1993) Factors affecting the range of movement of total knee arthroplasty. J Bone Joint Surg Br 75:950–955PubMed Harvey IA, Barry K, Kirby SP, Johnson R, Elloy MA (1993) Factors affecting the range of movement of total knee arthroplasty. J Bone Joint Surg Br 75:950–955PubMed
11.
Zurück zum Zitat Hosmer DW, Lemeshow S (2000) Applied logistic regression, 2nd edn. Wiley, New York, pp 33–43CrossRef Hosmer DW, Lemeshow S (2000) Applied logistic regression, 2nd edn. Wiley, New York, pp 33–43CrossRef
12.
Zurück zum Zitat Joshi AB, Lee CM, Markovic L, Murphy JC, Hardinge K (1994) Total knee arthroplasty after patellectomy. J Bone Joint Surg Br 76:926–929PubMed Joshi AB, Lee CM, Markovic L, Murphy JC, Hardinge K (1994) Total knee arthroplasty after patellectomy. J Bone Joint Surg Br 76:926–929PubMed
13.
Zurück zum Zitat Kadoya Y, Kobayashi A, Komatsu T, Nakagawa S, Yamano Y (2001) Effects of posterior cruciate ligament resection on the tibiofemoral joint gap. Clin Orthop Relat Res 391:210–217PubMedCrossRef Kadoya Y, Kobayashi A, Komatsu T, Nakagawa S, Yamano Y (2001) Effects of posterior cruciate ligament resection on the tibiofemoral joint gap. Clin Orthop Relat Res 391:210–217PubMedCrossRef
14.
Zurück zum Zitat Kawamura H, Bourne RB (2001) Factors affecting range of flexion after total knee arthroplasty. J Orthop Sci 6:248–252PubMedCrossRef Kawamura H, Bourne RB (2001) Factors affecting range of flexion after total knee arthroplasty. J Orthop Sci 6:248–252PubMedCrossRef
15.
Zurück zum Zitat Kim H, Pelker RR, Gibson DH, Irving JF, Lynch JK (1997) Rollback in posterior cruciate ligament-retaining total knee arthroplasty. A radiographic analysis. J Arthroplasty 12:553–561PubMedCrossRef Kim H, Pelker RR, Gibson DH, Irving JF, Lynch JK (1997) Rollback in posterior cruciate ligament-retaining total knee arthroplasty. A radiographic analysis. J Arthroplasty 12:553–561PubMedCrossRef
16.
Zurück zum Zitat Lizaur A, Marco L, Cebrian R (1997) Preoperative factors influencing the range of movement after total knee arthroplasty for severe osteoarthritis. J Bone Joint Surg Br 79:626–629PubMedCrossRef Lizaur A, Marco L, Cebrian R (1997) Preoperative factors influencing the range of movement after total knee arthroplasty for severe osteoarthritis. J Bone Joint Surg Br 79:626–629PubMedCrossRef
17.
Zurück zum Zitat Lombardi AV Jr, Berend KR, Aziz-Jacobo J, Davis MB (2008) Balancing the flexion gap: relationship between tibial slope and posterior cruciate ligament release and correlation with range of motion. J Bone Joint Surg Am 90(4):121–132PubMedCrossRef Lombardi AV Jr, Berend KR, Aziz-Jacobo J, Davis MB (2008) Balancing the flexion gap: relationship between tibial slope and posterior cruciate ligament release and correlation with range of motion. J Bone Joint Surg Am 90(4):121–132PubMedCrossRef
18.
Zurück zum Zitat Massin P, Gournay A (2006) Optimization of the posterior condylar offset, tibial slope, and condylar roll-back in total knee arthroplasty. J Arthroplasty 21:889–896PubMedCrossRef Massin P, Gournay A (2006) Optimization of the posterior condylar offset, tibial slope, and condylar roll-back in total knee arthroplasty. J Arthroplasty 21:889–896PubMedCrossRef
19.
Zurück zum Zitat Matsumoto T, Kuroda R, Kubo S, Muratsu H, Mizuno K, Kurosaka M (2009) The intra-operative joint gap in cruciate-retaining compared with posterior-stabilised total knee replacement. J Bone Joint Surg Br 91:475–480PubMedCrossRef Matsumoto T, Kuroda R, Kubo S, Muratsu H, Mizuno K, Kurosaka M (2009) The intra-operative joint gap in cruciate-retaining compared with posterior-stabilised total knee replacement. J Bone Joint Surg Br 91:475–480PubMedCrossRef
20.
Zurück zum Zitat Matsumoto T, Mizuno K, Muratsu H, Tsumura N, Fukase N, Kubo S, Yoshiya S, Kurosaka M, Kuroda R (2007) Influence of intra-operative joint gap on post-operative flexion angle in osteoarthritis patients undergoing posterior-stabilized total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 15:1013–1018PubMedCrossRef Matsumoto T, Mizuno K, Muratsu H, Tsumura N, Fukase N, Kubo S, Yoshiya S, Kurosaka M, Kuroda R (2007) Influence of intra-operative joint gap on post-operative flexion angle in osteoarthritis patients undergoing posterior-stabilized total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 15:1013–1018PubMedCrossRef
21.
Zurück zum Zitat Matsumoto T, Muratsu H, Kubo S, Matsushita T, Kurosaka M, Kuroda R Soft Tissue Tension in Cruciate-Retaining and Posterior-Stabilized Total Knee Arthroplasty. J Arthroplasty [epub ahead of print]. doi:10.1016/j.arth.2010.06.006 Matsumoto T, Muratsu H, Kubo S, Matsushita T, Kurosaka M, Kuroda R Soft Tissue Tension in Cruciate-Retaining and Posterior-Stabilized Total Knee Arthroplasty. J Arthroplasty [epub ahead of print]. doi:10.​1016/​j.​arth.​2010.​06.​006
22.
Zurück zum Zitat Matsumoto T, Muratsu H, Tsumura N, Mizuno K, Kuroda R, Yoshiya S, Kurosaka M (2006) Joint gap kinematics in posterior-stabilized total knee arthroplasty measured by a new tensor with the navigation system. J Biomech Eng 128:867–871PubMedCrossRef Matsumoto T, Muratsu H, Tsumura N, Mizuno K, Kuroda R, Yoshiya S, Kurosaka M (2006) Joint gap kinematics in posterior-stabilized total knee arthroplasty measured by a new tensor with the navigation system. J Biomech Eng 128:867–871PubMedCrossRef
23.
Zurück zum Zitat Matsumoto T, Muratsu H, Tsumura N, Mizuno K, Kurosaka M, Kuroda R (2009) Soft tissue balance measurement in posterior-stabilized total knee arthroplasty with a navigation system. J Arthroplasty 24:358–364PubMedCrossRef Matsumoto T, Muratsu H, Tsumura N, Mizuno K, Kurosaka M, Kuroda R (2009) Soft tissue balance measurement in posterior-stabilized total knee arthroplasty with a navigation system. J Arthroplasty 24:358–364PubMedCrossRef
24.
Zurück zum Zitat Matsumoto T, Tsumura N, Kubo S, Shiba R, Kurosaka M, Yoshiya S (2005) Influence of hip position on knee flexion angle in patients undergoing total knee arthroplasty. J Arthroplasty 20:669–673PubMedCrossRef Matsumoto T, Tsumura N, Kubo S, Shiba R, Kurosaka M, Yoshiya S (2005) Influence of hip position on knee flexion angle in patients undergoing total knee arthroplasty. J Arthroplasty 20:669–673PubMedCrossRef
25.
Zurück zum Zitat Mizu-Uchi H, Colwell CW, Jr., Matsuda S, Flores-Hernandez C, Iwamoto Y, D’Lima DD Effect of Total Knee Arthroplasty Implant Position on Flexion Angle Before Implant-Bone Impingement. J Arthroplasty [epub ahead of print]. doi:10.1016/j.arth.2010.08.002 Mizu-Uchi H, Colwell CW, Jr., Matsuda S, Flores-Hernandez C, Iwamoto Y, D’Lima DD Effect of Total Knee Arthroplasty Implant Position on Flexion Angle Before Implant-Bone Impingement. J Arthroplasty [epub ahead of print]. doi:10.​1016/​j.​arth.​2010.​08.​002
26.
Zurück zum Zitat Moro-oka TA, Shiraishi H, Iwamoto Y, Banks SA (2010) Modified gap-balancing technique in total knee arthroplasty: evaluation of the post-operative coronal laxity. Knee Surg Sports Traumatol Arthrosc 18:375–380PubMedCrossRef Moro-oka TA, Shiraishi H, Iwamoto Y, Banks SA (2010) Modified gap-balancing technique in total knee arthroplasty: evaluation of the post-operative coronal laxity. Knee Surg Sports Traumatol Arthrosc 18:375–380PubMedCrossRef
27.
Zurück zum Zitat Muratsu H, Matsumoto T, Kubo S, Maruo A, Miya H, Kurosaka M, Kuroda R (2010) Femoral component placement changes soft tissue balance in posterior-stabilized total knee arthroplasty. Clin Biomech (Bristol, Avon) 25:926–930CrossRef Muratsu H, Matsumoto T, Kubo S, Maruo A, Miya H, Kurosaka M, Kuroda R (2010) Femoral component placement changes soft tissue balance in posterior-stabilized total knee arthroplasty. Clin Biomech (Bristol, Avon) 25:926–930CrossRef
28.
Zurück zum Zitat Muratsu H, Tsumura N, Yamaguchi M, Mizuno K, Kuroda R, Harada T, Yoshiya S, Kurosaka M (2003) Patellar eversion affects soft tissue balance in total knee arthroplasty. Trans Orthop Res Soc 28–242 Muratsu H, Tsumura N, Yamaguchi M, Mizuno K, Kuroda R, Harada T, Yoshiya S, Kurosaka M (2003) Patellar eversion affects soft tissue balance in total knee arthroplasty. Trans Orthop Res Soc 28–242
29.
Zurück zum Zitat Nozaki H, Banks SA, Suguro T, Hodge WA (2002) Observations of femoral rollback in cruciate-retaining knee arthroplasty. Clin Orthop Relat Res 404:308–314PubMedCrossRef Nozaki H, Banks SA, Suguro T, Hodge WA (2002) Observations of femoral rollback in cruciate-retaining knee arthroplasty. Clin Orthop Relat Res 404:308–314PubMedCrossRef
30.
Zurück zum Zitat Pang HN, Yeo SJ, Chong HC, Chin PL, Ong J, Lo NN (2011) Computer-assisted gap balancing technique improves outcome in total knee arthroplasty, compared with conventional measured resection technique. Knee Surg Sports Traumatol Arthrosc [Epub ahead of print]. doi:10.1007/s00167-011-1483-3 Pang HN, Yeo SJ, Chong HC, Chin PL, Ong J, Lo NN (2011) Computer-assisted gap balancing technique improves outcome in total knee arthroplasty, compared with conventional measured resection technique. Knee Surg Sports Traumatol Arthrosc [Epub ahead of print]. doi:10.​1007/​s00167-011-1483-3
31.
Zurück zum Zitat Parsley BS, Engh GA, Dwyer KA (1992) Preoperative flexion. Does it influence postoperative flexion after posterior-cruciate-retaining total knee arthroplasty? Clin Orthop Relat Res 275:204–210PubMed Parsley BS, Engh GA, Dwyer KA (1992) Preoperative flexion. Does it influence postoperative flexion after posterior-cruciate-retaining total knee arthroplasty? Clin Orthop Relat Res 275:204–210PubMed
32.
Zurück zum Zitat Ritter MA, Faris PM, Keating EM (1988) Posterior cruciate ligament balancing during total knee arthroplasty. J Arthroplasty 3:323–326PubMedCrossRef Ritter MA, Faris PM, Keating EM (1988) Posterior cruciate ligament balancing during total knee arthroplasty. J Arthroplasty 3:323–326PubMedCrossRef
33.
Zurück zum Zitat Ritter MA, Stringer EA (1979) Predictive range of motion after total knee replacement. Clin Orthop Relat Res 143:115–119PubMed Ritter MA, Stringer EA (1979) Predictive range of motion after total knee replacement. Clin Orthop Relat Res 143:115–119PubMed
34.
Zurück zum Zitat Schurman DJ, Matityahu A, Goodman SB, Maloney W, Woolson S, Shi H, Bloch DA (1998) Prediction of postoperative knee flexion in Insall-Burstein II total knee arthroplasty. Clin Orthop Relat Res 353:175–184PubMedCrossRef Schurman DJ, Matityahu A, Goodman SB, Maloney W, Woolson S, Shi H, Bloch DA (1998) Prediction of postoperative knee flexion in Insall-Burstein II total knee arthroplasty. Clin Orthop Relat Res 353:175–184PubMedCrossRef
35.
Zurück zum Zitat Schurman DJ, Parker JN, Ornstein D (1985) Total condylar knee replacement. A study of factors influencing range of motion as late as two years after arthroplasty. J Bone Joint Surg Am 67:1006–1014PubMed Schurman DJ, Parker JN, Ornstein D (1985) Total condylar knee replacement. A study of factors influencing range of motion as late as two years after arthroplasty. J Bone Joint Surg Am 67:1006–1014PubMed
36.
Zurück zum Zitat Schuster AJ, von Roll AL, Pfluger D, Wyss T Anteroposterior stability after posterior cruciate-retaining total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc [epub ahead of print]. doi:10.1007/s00167-010-1364-1 Schuster AJ, von Roll AL, Pfluger D, Wyss T Anteroposterior stability after posterior cruciate-retaining total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc [epub ahead of print]. doi:10.​1007/​s00167-010-1364-1
37.
Zurück zum Zitat Sharkey PF, Hozack WJ, Rothman RH, Shastri S, Jacoby SM (2002) Insall award paper. Why are total knee arthroplasties failing today? Clin Orthop Relat Res 404:7–13PubMedCrossRef Sharkey PF, Hozack WJ, Rothman RH, Shastri S, Jacoby SM (2002) Insall award paper. Why are total knee arthroplasties failing today? Clin Orthop Relat Res 404:7–13PubMedCrossRef
38.
Zurück zum Zitat Stiehl JB, Komistek RD, Dennis DA (1999) Detrimental kinematics of a flat on flat total condylar knee arthroplasty. Clin Orthop Relat Res 365:139–148PubMedCrossRef Stiehl JB, Komistek RD, Dennis DA (1999) Detrimental kinematics of a flat on flat total condylar knee arthroplasty. Clin Orthop Relat Res 365:139–148PubMedCrossRef
39.
Zurück zum Zitat Yamakado K, Kitaoka K, Yamada H, Hashiba K, Nakamura R, Tomita K (2003) Influence of stability on range of motion after cruciate-retaining TKA. Arch Orthop Trauma Surg 123:1–4PubMed Yamakado K, Kitaoka K, Yamada H, Hashiba K, Nakamura R, Tomita K (2003) Influence of stability on range of motion after cruciate-retaining TKA. Arch Orthop Trauma Surg 123:1–4PubMed
Metadaten
Titel
Influence of intra-operative joint gaps on post-operative flexion angle in posterior cruciate-retaining total knee arthroplasty
verfasst von
Koji Takayama
Tomoyuki Matsumoto
Seiji Kubo
Hirotsugu Muratsu
Kazunari Ishida
Takehiko Matsushita
Masahiro Kurosaka
Ryosuke Kuroda
Publikationsdatum
01.03.2012
Verlag
Springer-Verlag
Erschienen in
Knee Surgery, Sports Traumatology, Arthroscopy / Ausgabe 3/2012
Print ISSN: 0942-2056
Elektronische ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-011-1594-x

Weitere Artikel der Ausgabe 3/2012

Knee Surgery, Sports Traumatology, Arthroscopy 3/2012 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.