Flexion gap configuration in total knee arthroplasty following high tibial osteotomy.
Previous reports have described the potentially compromising effect of a high tibial osteotomy (HTO) on the results of a subsequent total knee arthroplasty (TKA). Although the reasons are not clear, some authors reported problems in soft-tissue balancing. In a prospective study, 22 patients with an average interval of 5.8 years after closed-wedge HTO were operated for TKA. All operations were performed with a CT-free navigation system, and measurements of the extension and flexion gap were assessed. The intraoperative data were compared to a control group of 100 consecutive computer-assisted TKA without previous osteotomy. In the study group, a highly significant shift towards a medial opening of the flexion gap between the posterior condylar line and the tibial resection (study group 0.4+/-4.7 degrees medial opening versus control group 3.4+/-3.3 degrees lateral opening, p<0.001) was observed. In the study group, 10/22 showed a medial opening of the flexion gap compared to 11/100 in the control group. Surgeons should be aware of difficulties in soft-tissue balance in TKA following HTO, especially for the flexion gap configuration and the axial rotation of the femoral component.
Bäthis
H
H
Department of Orthopaedic Surgery, University of Regensburg, P.O. Box 100662, 93042, Regensburg, Germany. holger.baethis@klinik.uni-regensburg.de
Perlick
L
L
Tingart
M
M
Lüring
C
C
Perlick
C
C
Grifka
J
J
D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000295:instrumentation; D004867:Equipment Design; D005260:Female; D006801:Humans; D007720:Knee Prosthesis; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods*; D011446:Prospective Studies; D025321:Surgery, Computer-Assisted; D013977:Tibia / Q000601:surgery*