Intraoperative midflexion medial laxity using navigation affects patient expectations following posterior stabilized total knee arthroplasty.

Background: Patient satisfaction and expectations are now recognized as an outcome measure for successful total knee arthroplasty (TKA). The purpose of this study was to determine which factors including soft tissue balance during surgery affect patient satisfaction and expectations after TKA.

Methods: A total of 135 patients (157 knees) with knee osteoarthritis who underwent primary TKA with a posterior stabilized design were studied. After implantation of all components, varus/valgus laxity of the knee was measured intraoperatively with the knee at 0°, 30°, 60°, 90°, and 120° guided by an image-free navigation system. Factors that affected patient satisfaction and expectations, including lateral and medial laxities, were evaluated using the 2011 Knee Society score.

Results: The mean intraoperative lateral laxity was 1.1°, 1.6°, 0.9°, 1.3°, and 1.7° with the knee at 0°, 30°, 60°, 90°, and 120°, respectively. The mean intraoperative medial laxity was 1.1°, 1.4°, 1.1°, 1.1°, and 1.7° with the knee at 0°, 30°, 60°, 90°, and 120°, respectively. Patient satisfaction after TKA correlated positively with symptom (R = 0.61, p < 0.01) and functional activity (R = 0.47, p < 0.01) scores. Patient expectations after TKA weakly positively correlated with symptom (R = 0.29, p < 0.01) and functional activity (R = 0.20, p = 0.01) scores, and weakly negatively with medial laxity at 30° (R = -0.21, p < 0.01).

Conclusion: Midflexion medial laxity was associated with worse patient expectations after TKA. Avoiding medial laxity could be one of the important techniques during TKA.