DETERMINATION OF TIBIAL BONE RESECTION THICKNESS BY LATERAL TIBIOFEMORAL JOINT 90° FLEXIONAL GAP IN TOTAL KNEE ARTHROPLASTY FOR VARUS OSTEOARTHRITIC KNEES_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANGLei ¹ , SUNZhenhui ² , SUNYunbo ² , ZHANGDongliang ² , TIANMengqiang ² ,  FENGShiqing ¹

1. Department of Orthopedics, General Hospital of Tianjin Medical University, Tianjin, 300052, P. R. China;
2. Department of Joint Surgery, Tianjin People's Hospital;

Corresponding author：

FENGShiqing, Email: fengsq@hotmail.com

Keywords：

Total knee arthroplasty; Tibiofemoral joint; Posterior condylar offset; Bone resection thickness

DOI：

10.7507/1002-1892.20140315

Video：

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Objective To investigate the efficiency of total knee arthroplasty (TKA) for varus osteoarthritic knees with tibial bone resection determined by lateral tibiofemoral joint 90° flexional gap measurement. Methods Between March and June 2013, 60 patients (60 knees) with varus osteoarthritic knees underwent TKA. All patients were randomly divided into traditional osteotomy group (control group, 30 cases) and lateral tibiofemoral joint 90° flexional gap measurement resection group (trial group, 30 cases). There was no significant difference in gender, age, affected side, body mass index and preoperative knee society score (KSS), range of motion (ROM) of the knee, anatomic tibiofemoral angle (ATFA), patellar tilt angle, posterior condylar offset (PCO), and joint line height between 2 groups (P>0.05). The bone resection thickness of the distal femoral lateral condyle, femoral posterior lateral condyle, and lateral tibial plateau were measured; and the X-ray films were taken to measure and compare ATFA, patellar tilt angle, PCO, and joint line height after TKA. The knee function recovery was evaluated with KSS score and ROM of the knee. Results The bone resection thickness of the lateral tibial plateau and distal femoral lateral condyle in trial group was significantly smaller than that in control group (P<0.05); while the bone resection thickness of the femoral posterior lateral condyle was significantly bigger than that in control group (P<0.05). The 10 mm polyethylene insert was used in 19 cases of the trial group and in 8 cases of the control group, showing significant difference (Z=-4.040, P=0.003). All the patients were followed up 13-16 months (mean, 14.5 months). Radiography at 6 weeks after TKA indicated that the ATFA, patellar tilt angle, and joint line height had no significant difference between 2 groups (P>0.05); the PCO of trial group was significantly lower than that of control group (P<0.05). The KSS score and ROM of the knee at 12 months after operation were significantly improved when compared with preoperative ones in 2 groups (P<0.05), and trial group was significantly better than control group (P<0.05). Conclusion It was an effective method to determine bone resection thickness using lateral tibiofemoral joint 90° flexional gap measurement in TKA for varus osteoarthritic knees, which can reduce the bone resection thickness of the tibial plateau and distal femoral lateral condyle and restore the joint line and PCO with better early recovery of the knee function.

Citation： WANGLei, SUNZhenhui, SUNYunbo, ZHANGDongliang, TIANMengqiang, FENGShiqing. DETERMINATION OF TIBIAL BONE RESECTION THICKNESS BY LATERAL TIBIOFEMORAL JOINT 90° FLEXIONAL GAP IN TOTAL KNEE ARTHROPLASTY FOR VARUS OSTEOARTHRITIC KNEES. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(12): 1453-1458. doi: 10.7507/1002-1892.20140315 Copy

1.	Atrey A, Edmondson MC, East D, et al. A retrospective medium-to long-term results of 1500 AGC total knee replacements-An independent centre functional follow up and survivorshi p. J Orthop, 2014, 11(1):37-42.
2.	刘军, 曹建刚, 张宇, 等. 全膝关节置换治疗内翻型膝关节骨性关节炎. 天津医药, 2011, 39(6):523-526.
3.	Nagai K, Muratsu H, Matsumoto T, et al. Influence of intra-operative parameters on postoperative early recovery of active knee flexion in posterior-stabil ized total knee arthroplasty. Int Orthop, 2013, 37(11): 2153-2157.
4.	Sensi L, Buzzi R, Giron F, et al. Patellofemoral function after total knee arthroplasty:gender-related differences. J Arthroplasty, 2011, 26(8): 1475-1480.
5.	McPherson EJ, Cuckler J, Lombardi AV. Midflexion instabil ity in revision total knee arthroplasty. Surg Technol Int, 2008, 17:249-252.
6.	孙振辉, 刘军, 田峥巍, 等. 间隙平衡技术在全膝关节置换术中应用的中期随访研究. 中国矫形外科杂志, 2013, 21(13):1292-1296.
7.	Havet E, Gabrion A, Leiber-Wackenheim F, et al. Radiological study of the knee joint line position measured from the fibular head and proximal tibial landmarks. Surg Radiol Anat, 2007, 29(4):285-289.
8.	Figgie HE 3rd, Goldberg VM, Heiple KG, et al. The influence of tibialpatellofemoral location on function of the knee in patients with the posterior stabilized condylar knee prosthesis. J Bone Joint Surg (Am), 1986, 68(7):1035-1040.
9.	Abdeen AR, Collen SR, Vince KG. Fifteen-year to 19-year follow-up of the Insall-Burstein-1 total knee arthroplasty. J Arthroplasty, 2010, 25(2):173-178.
10.	Song IS, Sun DH, Chon JG, et al. Results of revision surgery and causes of unstable total knee arthroplasty. Clin Orthop Surg, 2014, 6(2):165-172.
11.	Schnurr C, Csécsei G, Nessler J, et al. How much tibial resection is required in total knee arthroplasty? Int Orthop, 2011, 35(7):989-994.
12.	Daniilidis K, Tibesku CO. A comparison of conventional and patientspecific instruments in total knee arthroplasty. Int Orthop, 2014, 38(3): 503-508.
13.	O'Connor MI, Kransdorf MJ. Customized knee arthroplasty and the role of preoperative imaging. AJR Am J Roentgenol, 2013, 201(3): W443-450.
14.	Vince KG. Diagnosis and management of patients with instabil ity of the knee. Instr Course Lect, 2012, 61:515-524.
15.	Berend ME, Small SR, Ritter MA, et al. The effects of bone resection depth and malalignment on strain in the proximal tibia after total knee arthroplasty. J Arthroplasty, 2010, 25(2):314-318.
16.	Shetty GM, Mullaji A, Bhayde S. Computer guided restoration of joint line and femoral offset in cruciate substituting total knee arthroplasty. Knee, 2012, 19(5):611-616.
17.	Dennis DA, Komistek RD, Kim RH, et al. Gap balancing versus measured resection technique for total knee arthroplasty. Cl in Orthop Relat Res, 2010, 468(1):102-107.
18.	Ishii Y, Noguchi H, Takeda M, et al. Posterior condylar offset does not correlate with knee flexion after TKA. Clin Orthop Relat Res, 2013, 471(9):2995-3001.
19.	Arabori M, Matsui N, Kuroda R, et al. Posterior condylar offset and flexion in posterior cruciate-retaining and posterior stabilized TKA. J Orthop Sci, 2008, 13(1):46-50.
20.	Han HS, Kang SB, Yoon KS. High incidence of loosening of the femoral component in legacy posterior stabil ised-flex total knee replacement. J Bone Joint Surg (Br), 2007, 89(11):1457-1461.

1. Atrey A, Edmondson MC, East D, et al. A retrospective medium-to long-term results of 1500 AGC total knee replacements-An independent centre functional follow up and survivorshi p. J Orthop, 2014, 11(1):37-42.
2. 刘军, 曹建刚, 张宇, 等. 全膝关节置换治疗内翻型膝关节骨性关节炎. 天津医药, 2011, 39(6):523-526.
3. Nagai K, Muratsu H, Matsumoto T, et al. Influence of intra-operative parameters on postoperative early recovery of active knee flexion in posterior-stabil ized total knee arthroplasty. Int Orthop, 2013, 37(11): 2153-2157.
4. Sensi L, Buzzi R, Giron F, et al. Patellofemoral function after total knee arthroplasty:gender-related differences. J Arthroplasty, 2011, 26(8): 1475-1480.
5. McPherson EJ, Cuckler J, Lombardi AV. Midflexion instabil ity in revision total knee arthroplasty. Surg Technol Int, 2008, 17:249-252.
6. 孙振辉, 刘军, 田峥巍, 等. 间隙平衡技术在全膝关节置换术中应用的中期随访研究. 中国矫形外科杂志, 2013, 21(13):1292-1296.
7. Havet E, Gabrion A, Leiber-Wackenheim F, et al. Radiological study of the knee joint line position measured from the fibular head and proximal tibial landmarks. Surg Radiol Anat, 2007, 29(4):285-289.
8. Figgie HE 3rd, Goldberg VM, Heiple KG, et al. The influence of tibialpatellofemoral location on function of the knee in patients with the posterior stabilized condylar knee prosthesis. J Bone Joint Surg (Am), 1986, 68(7):1035-1040.
9. Abdeen AR, Collen SR, Vince KG. Fifteen-year to 19-year follow-up of the Insall-Burstein-1 total knee arthroplasty. J Arthroplasty, 2010, 25(2):173-178.
10. Song IS, Sun DH, Chon JG, et al. Results of revision surgery and causes of unstable total knee arthroplasty. Clin Orthop Surg, 2014, 6(2):165-172.
11. Schnurr C, Csécsei G, Nessler J, et al. How much tibial resection is required in total knee arthroplasty? Int Orthop, 2011, 35(7):989-994.
12. Daniilidis K, Tibesku CO. A comparison of conventional and patientspecific instruments in total knee arthroplasty. Int Orthop, 2014, 38(3): 503-508.
13. O'Connor MI, Kransdorf MJ. Customized knee arthroplasty and the role of preoperative imaging. AJR Am J Roentgenol, 2013, 201(3): W443-450.
14. Vince KG. Diagnosis and management of patients with instabil ity of the knee. Instr Course Lect, 2012, 61:515-524.
15. Berend ME, Small SR, Ritter MA, et al. The effects of bone resection depth and malalignment on strain in the proximal tibia after total knee arthroplasty. J Arthroplasty, 2010, 25(2):314-318.
16. Shetty GM, Mullaji A, Bhayde S. Computer guided restoration of joint line and femoral offset in cruciate substituting total knee arthroplasty. Knee, 2012, 19(5):611-616.
17. Dennis DA, Komistek RD, Kim RH, et al. Gap balancing versus measured resection technique for total knee arthroplasty. Cl in Orthop Relat Res, 2010, 468(1):102-107.
18. Ishii Y, Noguchi H, Takeda M, et al. Posterior condylar offset does not correlate with knee flexion after TKA. Clin Orthop Relat Res, 2013, 471(9):2995-3001.
19. Arabori M, Matsui N, Kuroda R, et al. Posterior condylar offset and flexion in posterior cruciate-retaining and posterior stabilized TKA. J Orthop Sci, 2008, 13(1):46-50.
20. Han HS, Kang SB, Yoon KS. High incidence of loosening of the femoral component in legacy posterior stabil ised-flex total knee replacement. J Bone Joint Surg (Br), 2007, 89(11):1457-1461.

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Chinese Journal of Reparative and Reconstructive Surgery

DETERMINATION OF TIBIAL BONE RESECTION THICKNESS BY LATERAL TIBIOFEMORAL JOINT 90° FLEXIONAL GAP IN TOTAL KNEE ARTHROPLASTY FOR VARUS OSTEOARTHRITIC KNEES

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