Abstract
Objective
Although both accurate component placement and adequate soft tissue balance have been recognized as essential surgical principle in total knee arthroplasty (TKA), the influence of intra-operative soft tissue balance on the post-operative clinical results has not been well investigated. In the present study, newly developed TKA tensor was used to evaluate soft tissue balance quantitatively. We analyzed the influence of soft tissue balance on the post-operative knee extension after posterior-stabilized (PS) TKA.
Materials and Methods
Fifty varus type osteoarthritic knees implanted with PS-TKAs were subjected to this study. All TKAs were performed using measured resection technique with anterior reference method. The thickness of resected bone fragments was measured.
Following each bony resection and soft tissue releases, we measured soft tissue balance at extension and flexion of the knee using a newly developed offset type tensor. This tensor device enabled quantitative soft tissue balance measurement with femoral trial component in place and patello-femoral (PF) joint repaired (component gap evaluation) in addition to the conventional measurement between osteotomized surfaces (osteotomy gap evaluation). Soft tissue balance was evaluated by the center gap (mm) and ligament balance (°; positive in varus) applying joint distraction forces at 40 lbs (178 N).
Active knee extension in spine position was measured by lateral X-ray at 4 weeks post-operatively. The effect of each parameter (soft tissue balance evaluations, thickness of polyethylene insert and resected bone) on the post-operative knee extension was evaluated using simple linear regression analysis. P<0.05 was considered statistically significant.
Results
The thickness of resected bone, flexion center gap and ligament balance at extension and flexion had no correlations to the knee extension angle. Thickness of polyethylene insert correlated positively to knee extension (r=0.38, p=0.007). Significant positive correlation were found between extension center gap in both osteotomy and component gap evaluation to the post-operative knee extension. The coefficient of correlations were 0.33 (p=.02) with osteotomy gap and 0.47 (p=0.0007) with component gap evaluation.
Discussion and Conclusion
In the present study, extension center gap was found to positively correlate to the early post-operative knee extension. The extension center gap could be considered as the summation of the simultaneous gap from bone resections and the elongation of soft tissue envelope under joint distraction force applied by tensor. The soft tissue with the lower stiffness would be elongated more, and result in the larger center gap. Accordingly, the stiffness of the soft tissue envelope might play an important role on the magnitude of extension center gap and the post-operative knee extension.
Furthermore, the center gap in component gap evaluation had higher coefficient of correlation comparing to that in osteotomy gap. Proposed component gap evaluation in soft tissue balance measurement might be more physiological and relevant to the joint condition after TKA, and useful to predict post-operative clinical results.
