J Knee Surg 2023; 36(01): 095-104
DOI: 10.1055/s-0041-1729968
Original Article

Knee Stability following Posterior-Stabilized Total Knee Arthroplasty: Comparison of Medial Preserving Gap Technique and Measured Resection Technique

1   Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
,
Hirotsugu Muratsu
2   Department of Orthopedic Surgery, Steel Memorial Hirohata Hospital, Himeji, Japan
,
Naoki Nakano
1   Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
,
Tomoyuki Kamenaga
1   Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
,
Yuichi Kuroda
1   Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
,
Takao Inokuchi
2   Department of Orthopedic Surgery, Steel Memorial Hirohata Hospital, Himeji, Japan
,
Hidetoshi Miya
2   Department of Orthopedic Surgery, Steel Memorial Hirohata Hospital, Himeji, Japan
,
Ryosuke Kuroda
1   Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
,
Tomoyuki Matsumoto
1   Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
› Author Affiliations

Abstract

Novel medial preserving gap technique (MPGT) focuses on medial compartment stability and allows lateral physiological laxity. This study aimed to compare the MPGT with the measured resection technique (MRT) to determine which provides better postoperative knee stability after posterior-stabilized total knee arthroplasty (PS-TKA). Primary PS-TKA, using either MPGT (n = 65) or MRT (n = 65), was performed in 130 patients with varus knee osteoarthritis. Postoperative knee stabilities at extension and flexion were assessed using varus–valgus stress radiographs and stress epicondylar view, respectively (at 1 month, 6 months, 1 year, and 3 years postoperatively). The distance between the femoral prosthesis and polyethylene insert was measured on each medial and lateral side, defined as the medial joint opening (MJO) and lateral joint opening (LJO), respectively. Decreasing MJO or LJO translated to increasing postoperative stability. The femoral external rotation angle was compared between the two surgical techniques; postoperative knee stability was also compared between the medial and lateral compartments, as well as the surgical techniques. A significant difference was found in the femoral external rotation angle between MPGT (4.2 ± 0.2 degrees) and MRT (3.6 ± 0.1 degrees, p < 0.01). Postoperative MJOs both at extension and flexion were significantly smaller than LJOs using MPGT and MRT at all time points (p < 0.05). MJOs and LJOs at extension using MPGT were significantly smaller than those when using MRT, at 1 and 3 years postoperatively (p < 0.05). Furthermore, MJOs at flexion using MPGT were significantly smaller than those when using MRT at 6 months, 1 year, and 3 years postoperatively (p < 0.05). MPGT provided higher postoperative medial knee stability than MRT both at extension and flexion, even at 3 years after PS-TKA. This suggests that this newly developed surgical technique is a more feasible option than MRT for the preservation of postoperative medial knee stability.



Publication History

Received: 21 January 2021

Accepted: 01 April 2021

Article published online:
15 May 2021

© 2021. Thieme. All rights reserved.

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  • References

  • 1 Hungerford DS. Measured resection: a valuable tool in TKA. Orthopedics 2008; 31 (09) 941-942
  • 2 Dennis DA. Measured resection: an outdated technique in total knee arthroplasty. Orthopedics 2008; 31 (09) 940,943–944
  • 3 Matsumoto T, Muratsu H, Kawakami Y. et al. Soft-tissue balancing in total knee arthroplasty: cruciate-retaining versus posterior-stabilised, and measured-resection versus gap technique. Int Orthop 2014; 38 (03) 531-537
  • 4 Liebs TR, Kloos S-A, Herzberg W, Rüther W, Hassenpflug J. The significance of an asymmetric extension gap on routine radiographs after total knee replacement: a new sign and its clinical significance. Bone Joint J 2013; 95-B (04) 472-477
  • 5 Nakamura S, Ito H, Yoshitomi H, Kuriyama S, Komistek RD, Matsuda S. Analysis of the flexion gap on in vivo knee kinematics using fluoroscopy. J Arthroplasty 2015; 30 (07) 1237-1242
  • 6 Tsubosaka M, Muratsu H, Takayama K, Miya H, Kuroda R, Matsumoto T. Comparison of intraoperative soft tissue balance between cruciate-retaining and posterior-stabilized total knee arthroplasty performed by a newly developed medial preserving gap technique. J Arthroplasty 2018; 33 (03) 729-734
  • 7 Nagai K, Muratsu H, Kanda Y. et al. 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 2018; 26 (11) 3474-3481
  • 8 Kamenaga T, Muratsu H, Kanda Y, Miya H, Kuroda R, Matsumoto T. The influence of postoperative knee stability on patient satisfaction in cruciate-retaining total knee arthroplasty. J Arthroplasty 2018; 33 (08) 2475-2479
  • 9 Iranpour-Boroujeni T, Li J, Lynch JA, Nevitt M, Duryea J. OAI Investigators. A new method to measure anatomic knee alignment for large studies of OA: data from the osteoarthritis initiative. Osteoarthritis Cartilage 2014; 22 (10) 1668-1674
  • 10 Matsumoto T, Muratsu H, Tsumura N. et al. Joint gap kinematics in posterior-stabilized total knee arthroplasty measured by a new tensor with the navigation system. J Biomech Eng 2006; 128 (06) 867-871
  • 11 Matsumoto T, Kuroda R, Kubo S, Muratsu H, Mizuno K, Kurosaka M. The intra-operative joint gap in cruciate-retaining compared with posterior-stabilised total knee replacement. J Bone Joint Surg Br 2009; 91 (04) 475-480
  • 12 Muratsu H, Matsumoto T, Kubo S. et al. Femoral component placement changes soft tissue balance in posterior-stabilized total knee arthroplasty. Clin Biomech (Bristol, Avon) 2010; 25 (09) 926-930
  • 13 Nagai K, Muratsu H, Matsumoto T, Miya H, Kuroda R, Kurosaka M. Soft tissue balance changes depending on joint distraction force in total knee arthroplasty. J Arthroplasty 2014; 29 (03) 520-524
  • 14 Hungerford DS, Kenna RV. Preliminary experience with a total knee prosthesis with porous coating used without cement. Clin Orthop Relat Res 1983; (176) 95-107
  • 15 Arima J, Whiteside LA, McCarthy DS, White SE. Femoral rotational alignment, based on the anteroposterior axis, in total knee arthroplasty in a valgus knee. A technical note. J Bone Joint Surg Am 1995; 77 (09) 1331-1334
  • 16 Whiteside LA, Arima J. The anteroposterior axis for femoral rotational alignment in valgus total knee arthroplasty. Clin Orthop Relat Res 1995; (321) 168-172
  • 17 Berger RA, Rubash HE, Seel MJ, Thompson WH, Crossett LS. Determining the rotational alignment of the femoral component in total knee arthroplasty using the epicondylar axis. Clin Orthop Relat Res 1993; (286) 40-47
  • 18 Yoshino N, Takai S, Ohtsuki Y, Hirasawa Y. Computed tomography measurement of the surgical and clinical transepicondylar axis of the distal femur in osteoarthritic knees. J Arthroplasty 2001; 16 (04) 493-497
  • 19 Ishii Y, Matsuda Y, Ishii R, Sakata S, Omori G. Coronal laxity in extension in vivo after total knee arthroplasty. J Orthop Sci 2003; 8 (04) 538-542
  • 20 Matsumoto T, Muratsu H, Kubo S, Matsushita T, Kurosaka M, Kuroda R. Intraoperative soft tissue balance reflects minimum 5-year midterm outcomes in cruciate-retaining and posterior-stabilized total knee arthroplasty. J Arthroplasty 2012; 27 (09) 1723-1730
  • 21 Kanekasu K, Kondo M, Kadoya Y. Axial radiography of the distal femur to assess rotational alignment in total knee arthroplasty. Clin Orthop Relat Res 2005; (434) 193-197
  • 22 Tokuhara Y, Kadoya Y, Kanekasu K, Kondo M, Kobayashi A, Takaoka K. Evaluation of the flexion gap by axial radiography of the distal femur. J Bone Joint Surg Br 2006; 88 (10) 1327-1330
  • 23 Scuderi GR, Insall JN. The posterior stabilized knee prosthesis. Orthop Clin North Am 1989; 20 (01) 71-78
  • 24 Luyckx T, Peeters T, Vandenneucker H, Victor J, Bellemans J. Is adapted measured resection superior to gap-balancing in determining femoral component rotation in total knee replacement?. J Bone Joint Surg Br 2012; 94 (09) 1271-1276
  • 25 Lee JK, Lee S, Chun SH, Kim KT, Lee MC. Rotational alignment of femoral component with different methods in total knee arthroplasty: a randomized, controlled trial. BMC Musculoskelet Disord 2017; 18 (01) 217
  • 26 Okazaki K, Miura H, Matsuda S. et al. Asymmetry of mediolateral laxity of the normal knee. J Orthop Sci 2006; 11 (03) 264-266
  • 27 Aunan E, Kibsgård TJ, Diep LM, Röhrl SM. Intraoperative ligament laxity influences functional outcome 1 year after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2015; 23 (06) 1684-1692
  • 28 Nakamura S, Kuriyama S, Nishitani K, Ito H, Murata K, Matsuda S. Correlation between intraoperative anterior stability and flexion gap in total knee arthroplasty. J Arthroplasty 2018; 33 (08) 2480-2484
  • 29 Yagishita K, Muneta T, Ikeda H. Step-by-step measurements of soft tissue balancing during total knee arthroplasty for patients with varus knees. J Arthroplasty 2003; 18 (03) 313-320
  • 30 Mullaji A, Sharma A, Marawar S, Kanna R. Quantification of effect of sequential posteromedial release on flexion and extension gaps: a computer-assisted study in cadaveric knees. J Arthroplasty 2009; 24 (05) 795-805
  • 31 Moro-oka TA, Shiraishi H, Iwamoto Y, Banks SA. Modified gap-balancing technique in total knee arthroplasty: evaluation of the post-operative coronal laxity. Knee Surg Sports Traumatol Arthrosc 2010; 18 (03) 375-380