Highlights
- •Osteophyte resection width correlates with medial gap change.
- •Medial osteophyte resection increases the medial gap without lateral gap increase.
- •Medial osteophyte resection decreases joint varus angles in total knee arthroplasty.
Abstract
Background
There is a lack of robust evidence for a correlation between the medial osteophyte
resection and correction of the medio-lateral gap imbalance during total knee arthroplasty.
The purpose of the present study was to quantify the effect of osteophyte resection
on the medio-lateral component gap imbalance during posterior-stabilized total knee
arthroplasty.
Methods
Forty-five cases of primary posterior-stabilized total knee arthroplasty using the
measured resection technique with posterior-stabilized prosthesis for varus knee osteoarthritis
were reviewed. Medial and lateral joint gaps at 0°, 10°, 45°, and 90° of flexion,
and maximum flexion were measured intraoperatively before and after the osteophyte
resection. The relationship between medial osteophyte resection width and change of
joint varus angle and medial component gap were assessed using Pearson's correlation
coefficient.
Findings
Medial component gap and joint varus angle values at post medial osteophyte resection
were significantly larger and lower than at pre-resection (Medial gap: pre 9.5 ± 1.8 mm,
post 10.3 ± 1.8 mm, P < 0.001, Joint angle: pre 5.2 ± 2.9°, post 4.2 ± 2.9°, P < 0.001). There was no significant difference between pre and post medial osteophyte
resection in lateral component gaps. Per each 1 mm of medial osteophyte resection
width, increases of 0.13 mm medial component gap and 0.2° valgus were observed (Medial
gap: r = 0.38, P < 0.001, Joint angle: r = 0.38, P < 0.001).
Interpretation
Medial osteophyte resection increases the medial component gap without lateral component
gap increase, while decreasing the joint varus angle in primary posterior-stabilized
total knee arthroplasty for varus knee osteoarthritis. Osteophyte resection width
was found to correlate with correction of the medio-lateral component gap imbalance.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Clinical BiomechanicsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Intraoperative medial joint laxity in flexion decreases patient satisfaction after total knee arthroplasty.Arch. Orthop. Trauma Surg. 2018; 138: 1143-1150
- The influence of coronal plane deformity on mediolateral ligament status: an observational study in varus knees.Knee Surg. Sports Traumatol. Arthrosc.: Off. J. ESSKA. 2010; 18: 152-156
- Interpreting change scores of tests and measures used in physical therapy.Phys. Ther. 2006; 86: 735-743
- The implications of mechanical alignment on soft tissue balancing in total knee arthroplasty.Knee Surg. Sports Traumatol. Arthrosc.: Off. J. ESSKA. 2015; 23: 3632-3636
- Outcome in total knee arthroplasty with a medial-lateral balanced versus unbalanced gap.J. Orthopaed. Surg. (Hong Kong). 2016; 24: 298-301
- Relationship between outcome scores and knee laxity following total knee arthroplasty: a systematic review.Acta Orthop. 2019; 90: 46-52
- Medial over-resection of the tibia in total knee arthroplasty for varus deformity using computer navigation.J. Arthroplast. 2015; 30: 766-769
- Control of frontal plane knee laxity during gait in patients with medial compartment knee osteoarthritis.Osteoarthr. Cartil. 2004; 12: 745-751
- Joint gap kinematics in posterior-stabilized total knee arthroplasty measured by a new tensor with the navigation system.J. Biomech. Eng. 2006; 128: 867-871
- Are varus knees contracted? Reconciling the literature.J. Orthopaed. Surg. (Hong Kong). 2017; 25 (2309499017731445)
- Soft-tissue balancing during total knee arthroplasty in the varus knee.J. Am. Acad. Orthopaed. Surg. 2009; 17: 766-774
- Can isolated removal of osteophytes achieve correction of varus deformity and gap-balance in computer-assisted total knee arthroplasty?.Bone Joint J. 2020; 102-b: 49-58
- Correction of varus deformity during TKA with reduction osteotomy.Clin. Orthop. Relat. Res. 2014; 472: 126-132
- Soft tissue balance changes depending on joint distraction force in total knee arthroplasty.J. Arthroplast. 2014; 29: 520-524
- Intraoperative soft tissue balance using novel medial preserving gap technique in posterior-stabilized total knee arthroplasty: comparison to measured resection technique.Knee Surg. Sports Traumatol. Arthrosc.: Off. J. ESSKA. 2018; 26: 3474-3481
- Effects of reduction osteotomy on gap balancing during total knee arthroplasty for severe varus deformity.J. Arthroplast. 2015; 30: 2116-2120
- Correction of Varus alignment with peripheral osteophyte removal during Total knee arthroplasty: an assessment with computer navigation.J. Knee Surg. 2021; (Online ahead of print)https://doi.org/10.1055/s-0041-1731737
- The effect of flexion balance on functional outcomes in cruciate-retaining total knee arthroplasty.Arch. Orthop. Trauma Surg. 2015; 135: 401-406
- The effect of marginal osteophytes on reduction of varus-valgus instability in osteoarthritic knees.Arthritis Rheum. 1990; 33: 853-858
- Effect of medial collateral ligament release and osteophyte resection on medial laxity in total knee arthroplasty.Knee Surg. Sports Traumatol. Arthrosc.: Off. J. ESSKA. 2021; 29: 3418-3425
- Investigation of association between the preoperative intra-articular anesthetic test and persistent pain after total knee arthroplasty.J. Orthopaed. Sci.: Off. J. Jpn. Orthopaed. Assoc. 2020; 6: 1055-1060
- Laxity profiles in the native and replaced knee-application to robotic-assisted gap-balancing Total knee arthroplasty.J. Arthroplast. 2018; 33: 3043-3048
- Comparison of intraoperative soft tissue balance measurement between two tensor systems in total knee arthroplasty.Knee. 2020; 27: 1071-1077
- Intraoperative physiological lateral laxity in extension and flexion for varus knees did not affect short-term clinical outcomes and patient satisfaction.Knee Surg. Sports Traumatol. Arthrosc.: Off. J. ESSKA. 2020; 28: 3888-3898
- What should the surgeon aim for when performing computer-assisted total knee arthroplasty?.J. Bone Joint Surg. Am. 2005; 87: 52-58
- Soft tissue balancing in varus total knee arthroplasty: an algorithmic approach.Knee Surg. Sports Traumatol. Arthrosc.: Off. J. ESSKA. 2009; 17: 660-666
- When to use agreement versus reliability measures.J. Clin. Epidemiol. 2006; 59: 1033-1039
- Improved total knee arthroplasty pain outcome when joint gap targets are achieved throughout flexion.Knee Surg. Sports Traumatol. Arthrosc.: Off. J. ESSKA. 2021; 30: 939-947
- What is a balanced knee replacement?.EFORT Open Rev. 2018; 3: 614-619
- Intraoperative joint gaps affect postoperative range of motion in TKAs with posterior-stabilized prostheses.Clin. Orthop. Relat. Res. 2013; 471: 1326-1333
- Step-by-step measurements of soft tissue balancing during total knee arthroplasty for patients with varus knees.J. Arthroplast. 2003; 18: 313-320
Article info
Publication history
Published online: October 19, 2022
Accepted:
October 17,
2022
Received:
August 9,
2022
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
