Extension gap needs more than 1-mm laxity after implantation to avoid post-operative flexion contracture in total knee arthroplasty

Shigetoshi Okamoto, Ken Okazaki, Hiroaki Mitsuyasu, Shuichi Matsuda, Hideki Mizu-uchi, Satoshi Hamai, Yasutaka Tashiro, Yukihide Iwamoto

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Purpose: In total knee arthroplasty (TKA), a high soft-tissue tension in extension at the time of operation would cause a post-operative flexion contracture. However, how tight the extension gap should be during surgery to avoid a post-operative flexion contracture remains unclear. The hypothesis is that some laxity in the intraoperative extension gap is necessary to avoid the post-operative flexion contracture.

Methods: A posterior-stabilized TKA was performed for 75 osteoarthritic knees with a varus deformity. The intraoperative extension gap was measured using a tensor device that provides the gap length and the angle between the femoral component and the tibial cut surface. The medial component gap was defined as the gap calculated by subtracting the selected thickness of the tibial component, including the polyethylene liner, from the extension gap at the medial side. Then, the patients were divided into three groups according to the medial component gap, and post-operative extension angle measured 1 year after the surgery was compared between each groups.

Results: One year post-operatively, a flexion contracture of more than 5° was found in 0/34 patients when the medial component gap was more than 1 mm, in 2/26 (8 %) patients when the gap was between 0 and 1 mm, and in 3/15 (20 %) patients when the gap was <0 mm. Three factors were associated significantly with the post-operative extension angle: age, preoperative extension angle, and medial component gap.

Conclusion: The intraoperative extension gap is related to the post-operative extension angle. Surgeons should leave more than 1-mm laxity after the implantation to avoid the post-operative flexion contracture. As a clinical relevance, this study clarified the optimal extension gap to avoid the post-operative flexion contracture.

Level of evidence: Prospective comparative study, Level II.

Original languageEnglish
Pages (from-to)3174-3180
Number of pages7
JournalKnee Surgery, Sports Traumatology, Arthroscopy
Volume22
Issue number12
DOIs
Publication statusPublished - Nov 20 2014

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Knee Replacement Arthroplasties
Contracture
Polyethylene
Thigh
Knee
Prospective Studies
Equipment and Supplies

All Science Journal Classification (ASJC) codes

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Extension gap needs more than 1-mm laxity after implantation to avoid post-operative flexion contracture in total knee arthroplasty. / Okamoto, Shigetoshi; Okazaki, Ken; Mitsuyasu, Hiroaki; Matsuda, Shuichi; Mizu-uchi, Hideki; Hamai, Satoshi; Tashiro, Yasutaka; Iwamoto, Yukihide.

In: Knee Surgery, Sports Traumatology, Arthroscopy, Vol. 22, No. 12, 20.11.2014, p. 3174-3180.

Research output: Contribution to journalArticle

Okamoto, Shigetoshi ; Okazaki, Ken ; Mitsuyasu, Hiroaki ; Matsuda, Shuichi ; Mizu-uchi, Hideki ; Hamai, Satoshi ; Tashiro, Yasutaka ; Iwamoto, Yukihide. / Extension gap needs more than 1-mm laxity after implantation to avoid post-operative flexion contracture in total knee arthroplasty. In: Knee Surgery, Sports Traumatology, Arthroscopy. 2014 ; Vol. 22, No. 12. pp. 3174-3180.
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abstract = "Purpose: In total knee arthroplasty (TKA), a high soft-tissue tension in extension at the time of operation would cause a post-operative flexion contracture. However, how tight the extension gap should be during surgery to avoid a post-operative flexion contracture remains unclear. The hypothesis is that some laxity in the intraoperative extension gap is necessary to avoid the post-operative flexion contracture.Methods: A posterior-stabilized TKA was performed for 75 osteoarthritic knees with a varus deformity. The intraoperative extension gap was measured using a tensor device that provides the gap length and the angle between the femoral component and the tibial cut surface. The medial component gap was defined as the gap calculated by subtracting the selected thickness of the tibial component, including the polyethylene liner, from the extension gap at the medial side. Then, the patients were divided into three groups according to the medial component gap, and post-operative extension angle measured 1 year after the surgery was compared between each groups.Results: One year post-operatively, a flexion contracture of more than 5° was found in 0/34 patients when the medial component gap was more than 1 mm, in 2/26 (8 {\%}) patients when the gap was between 0 and 1 mm, and in 3/15 (20 {\%}) patients when the gap was <0 mm. Three factors were associated significantly with the post-operative extension angle: age, preoperative extension angle, and medial component gap.Conclusion: The intraoperative extension gap is related to the post-operative extension angle. Surgeons should leave more than 1-mm laxity after the implantation to avoid the post-operative flexion contracture. As a clinical relevance, this study clarified the optimal extension gap to avoid the post-operative flexion contracture.Level of evidence: Prospective comparative study, Level II.",
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AU - Okamoto, Shigetoshi

AU - Okazaki, Ken

AU - Mitsuyasu, Hiroaki

AU - Matsuda, Shuichi

AU - Mizu-uchi, Hideki

AU - Hamai, Satoshi

AU - Tashiro, Yasutaka

AU - Iwamoto, Yukihide

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N2 - Purpose: In total knee arthroplasty (TKA), a high soft-tissue tension in extension at the time of operation would cause a post-operative flexion contracture. However, how tight the extension gap should be during surgery to avoid a post-operative flexion contracture remains unclear. The hypothesis is that some laxity in the intraoperative extension gap is necessary to avoid the post-operative flexion contracture.Methods: A posterior-stabilized TKA was performed for 75 osteoarthritic knees with a varus deformity. The intraoperative extension gap was measured using a tensor device that provides the gap length and the angle between the femoral component and the tibial cut surface. The medial component gap was defined as the gap calculated by subtracting the selected thickness of the tibial component, including the polyethylene liner, from the extension gap at the medial side. Then, the patients were divided into three groups according to the medial component gap, and post-operative extension angle measured 1 year after the surgery was compared between each groups.Results: One year post-operatively, a flexion contracture of more than 5° was found in 0/34 patients when the medial component gap was more than 1 mm, in 2/26 (8 %) patients when the gap was between 0 and 1 mm, and in 3/15 (20 %) patients when the gap was <0 mm. Three factors were associated significantly with the post-operative extension angle: age, preoperative extension angle, and medial component gap.Conclusion: The intraoperative extension gap is related to the post-operative extension angle. Surgeons should leave more than 1-mm laxity after the implantation to avoid the post-operative flexion contracture. As a clinical relevance, this study clarified the optimal extension gap to avoid the post-operative flexion contracture.Level of evidence: Prospective comparative study, Level II.

AB - Purpose: In total knee arthroplasty (TKA), a high soft-tissue tension in extension at the time of operation would cause a post-operative flexion contracture. However, how tight the extension gap should be during surgery to avoid a post-operative flexion contracture remains unclear. The hypothesis is that some laxity in the intraoperative extension gap is necessary to avoid the post-operative flexion contracture.Methods: A posterior-stabilized TKA was performed for 75 osteoarthritic knees with a varus deformity. The intraoperative extension gap was measured using a tensor device that provides the gap length and the angle between the femoral component and the tibial cut surface. The medial component gap was defined as the gap calculated by subtracting the selected thickness of the tibial component, including the polyethylene liner, from the extension gap at the medial side. Then, the patients were divided into three groups according to the medial component gap, and post-operative extension angle measured 1 year after the surgery was compared between each groups.Results: One year post-operatively, a flexion contracture of more than 5° was found in 0/34 patients when the medial component gap was more than 1 mm, in 2/26 (8 %) patients when the gap was between 0 and 1 mm, and in 3/15 (20 %) patients when the gap was <0 mm. Three factors were associated significantly with the post-operative extension angle: age, preoperative extension angle, and medial component gap.Conclusion: The intraoperative extension gap is related to the post-operative extension angle. Surgeons should leave more than 1-mm laxity after the implantation to avoid the post-operative flexion contracture. As a clinical relevance, this study clarified the optimal extension gap to avoid the post-operative flexion contracture.Level of evidence: Prospective comparative study, Level II.

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