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Mid-flexion stability in the anteroposterior plane is achieved with a medial congruent insert in cruciate-retaining total knee arthroplasty for varus osteoarthritis

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

This study aimed to compare the intraoperative kinematics, especially for mid-flexion femorotibial anteroposterior (AP) stability, between newly developed medial congruent (MC) inserts and cruciate-retaining (CR) inserts in navigated cruciate-retaining total knee arthroplasty (CR-TKA).

Methods

Thirty consecutive patients with varus osteoarthritis undergoing CR-TKA using an image-free navigation system were enrolled. AP kinematics, the AP translation under manual maximum stress to the knee joint at 45° flexion, rotational kinematics, and varus–valgus laxity were evaluated using a navigation system and statistically compared between the MC and CR inserts.

Results

AP kinematic analysis showed that the femoral position with the CR insert was significantly anterior at a maximum extension to 45° flexion compared with the MC insert (p < 0.05). The amount of AP translation at 45° flexion with the MC insert was significantly smaller than that with the CR insert (p < 0.05). Rotational kinematics found that the tibial position at maximum extension was significantly externally rotated with the MC inserts than with the CR inserts. Varus–valgus laxity was comparable between the MC and CR inserts.

Conclusion

The current results showed that greater mid-flexion AP stability was achieved with the MC inserts than with the CR inserts in CR-TKA. Intraoperative kinematics with the MC inserts more closely resembled those with preoperative conditions in CR-TKA.

Level of evidence

III, prospective comparative study.

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Funding

This study was not funded by any company.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki, Chuo, Kobe, 650-0017, Japan

    Masanori Tsubosaka, Shinya Hayashi, Ryosuke Kuroda & Tomoyuki Matsumoto

  2. Department of Orthopedic Surgery, Kobe Kaisei Hospital, 3-11-15, Shinohara-Kita, Nada, Kobe, 657-0068, Japan

    Kazunari Ishida, Kazuki Kodato, Nao Shibanuma & Masahiro Kurosaka

Authors
  1. Masanori Tsubosaka
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  2. Kazunari Ishida
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  3. Kazuki Kodato
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  4. Nao Shibanuma
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  5. Shinya Hayashi
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  6. Masahiro Kurosaka
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  7. Ryosuke Kuroda
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  8. Tomoyuki Matsumoto
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Corresponding author

Correspondence to Kazunari Ishida.

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Conflict of interest

No author associated with this paper has disclosed any potential or pertinent conflicts which may be perceived to have impending conflict with this work.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Tsubosaka, M., Ishida, K., Kodato, K. et al. Mid-flexion stability in the anteroposterior plane is achieved with a medial congruent insert in cruciate-retaining total knee arthroplasty for varus osteoarthritis. Knee Surg Sports Traumatol Arthrosc 29, 467–473 (2021). https://doi.org/10.1007/s00167-020-05927-4

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  • DOI: https://doi.org/10.1007/s00167-020-05927-4

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