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TECHNICAL PAPERS: Joint/Whole Body

Joint Gap Kinematics in Posterior-Stabilized Total Knee Arthroplasty Measured by a New Tensor With the Navigation System

[+] Author and Article Information
Tomoyuki Matsumoto

Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japanmatsun@m4.dion.ne.jp

Hirotsugu Muratsu

Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japanhimuratsu@aol.com

Nobuhiro Tsumura

Department of Orthopaedic Surgery, Hyogo Rehabilitation Center, 1070, Akebono-cho, Nishi-ku, Kobe, 651-2181, Japantsumuranob@nifty.com

Kiyonori Mizuno

Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japanmizunok@med.kobe-u.ac.jp

Ryosuke Kuroda

Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japankurodar@med.kobe-u.ac.jp

Shinichi Yoshiya

Department of Orthopaedic Surgery, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, 663-8131, Japanyoshiya@hyo-med.ac.jp

Masahiro Kurosaka

Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japankurosaka@med.kobe-u.ac.jp

J Biomech Eng 128(6), 867-871 (Jun 14, 2006) (5 pages) doi:10.1115/1.2354201 History: Received June 08, 2005; Revised June 14, 2006

Background: The management of soft tissue balance during surgery is essential for the success of total knee arthroplasty (TKA) but remains difficult, leaving it much to the surgeon’s feel. Previous assessments for soft tissue balance have been performed under unphysiological joint conditions, with patellar eversion and without the prosthesis only at extension and 90 deg of flexion. We therefore developed a new tensor for TKA procedures, enabling soft tissue balance assessment throughout the range of motion while reproducing postoperative joint alignment with the patellofemoral (PF) joint reduced and the tibiofemoral joint aligned. Our purpose in the present study was to clarify joint gap kinematics using the tensor with the CT-free computer assisted navigation system. Method of Approach: Joint gap kinematics, defined as joint gap change during knee motion, was evaluated during 30 consecutive, primary posterior-stabilized (PS) TKA with the navigation system in 30 osteoarthritic patients. Measurements were performed using a newly developed tensor, which enabled the measurement of the joint gap throughout the range of motion, including the joint conditions relevant after TKA with PF joint reduced and trial femoral component in place. Joint gap was assessed by the tensor at full extension, 5 deg, 10 deg, 15 deg, 30 deg, 45 deg, 60 deg, 90 deg, and 135 deg of flexion with the patella both everted and reduced. The navigation system was used to obtain the accuracy of implantations and to measure an accurate flexion angle of the knee during the intraoperative joint gap measurement. Results: Results showed that the joint gap varied depending on the knee flexion angle. Joint gap showed an accelerated decrease during full knee extension. With the PF joint everted, the joint gap increased throughout knee flexion. In contrast, the joint gap with the PF joint reduced increased with knee flexion but decreased after 60 deg of flexion. Conclusions: We clarified the characteristics of joint gap kinematics in PS TKA under physiological and reproducible joint conditions. Our findings can provide useful information for prosthetic design and selection and allow evaluation of surgical technique throughout the range of knee motion that may lead to consistent clinical outcomes after TKA.

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Copyright © 2006 by American Society of Mechanical Engineers
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Figures

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Figure 3

Slope of the joint gap. During the full knee extension (from 0 to 15 deg), the trend in the joint gap gradient revealed an accelerated decrease in the joint gap. At the midrange of flexion between 15 to 60 deg, the joint gap increased consistently during knee flexion with a relatively small and constant joint gap gradient. The joint gap started to decrease from 60 deg and the trend of the joint gap gradient showed an accelerated decrease in the joint gap with the deep knee bend. (††: P<0.01 versus patellar eversion).

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Figure 2

Joint gap kinematics. The average joint gap increased during knee flexion from full extension with the peak of 60 deg of flexion, changing to a decrease during a deep knee bend with PF joint reduction. In contrast, the joint gap with the patellar eversion continuously showed a significant increase, even with more than 60 deg of flexion (††: P<0.01 versus patellar eversion).

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Figure 1

New TKA Tensor (A: anteroposterior view, B: intraoperative view). The new tensor consists of three parts: upper seesaw plate (a), lower platform plate (b), and extra-articular main body (c). Two plates are connected to the extra-articular main body by the offset connection arm (d) through medial parapatellar arthrotomy, which allows the PF joint reduction during the measurement.

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