Association of intraoperative medial joint gap laxity in the flexion position with subjective knee instability after fixed-bearing posterior-stabilised total knee arthroplasty
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Abstract
Background
Postoperative subjective knee instability is an important clinical outcome after total knee arthroplasty (TKA), however the association with intraoperative soft tissue balance remains unclear. This study aimed to assess the association between intraoperative soft tissue balance and postoperative subjective knee instability in fixed-bearing posterior-stabilised (PS) TKA.
Methods
This retrospective case-control study included 457 patients who underwent fixed-bearing PS TKA. Intra-articular distraction force was quantitatively applied to measure the gap parameters (length and angle) during surgery. The intraoperative joint gap parameters and postoperative clinical outcomes between the patients with (n = 90) and without (n = 367) subjective knee instability were compared. The risk factors for subjective postoperative knee instability were analysed using multivariate logistic regression analysis.
Results
The patients with subjective knee instability demonstrated a medially wider intra-articular gap angle and worse Knee Society Score 2011 symptoms (18 vs. 21; p < 0.01), satisfaction (27 vs. 30; p < 0.01), functional activity (55 vs. 65; p < 0.01), and Forgotten Joint Score 12 items (51 vs. 65; p < 0.01) than those in the patients without subjective knee instability. The use of measured resection technique (odds ratio, 2.3; 95% CI, 1.1–4.8; p = 0.02) and the medial laxity of joint gap balance in the flexion position (odds ratio, 1.2; 95% CI, 1.0–1.4; p = 0.04) were detected as risk factors for postoperative subjective knee instability.
Conclusion
In fixed-bearing PS TKA, intraoperative medial joint laxity in the flexion position was associated with postoperative subjective knee instability, and surgical techniques to achieve sufficient soft tissue balance contributed to improve postoperative subjective clinical outcomes.
期刊介绍：
The Knee is an international journal publishing studies on the clinical treatment and fundamental biomechanical characteristics of this joint. The aim of the journal is to provide a vehicle relevant to surgeons, biomedical engineers, imaging specialists, materials scientists, rehabilitation personnel and all those with an interest in the knee.
The topics covered include, but are not limited to:
• Anatomy, physiology, morphology and biochemistry;
• Biomechanical studies;
• Advances in the development of prosthetic, orthotic and augmentation devices;
• Imaging and diagnostic techniques;
• Pathology;
• Trauma;
• Surgery;
• Rehabilitation.
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