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. 2004 Dec;28(6):366-9.
doi: 10.1007/s00264-004-0595-5. Epub 2004 Sep 30.

Flexion gap configuration in total knee arthroplasty following high tibial osteotomy

H Bäthis  1 , L Perlick, M Tingart, C Lüring, C Perlick, J Grifka
Affiliations

Flexion gap configuration in total knee arthroplasty following high tibial osteotomy

H Bäthis et al. Int Orthop. 2004 Dec.

Abstract
in English, French

Previous reports have described the potentially compromising effect of a high tibial osteotomy (HTO) on the results of a subsequent total knee arthroplasty (TKA). Although the reasons are not clear, some authors reported problems in soft-tissue balancing. In a prospective study, 22 patients with an average interval of 5.8 years after closed-wedge HTO were operated for TKA. All operations were performed with a CT-free navigation system, and measurements of the extension and flexion gap were assessed. The intraoperative data were compared to a control group of 100 consecutive computer-assisted TKA without previous osteotomy. In the study group, a highly significant shift towards a medial opening of the flexion gap between the posterior condylar line and the tibial resection (study group 0.4+/-4.7 degrees medial opening versus control group 3.4+/-3.3 degrees lateral opening, p<0.001) was observed. In the study group, 10/22 showed a medial opening of the flexion gap compared to 11/100 in the control group. Surgeons should be aware of difficulties in soft-tissue balance in TKA following HTO, especially for the flexion gap configuration and the axial rotation of the femoral component.

Plusieurs rapports ont décrit l’effet potentiellement défavorable d’une ostéotomie tibiale supérieure sur les résultats d’une arthroplastie totale du genou secondaire. Bien que les raisons ne soient pas claires, quelques auteurs ont rapporté des problèmes dans l’équilibre des parties molles. Dans une étude prospective 22 malades ont eu une arthroplastie totale du genou avec un intervalle moyen de 5,8 ans après une ostéotomie tibiale. Toutes les opérations ont été exécutées avec un système de navigation sans scanner et l’intervalle en flexion et en extension a été mesuré. Les données intraopératoires ont été comparées à un groupe témoin de 100 arthroplasties totales du genou consécutives, sous contrôle informatique, sans ostéotomie préalable. Dans le groupe d’étude a été constaté une modification très importante vers une ouverture médiale de l’intervalle en flexion entre la ligne condylienne postérieure et la résection tibiale (groupe d’étude 0,4±4,7° d’ouverture médiale contre, dans le groupe témoin, 3,4±3,3° d’ouverture latérale, p<0.001). Dans le groupe d’étude 10/22 ont montré une ouverture médiale de l’intervalle en flexion comparée à 11/100 dans le groupe témoin. Les chirurgiens doivent être conscients de la difficulté d’équilibrer les parties molles dans l’arthroplastie du genou aprés ostéotomie tibiale, surtout pour la configuration de l’intervalle en flexion et l’orientation axiale du composant fémoral.

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Figures

Fig. 1
Fig. 1
Tensor device, BalAnswer (DePuy, Inc.): similar tension on the medial and lateral knee compartment is provided with two independent, calibrated springs. The spring force can be adjusted continuously between 0 N and 135 N.
Fig. 2
Fig. 2
Flexion gap balance of study and control groups using the tensor device. Negative values represent medial opening and positive values represent lateral opening of the flexion gap in degrees.
Fig. 3
Fig. 3
Information given by the navigation system: the surgeon is aware of the relation of different axes for femoral component rotation before determining the final position of the anterior and posterior cut.
See this image and copyright information in PMC

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