What is the Effect of Posterior Osteophytes on Flexion and Extension Gaps in Total Knee Arthroplasty? A Cadaveric Study

Arthroplasty Today

Gary W. Doan, MS¹  Douglas A. Dennis, MD¹  Chadd W. Clary, PhD¹  David C. Holst, MD²  Martin W. Roche, MD³  Marc R. Angerame, MD⁴ 

[1] Department of Mechanical and Materials Engineering, University of Denver, Denver, CO;Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC;Holy Cross Orthopedic Institute, Ft. Lauderdale, FL;Illinois Bone and Joint Institute, Barrington, IL;

关键词: Posterior osteophytes;    total knee arthroplasty;    Ligament balance;   

DOI  :  

来源: DOAJ

【 摘 要 】

Background: Posterior compartment knee osteophytes may pose a challenge in achieving soft-tissue balance during total knee arthroplasty (TKA). Obtaining symmetry of flexion and extension gaps involves balance of both bony and soft-tissue structures. We hypothesize that space-occupying posteromedial femoral osteophytes affect soft-tissue balance. Methods: Five cadaveric limbs were acquired. Computed tomography scans were obtained to define the osseous contours. Three-dimensionally printed, specimen-specific synthetic posterior femoral osteophytes were fabricated in 10-mm and 15-mm sizes. TKAs were implanted. Medial and lateral compartment contact forces were measured during passive knee motion using pressure-sensing technology. For each specimen, trials were completed without osteophytes and with 10-mm and 15-mm osteophytes affixed to the posteromedial femoral condyle. Contact forces were obtained at full extension, 10°, 30°, 45°, 60°, and 90° of flexion. These were recorded across each specimen in each condition for three trials. Tukey post hoc tests were used with a repeated measures ANOVA for statistical data analysis. Results: The presence of posteromedial osteophytes increased asymmetric loading from full extension to 45° of flexion, with statistically significant differences observed at full extension and 30°. A reduction in lateral compartment forces was noted. The 25%-75% bounds of variability in the contact force was less than 3.5 lbs. Conclusions: Posteromedial femoral osteophytes caused an asymmetric increase in medial contact forces from full extension continuing into mid-flexion. The soft-tissue imbalance created from these osteophytes supports their removal before performing ligament releases to obtain desired soft-tissue balancing during TKA.

【 授权许可】

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