title: Evaluation of soft-tissue balance during total knee arthroplasty.
abstract: OBJECTIVE
  To evaluate soft-tissue balance during versus after total knee arthroplasty (TKA).
  
  
  METHODS
  18 men and 75 women aged 52 to 85 (mean, 68) years who had moderate-to-severe varus deformity underwent TKAs using the Scorpio non-restrictive geometry posterior-stabilised system (Stryker Howmedica Osteonics; Allendale, [NJ], USA). All surgeries were performed by a single surgeon using the medial parapatellar approach. After the bony and soft-tissue procedures, soft-tissue balance was measured intra-operatively using a tensor/balancer device. The coronal laxity--angles between the cut surfaces of the femur and tibia--were measured at 0 degree (in extension) and 90 degrees (in flexion). The central gap was also measured. Immediate postoperative soft-tissue balance was measured using an arthrometer, while anteroposterior stress radiographs were being taken. A valgus or varus force was applied just above the knee on the lateral or medial side, with the knee counter-supported and at 15 degrees flexion.
  
  
  RESULTS
  Intra-operatively, the mean coronal laxity at 0 degree (in extension) and 90 degrees (in flexion) was 2.1 degrees and -1.6 degrees, and the mean central gaps were 21.2 and 23.5 mm, respectively. Immediate postoperative mean coronal laxity was 2.9 degrees, indicating that lateral laxity was greater than medial laxity. The postoperative coronal laxity was positively corrected to the intra-operative coronal laxity at 0 degree (r=0.304, p=0.003), but not to the intra-operative coronal laxity at 90 degrees (r= -0.07, p=0.47).
  
  
  CONCLUSIONS
  Slightly greater lateral laxity was observed after TKA, although equal medial-lateral balance was achieved intra-operatively.
authors.affiliation: Department of Orthopedics, Jichi Medical University, Shimotsuke, Tochigi, Japan. sasakou@pop12.odn.ne.jp
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Sasanuma
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Sekiya
authors.forename: Kenzo
authors.initials: K
authors.lastname: Takatoku
authors.forename: Hisashi
authors.initials: H
authors.lastname: Takada
authors.forename: Naoya
authors.initials: N
authors.lastname: Sugimoto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D053587:Arthrometry, Articular; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D007593:Joint Instability / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D016059:Range of Motion, Articular; D015203:Reproducibility of Results; D012189:Retrospective Studies; D016474:Weight-Bearing