Effect of additional distal femoral resection on flexion deformity in posterior-stabilized total knee arthroplasty

Purpose Flexion deformity after total knee arthroplasty (TKA) is associated with poor function and dissatisfaction and should, therefore, be avoided. In the case of preoperative flexion deformity, an increased distal resection of the femur may be necessary. The degree of resection required has only...

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Bibliographic Details
Published in:Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA sports traumatology, arthroscopy : official journal of the ESSKA, 2020-09, Vol.28 (9), p.2924-2929
Main Authors: Matziolis, Georg, Loos, Manuela, Böhle, Sabrina, Schwerdt, Christiane, Roehner, Eric, Heinecke, Markus
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Algorithms
Arthroplasty (knee)
Arthroplasty, Replacement, Knee - methods
Biomedical materials
Contracture - surgery
Deformation effects
Female
Femur
Femur - surgery
Humans
Joint surgery
Knee
Knee Joint - physiology
Knee Prosthesis
Male
Medical personnel
Medicine
Medicine & Public Health
Middle Aged
Navigation systems
Orthopedics
Osteoarthritis, Knee - surgery
Osteophytes
Posterior Cruciate Ligament - surgery
Prospective Studies
Prostheses
Prosthetics
Range of Motion, Articular
Surgical implants
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Summary:Purpose Flexion deformity after total knee arthroplasty (TKA) is associated with poor function and dissatisfaction and should, therefore, be avoided. In the case of preoperative flexion deformity, an increased distal resection of the femur may be necessary. The degree of resection required has only been determined for cruciate-retaining (CR) prostheses to date and varies considerably from study to study. Although, for many surgeons, the algorithm for the treatment of a flexion deformity includes the resection of the posterior cruciate ligament (PCL) before additional distal resection, the degree of resection necessary for posterior-stabilized (PS)-type prostheses is not known. Methods Fifty consecutive patients (50 knees) who were due to undergo navigated TKA were included in this prospective study. At the end of the operation, the flexion deformity resulting from different sizes of distal femoral augmentations on the trial implants (0–8.5 mm) was determined using the navigation system. Results A linear relationship of 2.2° ± 0.3° flexion deformity per mm distal femoral augmentation was found. This was not dependent on age, sex, the preoperative coronal alignment, or the preoperative flexion deformity. Conclusions In conclusion, after the removal of posterior osteophytes and posterior capsule release, around 5 mm of the distal femur must be further resected in the case of 10° flexion deformity and 9 mm in the case of 20° flexion deformity. Level of evidence II (Prospective cohort study).
ISSN:0942-2056
1433-7347
DOI:10.1007/s00167-019-05675-0