TY - JOUR
T1 - Intraoperative medial joint laxity in flexion decreases patient satisfaction after total knee arthroplasty
AU - Azukizawa, Masayuki
AU - Kuriyama, Shinichi
AU - Nakamura, Shinichiro
AU - Nishitani, Kohei
AU - Lyman, Stephen
AU - Morita, Yugo
AU - Furu, Moritoshi
AU - Ito, Hiromu
AU - Matsuda, Shuichi
N1 - Publisher Copyright:
© 2018, Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2018/8/1
Y1 - 2018/8/1
N2 - Introduction: The relationship between postoperative tibiofemoral ligament balance and patient satisfaction in total knee arthroplasty (TKA) has been explored previously. However, the optimal intraoperative medial–lateral ligament balance during knee flexion in terms of postoperative patient satisfaction remains unknown. We evaluated the effect of intraoperative flexion instability on patient satisfaction after TKA. Materials and methods: This study consisted of 46 knees with varus osteoarthritis undergoing TKA. Medial–lateral component gaps at 0° knee extension and 90° flexion were measured intraoperatively using a knee balancer. Differences in postoperative patient outcomes at 3 weeks and 1 year were compared between medially tight knees in 90° flexion with a medial component gap of < 4 mm and medially loose knees in 90° flexion with a gap of ≥ 4 mm. Outcomes were measured using the 2011 Knee Society Scoring System (2011 KS). Results: The median total 2011 KS score at 1 year postoperatively in the medially loose knees [median 97; interquartile range (IQR) 75–117] was significantly lower than that in the medially tight knees (median 128; IQR 104–139, P < 0.01), while preoperative and 3-week postoperative scores were similar. In addition, medial flexion gaps were not significantly associated with total 2011 KS scores before surgery or at 3 weeks postoperatively. However, at 1 year after surgery, medial component flexion gaps were negatively associated with the total 2011 KS score (R = − 0.42; P < 0.01) and the 2011 KS satisfaction subscale score (R = − 0.36; P = 0.01). Conclusions: Excessive intraoperative medial joint laxity of ≥ 4 mm at 90° flexion progressively decreased patient satisfaction for 1 year. Since intraoperative medial laxity in flexion is likely to interfere with functional recovery after TKA, medial stabilization during TKA is important throughout knee flexion. Level of evidence: Therapeutic study, Level III.
AB - Introduction: The relationship between postoperative tibiofemoral ligament balance and patient satisfaction in total knee arthroplasty (TKA) has been explored previously. However, the optimal intraoperative medial–lateral ligament balance during knee flexion in terms of postoperative patient satisfaction remains unknown. We evaluated the effect of intraoperative flexion instability on patient satisfaction after TKA. Materials and methods: This study consisted of 46 knees with varus osteoarthritis undergoing TKA. Medial–lateral component gaps at 0° knee extension and 90° flexion were measured intraoperatively using a knee balancer. Differences in postoperative patient outcomes at 3 weeks and 1 year were compared between medially tight knees in 90° flexion with a medial component gap of < 4 mm and medially loose knees in 90° flexion with a gap of ≥ 4 mm. Outcomes were measured using the 2011 Knee Society Scoring System (2011 KS). Results: The median total 2011 KS score at 1 year postoperatively in the medially loose knees [median 97; interquartile range (IQR) 75–117] was significantly lower than that in the medially tight knees (median 128; IQR 104–139, P < 0.01), while preoperative and 3-week postoperative scores were similar. In addition, medial flexion gaps were not significantly associated with total 2011 KS scores before surgery or at 3 weeks postoperatively. However, at 1 year after surgery, medial component flexion gaps were negatively associated with the total 2011 KS score (R = − 0.42; P < 0.01) and the 2011 KS satisfaction subscale score (R = − 0.36; P = 0.01). Conclusions: Excessive intraoperative medial joint laxity of ≥ 4 mm at 90° flexion progressively decreased patient satisfaction for 1 year. Since intraoperative medial laxity in flexion is likely to interfere with functional recovery after TKA, medial stabilization during TKA is important throughout knee flexion. Level of evidence: Therapeutic study, Level III.
UR - http://www.scopus.com/inward/record.url?scp=85047935771&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85047935771&partnerID=8YFLogxK
U2 - 10.1007/s00402-018-2965-2
DO - 10.1007/s00402-018-2965-2
M3 - Article
C2 - 29855683
AN - SCOPUS:85047935771
VL - 138
SP - 1143
EP - 1150
JO - Archiv fur orthopadische und Unfall-Chirurgie
JF - Archiv fur orthopadische und Unfall-Chirurgie
SN - 0003-9330
IS - 8
ER -