title: Effects of Suture and Tourniquet on Intraoperative Kinematics in Navigated Total Knee Arthroplasty.
abstract: To investigate the effects of suture (soft tissue closure) and air tourniquet use on intraoperative kinematics in navigated total knee arthroplasty.
  
  
  
  The study included 20 patients with varus-type knee osteoarthritis who underwent primary posterior-stabilized total knee arthroplasty using computed tomography (CT)-based navigation. Intraoperative tibiofemoral kinematics from maximum extension to maximum flexion were measured using the computed tomography-based navigation. The measurements were performed 3 times as follows: measurement 1: before suture (tourniquet on), measurement 2: after suture (tourniquet on), and measurement 3: after tourniquet removal. Details of kinematics including knee joint gap, tibiofemoral rotational angles, and anteroposterior (AP) distance between the femur and tibia were compared among the 3 measurements and statistically evaluated.
  
  
  
  On the medial side, there was no significant difference among the 3 measurements in the extension gap, but measurement 1 showed a significantly larger flexion gap compared with the other 2 measurements. On the lateral side, there was no significant difference between the extension and flexion gaps in all measurements. The anteroposterior distance in measurement 1 showed that the femur was positioned significantly more anterior to the tibia at 10° and 20° of flexion compared with the other 2 measurements after suture. There was no significant difference among the 3 measurements in the tibiofemoral rotation angles.
  
  
  
  These results found that the effect of suture and tourniquet was minimal, and that intraoperative kinematics can effectively evaluate postoperative passive kinematic conditions.
authors.affiliation: Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Tsubosaka
authors.affiliation: Department of Orthopaedic Surgery, Kobe Kaisei Hospital, Kobe, Japan.
authors.forename: Kazunari
authors.initials: K
authors.lastname: Ishida
authors.affiliation: Department of Orthopaedic Surgery, Kobe Kaisei Hospital, Kobe, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sasaki
authors.affiliation: Department of Orthopaedic Surgery, Kobe Kaisei Hospital, Kobe, Japan.
authors.forename: Nao
authors.initials: N
authors.lastname: Shibanuma
authors.affiliation: Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Kuroda
authors.affiliation: Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Matsumoto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000295:instrumentation / Q000379:methods*; D001696:Biomechanical Phenomena; D005260:Female; D005269:Femur / Q000601:surgery; D006801:Humans; D007719:Knee Joint / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D010003:Osteoarthritis / Q000601:surgery; D011184:Postoperative Period; D011446:Prospective Studies; D016059:Range of Motion, Articular; D012399:Rotation; D025321:Surgery, Computer-Assisted; D013537:Sutures / Q000009:adverse effects*; D013977:Tibia / Q000601:surgery; D014057:Tomography, X-Ray Computed; D014111:Tourniquets / Q000009:adverse effects*
keywords: kinematics; navigation; soft tissue closure; total knee arthroplasty; tourniquet