Abstract
Background
We developed a new tensor for total knee arthroplasty enabling the soft tissue balance
measurement after femoral trial placement with the patello-femoral joint reduced.
The purpose of the present study is to compare the measurements of joint gap and ligament
balance between osteotomized femoral and tibial surfaces in posterior-stabilized total
knee arthroplasty with that between surfaces of femoral trial component and tibial
osteotomy.
Methods
Using this tensor, the effect of femoral trial placement on the soft tissue balance
was analyzed in 80 posterior-stabilized total knee arthroplasties for varus osteoarthritic
knees. Both joint gap and varus ligament imbalance were measured with 40 lb of joint distraction force at extension and flexion, and compared between before
and after femoral trial placement.
Findings
In assessing the joint gap, there was significant decrease as much as 5.3 mm at extension, not flexion, after femoral trial prosthesis placement. Varus ligament
imbalances were significantly reduced with 3.1° at extension and increased with 1.2°
in average at flexion after femoral trial placement.
Interpretation
These changes at extension were caused by tensed posterior structures of the knee
with the posterior condyle of the externally rotated aligned femoral trial. At the
knee flexion, medial tension in the extensor mechanisms might be increased after femoral
trial placement with patello-femoral joint repaired, and increased varus imbalance.
Accordingly, we conclude that intensive medial release before femoral component placement
to obtain rectangular joint gap depending on the conventional osteotomy gap measurement
has a possible risk of medial looseness after total knee arthroplasty.
Keywords
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Article info
Publication history
Published online: July 26, 2010
Accepted:
June 29,
2010
Received:
March 11,
2010
Identification
Copyright
© 2010 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
