Soft Tissue Release for Varus Knees during Posterior Stabilized Total Knee Arthroplasty: A New Algorithm
Journal Title: Journal of Orthopaedic Science and Research - Year 2022, Vol 3, Issue 1
Abstract
Introduction: Total Knee Replacement (TKA) surgeries are frequently performed surgeries used to treat knee osteoarthritis. Several methods of medial soft tissue balancing in the varus knee during total knee replacement surgeries have been reported. Traditionally, they included releasing the superficial Medial Collateral Ligament (sMCL) in severe varus cases by several methods. However, this release can create instability in the knee. The aim of this study was to create an algorithm for soft tissue release in varus osteoarthritic knees and to evaluate its efficacy in achieving intraoperative gap balancing without releasing the superficial MCL. Materials and Methods: One hundred and five varus osteoarthritic knees who received primary posterior stabilized total knee arthroplasties between October 2015 and January 2016 were included in this study. Varus deformities ranged between 10 to 40 degrees. Sequential balancing was done into 5 steps: step 1 – releasing of deep MCL, step 2 – excision of osteophytes, step 3 – excision of scarred tissue in the posteromedial corner, step 4 – excision of the posteromedial capsule and step 5 – release of semimembranosus. The V-STAT® Variable Soft Tissue Alignment Tensor was used to ensure a balanced medial and lateral gap following each step. Once the gaps were balanced, no further soft tissue release were carried out. Results: All knees were balanced without releasing the superficial MCL ligament. The maximum release step necessary was: step 1 (0 cases), step 2 (31 cases), step 3 (35 cases), step 4 (25 cases) and step 5 (14 cases). Conclusion: Superficial medial collateral ligament should not be released during intraoperative varus knees soft tissue balancing in posterior stabilized total knee arthroplasties. Preserving the superficial MCL is beneficial in maintaining implant stability without any increase in the constraint level of the implant even in cases with severe deformity.
Authors and Affiliations
Mohamed Elkabbani1, 2*, Kamel Youssef1, Mohamed Ragab2, Omar Ibrahim2, Amr Osman2, Apostu Dragos3, Samih Tarabichi2
Treating Patellar Instability After Total Knee Arthroplasty with Medial Retinaculum Reconstruction: A Clinical Case and Narrative Review
Background: Patellar instability after a total knee arthroplasty is a disabling complication that often needs surgical revision, prolonging hospital in-stay and rehabilitation. Different surgical techniques exist in lite...
How Sterile Are Our Operating Rooms? A Comparison of Air Quality During Primary TKA and THA
Introduction: Airborne Biologic Particles (ABPs) are a potential risk factor for infection following total joint arthroplasty. Factors such as temperature and humidity may affect the number of ABPs which can increase the...
Radiation-Induced Bilateral Hip Osteonecrosis and Acetabular Fractures
The case report talks about the surgical treatment of bilateral hip osteonecrosis after radiotherapy. The literature is poor on the subject even if a cause-effect correlation is described between radiotherapy and bone ne...
Hip Muscle Atrophy and Hip Osteoarthritis-Evidence and Continuing Challenges
Background: Hip osteoarthritis, a highly disabling disease with no distinct cause, and a disease associated with high degrees of pain, stiffness, and disability continues to affect the lives of many adults of all ages h...
Development and Validation of a Preclinical Canine Model for Delayed Onset Fracture-Related Infections
Background: Fracture-Related Infections (FRIs) are a challenging complication in orthopaedics. FRI incidence is considerably high, particularly in open fractures. FRI management typically involves multiple surgical inter...