Soft tissue balance measurement in minimal incision surgery compared to conventional total knee arthroplasty.
OBJECTIVE
Minimal incision surgery (MIS) total knee arthroplasty (TKA) is widely promoted as a possible improvement over conventional TKA, and accurate implantations have recently been reported using navigation systems. However, soft tissue balance during MIS-TKA remains challenging. Therefore, in this report, joint gap (component gap) and ligament balance (varus angle) were assessed during MIS-TKA using a tensor, which enables soft tissue balance assessment with a reduced patellofemoral joint and femoral component in place.


METHODS
Results were compared to those of conventional TKA. Posterior stabilized TKA were performed in 50 knees (25 knees: MIS-TKA using quadriceps-sparing approach; 25 knees: conventional TKA using medial parapatellar approach) with varus osteoarthritis. Component gap and varus angle were measured using the tensor with a reduced patellofemoral joint at 0, 10, 45, 90, and 135°.


RESULTS
Whereas the component gap in MIS-TKA was significantly larger through the entire arc of flexion compared with conventional TKA, the pattern of joint looseness showed no difference between the two procedures. The varus angle in MIS-TKA was significantly larger than that in conventional TKA at 0, 90, and 135° of knee flexion.


CONCLUSIONS
MIS-TKA may lead to ligament imbalance due to the difficulties induced by a limited working space. Understanding this pattern allows surgeons to be able to adjust the soft tissue balance more accurately and thereby expect a better post-operative outcome even in MIS-TKA.
Matsumoto
Tomoyuki
T
Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan. matsun@m4.dion.ne.jp
Muratsu
Hirotsugu
H
Kubo
Seiji
S
Mizuno
Kiyonori
K
Kinoshita
Keisuke
K
Ishida
Kazunari
K
Matsushita
Takehiko
T
Sasaki
Ken
K
Tei
Katsumasa
K
Takayama
Koji
K
Sasaki
Hiroshi
H
Oka
Shinya
S
Kurosaka
Masahiro
M
Kuroda
Ryosuke
R
D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D019645:Arthroplasty, Replacement, Knee / Q000295:instrumentation* / Q000379:methods*; D001696:Biomechanical Phenomena; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000517:prevention & control*; D007720:Knee Prosthesis; D008023:Ligaments, Articular / Q000503:physiopathology*; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D016343:Monitoring, Intraoperative / Q000379:methods; D020370:Osteoarthritis, Knee / Q000601:surgery*; D010147:Pain Measurement; D011182:Postoperative Care / Q000379:methods; D011446:Prospective Studies; D011474:Prosthesis Design; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function; D018570:Risk Assessment; D016037:Single-Blind Method