Highlights
- •Total knee arthroplasty (TKA) can lead to an ‘artificial’ joint perception.
- •An artificial perception is associated with lower patient satisfaction.
- •A gap difference ≥1.0 mm (distraction force, 1.5 BMI) improved outcomes.
- •Soft tissue balance during TKA is predictive of patient-reported outcomes.
Abstract
Background
We aimed to evaluate the association between the flexion–extension gap difference
and patient-reported outcome measures after total knee arthroplasty (TKA).
Methods
This was a retrospective case–control study of 60 cruciate-retaining single-radius
TKAs. Soft tissue balancing was measured using an offset seesaw tensioner and centre-type
digital knee balancer under joint distraction forces of 20–50 lbf and 1.5 times body
mass index (1.5 BMI). At the last follow up of 2.0–6.5 (mean, 4.5) years postoperatively,
patients were asked if they perceived their knee joint as ‘natural’ (26 knees) or
‘artificial’ (34 knees). Age, sex, and the flexion–extension gap were compared between
the two groups. A receiver operating characteristic curve was used to determine cut-off
values of variables predictive of a natural joint perception.
Results
Natural joint perception was associated with a greater flexion–extension gap difference
under a distraction force of 1.5 BMI (P = 0.016), higher knee function (Knee Injury and Osteoarthritis Outcome Score for
Joint Replacement, P = 0.019), and quality of life (EuroQol 5-Dimension, P = 0.029). A gap difference of 0.95 mm under 1.5 BMI distraction predicted a natural
joint perception post-TKA (sensitivity, 97.1%; specificity, 88.5%). Using a gap threshold
of 1.0 mm under a 1.5 BMI distraction force yielded significant between-group differences
in postoperative flexion (P = 0.040), satisfaction (P = 0.043), knee joint function (P < 0.001), quality of life (P = 0.032), and posterior femoral condylar offset (P = 0.037)
Conclusion
A flexion–extension gap difference ≥1.0 mm under a distraction force of 1.5 BMI predicted
superior outcomes, including patient satisfaction, after cruciate-retaining TKA. It
was suggested that posterior femoral condylar offset could influence this finding.
Keywords
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Article info
Publication history
Published online: January 24, 2023
Accepted:
December 21,
2022
Received in revised form:
November 13,
2022
Received:
August 4,
2022
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
