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. 2024 Jul 5;11(3):e12084.
doi: 10.1002/jeo2.12084. eCollection 2024 Jul.

Comparison of postoperative clinical outcomes and knee stability of cruciate-retaining total knee arthroplasty using the tibia-first gap navigation technique with a computer-aided system and measured-resection technique: A retrospective analysis of a propensity-matched cohort

Affiliations

Comparison of postoperative clinical outcomes and knee stability of cruciate-retaining total knee arthroplasty using the tibia-first gap navigation technique with a computer-aided system and measured-resection technique: A retrospective analysis of a propensity-matched cohort

Masaki Iguchi et al. J Exp Orthop. .

Abstract

Purpose: This study aimed to clarify whether the range of motion (ROM), anterior and posterior (AP) stability and other clinical measures changed in patients who underwent tibia-first total knee arthroplasty (TF-TKA) using navigation with a computer-aided system after surgery.

Methods: This is a retrospective study and we conducted a matched cohort analysis of 60 measured resection (MR)-TKAs and 52 TF-TKAs performed by a single surgeon. All the surgeries used the same implant and approach. Baseline differences between the groups were adjusted using propensity score matching. We compared each patient's measured ROM and Oxford Knee Score (OKS) and performed knee AP laxity measurements by using a device during routine follow-ups.

Results: A total of 40 MR-TKAs with a mean age of 73.5 ± 5.6 years and sex (male 10, female 30) were compared to 40 TF-TKAs with a mean age of 74.0 ± 5.7 years and sex (male 13, female 27) at 2-year follow-ups. Two years postoperatively, there was a significant difference in the AP laxity at 30° of knee flexion between both groups (7.0 ± 3.4 mm vs. 5.2 ± 2.3 mm, p < 0.01). In contrast, no differences were found between both groups for knee flexion (120.8 ± 9° vs. 116.7 ± 9.8°, p = 0.07) and OKS score (41.8 ± 6.9 vs. 41.0 ± 5.9, p = 0.61).

Conclusion: The AP stability in the midflexion obtained using the tibia-first technique remained consistent even after 2 years. However, OKS and ROM were not significantly different from those of the MR-TKA group.

Level of evidence: Retrospective comparative LEVEL III study.

Keywords: anterior and posterior knee stability; computer‐assist surgery; tibia‐first technique; total knee osteoarthritis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Bone resection was performed using an extramedullary bone cutting guide. By combining the manual guides with navigation, we installed a bone‐cutting guide while confirming the amount of bone resection as well as varus/valgus and posterior tilt.
Figure 2
Figure 2
(CAS screen display) The varus/valgus angle, posterior tilt and assumed bone resection amount were displayed for the anticipated bone cuts. On the left screen, the vertical and horizontal axes represent the knee angle and the gap, respectively. Medial and lateral gaps throughout the entire ROM of the knee joint are indicated. CAS, computer‐assisted surgery; ROM, range of motion.
Figure 3
Figure 3
Knee AP laxity measurements obtained using Kneelax 3 arthrometer after 2 years after surgery. Translation was significantly smaller in the TF‐TKA group than that in the MR‐TKA group for AP laxity with 30° of knee flexion (5.2 ± 2.3 mm vs. 7.0 ± 3.4 mm). On the other hand, no significant AP laxity was observed for 90° knee flexion (2.7 ± 1.7 mm vs. 3.1 ± 2.2 mm). AP, anterior and posterior; MR‐TKA, measured resection‐total knee arthroplasty; TF‐TKA, tibia‐first total knee arthroplasty.

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References

    1. Becker, R. , Malzdorf, M. , Stärke, C. , Randolf, P. & Lohmann, C. (2012) No difference between tibia‐first and femur‐first techniques in TKA using computer‐assisted surgery. Knee Surgery, Sports Traumatology, Arthroscopy, 20, 2011–2016. Available from: 10.1007/s00167-012-1928-3 - DOI - PubMed
    1. Cheng, T. , Zhang, G. & Zhang, X. (2011) Imageless navigation system does not improve component rotational alignment in total knee arthroplasty. Journal of Surgical Research, 171, 590–600. Available from: 10.1016/j.jss.2010.05.006 - DOI - PubMed
    1. Clary, C.W. , Fitzpatrick, C.K. , Maletsky, L.P. & Rullkoetter, P.J. (2013) The influence of total knee arthroplasty geometry on mid‐flexion stability: an experimental and finite element study. Journal of Biomechanics, 46, 1351–1357. Available from: 10.1016/j.jbiomech.2013.01.025 - DOI - PubMed
    1. Faul, F. , Erdfelder, E. , Lang, A.G. & Buchner, A. (2007) G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39, 175–191. Available from: 10.3758/BF03193146 - DOI - PubMed
    1. Kanda, Y. (2013) Investigation of the freely available easy‐to‐use software ‘EZR’ for medical statistics. Bone Marrow Transplantation, 48, 452–458. Available from: 10.1038/bmt.2012.244 - DOI - PMC - PubMed