title: Greater Medial Compartment Forces During Total Knee Arthroplasty Associated With Improved Patient Satisfaction and Ability to Navigate Stairs.
abstract: The purpose of this study was to determine if postoperative patient satisfaction, subjective outcomes, and functional force testing differed between those with symmetric or asymmetric intraoperative mediolateral (ML) compressive forces. We hypothesized that the threshold would be similar to the previously reported valued of 15 lbf and that a significantly greater proportion of those with more symmetrical medial and lateral compressive forces would be satisfied with their total knee arthroplasty.
  
  
  
  A commercially available instrumented trial tibial liner was used to measure ML compressive force differences with the knee at 0°, 20°, and 90°. Patient satisfaction and Knee Society Scores were compared between patients with ML asymmetries above and below the calculated optimal threshold.
  
  
  
  Surprisingly, lower ML asymmetries in extension were associated with a greater risk of being dissatisfied. Of the 50 total knee arthroplasties, 6 of 23 (26%) with ML force asymmetries <10 lbf were dissatisfied compared with 0 of 27 with ML asymmetries >10 lbf (P = .01). Greater asymmetry was associated with significantly greater gains in EQ-5D scores (P = .05) and pain scores (P = .03) and greater pain relief (P = .006) and reduced impact forces when navigating stairs (P = .05).
  
  
  
  Contrary to our hypotheses, the results of this study support the concept that recreating greater forces in the medial compartment much like that of the native knee may yield improved patient-reported outcomes and increased patient satisfaction. The current results further suggest that recreating greater medial compartment forces may have the greatest affect on more demanding activities such as navigating stairs.
authors.affiliation: Department of Orthopedic Surgery, University of Kentucky, Lexington, Kentucky.
authors.forename: Cale A
authors.initials: CA
authors.lastname: Jacobs
authors.affiliation: Bluegrass Orthopedics, Lexington, Kentucky.
authors.forename: Christian P
authors.initials: CP
authors.lastname: Christensen
authors.affiliation: Orthopedics-Sports Medicine Center, Lexington Clinic, Lexington, Kentucky.
authors.forename: Tharun
authors.initials: T
authors.lastname: Karthikeyan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000379:methods* / Q000523:psychology; D019245:Compressive Strength; D005260:Female; D006801:Humans; D007717:Knee / Q000601:surgery; D007719:Knee Joint / Q000601:surgery*; D008297:Male; D055595:Mechanical Phenomena; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000601:surgery*; D017060:Patient Satisfaction; D011184:Postoperative Period; D016059:Range of Motion, Articular; D057566:Self Report; D013977:Tibia / Q000601:surgery; D055815:Young Adult
keywords: function; ligament balance; outcome; patient satisfaction; total knee arthroplasty