Background: The management of soft tissue balance during surgery is essential for the success of total knee arthroplasty (TKA) but remains difficult, leaving it much to the surgeon’s feel. Previous assessments for soft tissue balance have been performed under unphysiological joint conditions, with patellar eversion and without the prosthesis only at extension and 90 deg of flexion. We therefore developed a new tensor for TKA procedures, enabling soft tissue balance assessment throughout the range of motion while reproducing postoperative joint alignment with the patellofemoral (PF) joint reduced and the tibiofemoral joint aligned. Our purpose in the present study was to clarify joint gap kinematics using the tensor with the CT-free computer assisted navigation system. Method of Approach: Joint gap kinematics, defined as joint gap change during knee motion, was evaluated during 30 consecutive, primary posterior-stabilized (PS) TKA with the navigation system in 30 osteoarthritic patients. Measurements were performed using a newly developed tensor, which enabled the measurement of the joint gap throughout the range of motion, including the joint conditions relevant after TKA with PF joint reduced and trial femoral component in place. Joint gap was assessed by the tensor at full extension, 5 deg, 10 deg, 15 deg, 30 deg, 45 deg, 60 deg, 90 deg, and 135 deg of flexion with the patella both everted and reduced. The navigation system was used to obtain the accuracy of implantations and to measure an accurate flexion angle of the knee during the intraoperative joint gap measurement. Results: Results showed that the joint gap varied depending on the knee flexion angle. Joint gap showed an accelerated decrease during full knee extension. With the PF joint everted, the joint gap increased throughout knee flexion. In contrast, the joint gap with the PF joint reduced increased with knee flexion but decreased after 60 deg of flexion. Conclusions: We clarified the characteristics of joint gap kinematics in PS TKA under physiological and reproducible joint conditions. Our findings can provide useful information for prosthetic design and selection and allow evaluation of surgical technique throughout the range of knee motion that may lead to consistent clinical outcomes after TKA.
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e-mail: matsun@m4.dion.ne.jp
e-mail: himuratsu@aol.com
e-mail: tsumuranob@nifty.com
e-mail: mizunok@med.kobe-u.ac.jp
e-mail: kurodar@med.kobe-u.ac.jp
e-mail: yoshiya@hyo-med.ac.jp
e-mail: kurosaka@med.kobe-u.ac.jp
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December 2006
Technical Papers
Joint Gap Kinematics in Posterior-Stabilized Total Knee Arthroplasty Measured by a New Tensor With the Navigation System
Tomoyuki Matsumoto,
Tomoyuki Matsumoto
Department of Orthopaedic Surgery,
e-mail: matsun@m4.dion.ne.jp
Kobe University Graduate School of Medicine, 7-5-1
Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
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Hirotsugu Muratsu,
Hirotsugu Muratsu
Department of Orthopaedic Surgery,
e-mail: himuratsu@aol.com
Kobe University Graduate School of Medicine, 7-5-1
Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
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Nobuhiro Tsumura,
Nobuhiro Tsumura
Department of Orthopaedic Surgery,
e-mail: tsumuranob@nifty.com
Hyogo Rehabilitation Center
, 1070, Akebono-cho, Nishi-ku, Kobe, 651-2181, Japan
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Kiyonori Mizuno,
Kiyonori Mizuno
Department of Orthopaedic Surgery,
e-mail: mizunok@med.kobe-u.ac.jp
Kobe University Graduate School of Medicine, 7-5-1
Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
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Ryosuke Kuroda,
Ryosuke Kuroda
Department of Orthopaedic Surgery,
e-mail: kurodar@med.kobe-u.ac.jp
Kobe University Graduate School of Medicine, 7-5-1
Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
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Shinichi Yoshiya,
Shinichi Yoshiya
Department of Orthopaedic Surgery,
e-mail: yoshiya@hyo-med.ac.jp
Hyogo College of Medicine
, 1-1, Mukogawa-cho, Nishinomiya, 663-8131, Japan
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Masahiro Kurosaka
Masahiro Kurosaka
Department of Orthopaedic Surgery,
e-mail: kurosaka@med.kobe-u.ac.jp
Kobe University Graduate School of Medicine, 7-5-1
Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
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Tomoyuki Matsumoto
Department of Orthopaedic Surgery,
Kobe University Graduate School of Medicine, 7-5-1
Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japane-mail: matsun@m4.dion.ne.jp
Hirotsugu Muratsu
Department of Orthopaedic Surgery,
Kobe University Graduate School of Medicine, 7-5-1
Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japane-mail: himuratsu@aol.com
Nobuhiro Tsumura
Department of Orthopaedic Surgery,
Hyogo Rehabilitation Center
, 1070, Akebono-cho, Nishi-ku, Kobe, 651-2181, Japane-mail: tsumuranob@nifty.com
Kiyonori Mizuno
Department of Orthopaedic Surgery,
Kobe University Graduate School of Medicine, 7-5-1
Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japane-mail: mizunok@med.kobe-u.ac.jp
Ryosuke Kuroda
Department of Orthopaedic Surgery,
Kobe University Graduate School of Medicine, 7-5-1
Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japane-mail: kurodar@med.kobe-u.ac.jp
Shinichi Yoshiya
Department of Orthopaedic Surgery,
Hyogo College of Medicine
, 1-1, Mukogawa-cho, Nishinomiya, 663-8131, Japane-mail: yoshiya@hyo-med.ac.jp
Masahiro Kurosaka
Department of Orthopaedic Surgery,
Kobe University Graduate School of Medicine, 7-5-1
Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japane-mail: kurosaka@med.kobe-u.ac.jp
J Biomech Eng. Dec 2006, 128(6): 867-871 (5 pages)
Published Online: June 14, 2006
Article history
Received:
June 8, 2005
Revised:
June 14, 2006
Citation
Matsumoto, T., Muratsu, H., Tsumura, N., Mizuno, K., Kuroda, R., Yoshiya, S., and Kurosaka, M. (June 14, 2006). "Joint Gap Kinematics in Posterior-Stabilized Total Knee Arthroplasty Measured by a New Tensor With the Navigation System." ASME. J Biomech Eng. December 2006; 128(6): 867–871. https://doi.org/10.1115/1.2354201
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