Effect of additional distal femoral resection on flexion deformity in posterior-stabilized total knee arthroplasty
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Effect of additional distal femoral resection on flexion deformity in posterior‑stabilized total knee arthroplasty Georg Matziolis1 · Manuela Loos1 · Sabrina Böhle1 · Christiane Schwerdt1 · Eric Roehner1 · Markus Heinecke1 Received: 5 June 2019 / Accepted: 9 August 2019 © European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019
Abstract Purpose Flexion deformity after total knee arthroplasty (TKA) is associated with poor function and dissatisfaction and should, therefore, be avoided. In the case of preoperative flexion deformity, an increased distal resection of the femur may be necessary. The degree of resection required has only been determined for cruciate-retaining (CR) prostheses to date and varies considerably from study to study. Although, for many surgeons, the algorithm for the treatment of a flexion deformity includes the resection of the posterior cruciate ligament (PCL) before additional distal resection, the degree of resection necessary for posterior-stabilized (PS)-type prostheses is not known. Methods Fifty consecutive patients (50 knees) who were due to undergo navigated TKA were included in this prospective study. At the end of the operation, the flexion deformity resulting from different sizes of distal femoral augmentations on the trial implants (0–8.5 mm) was determined using the navigation system. Results A linear relationship of 2.2° ± 0.3° flexion deformity per mm distal femoral augmentation was found. This was not dependent on age, sex, the preoperative coronal alignment, or the preoperative flexion deformity. Conclusions In conclusion, after the removal of posterior osteophytes and posterior capsule release, around 5 mm of the distal femur must be further resected in the case of 10° flexion deformity and 9 mm in the case of 20° flexion deformity. Level of evidence II (Prospective cohort study). Keywords Total knee replacement · Total knee arthroplasty · Flexion deformity · Distal femoral resection · Joint line · Posterior stabilized
Introduction When implanting a total knee arthroplasty (TKA), a flexion deformity of at least 5° is present in around one-third of cases and a flexion deformity of over 15° in around 5% of cases [3]. Flexion deformity is an independent risk factor for dissatisfaction and poor function after TKA [8, 13, 23, 24]. Moreover, if flexion deformity persists postoperatively, it leads to an increased energy requirement when walking and thus limits mobility, especially in elderly patients [21, 26]. Since extension, in contrast to flexion, only improves minimally over the course of rehabilitation after TKA, a full
* Georg Matziolis g.matziolis@waldkliniken‑eisenberg.de 1
Orthopaedic Department, Campus Eisenberg, University Hospital Jena, Klosterlausnitzer Str. 81, 07607 Eisenberg, Germany
extension of the knee joint must be achieved during TKA [12, 20]. The possible techniques have been well documented and comprise the removal of osteophytes, posterior capsule release, removal of the posterior cruciate ligament (PCL), and an in
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