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J Knee Surg 2022; 35(11): 1236-1241
DOI: 10.1055/s-0040-1722658
Original Article

Assessing the Role of Minimal Medial Tissue Release during Navigation-Assisted Varus Total Knee Arthroplasty Based on the Degree of Preoperative Varus Deformity

Seikai Toyooka
1   Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
,
Hironari Masuda
1   Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
,
Nobuhiro Nishihara
1   Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
,
Wataru Miyamoto
1   Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
,
Takashi Kobayashi
1   Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
,
Hirotaka Kawano
1   Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
,
Takumi Nakagawa
1   Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
› Author Affiliations Funding None.
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Abstract

We assessed the impact of a minimal medial soft-tissue release with complete peripheral osteophyte removal on the ability to attain manual preresection deformity correction during navigation-assisted total knee arthroplasty (TKA) for varus osteoarthritis. We included 131 TKAs for 109 patients with medial compartment predominant osteoarthritis. The steps for achieving minimal medial soft-tissue release were performed as follows: (1) elevation of a periosteal sleeve to 5-mm distal to the joint line and (2) complete removal of peripheral osteophytes. The evaluation criteria of this study were as follows: (1) age, (2) height, (3) weight, (4) body mass index (BMI), (5) sex, (6) the preoperative femorotibial mechanical angle in the neutral position before medial release and (7) the mechanical angle in maximum manual valgus stress after the two-step medial-release procedure (measured on the navigation screens). Multiple regression analysis of the criteria was performed to determine the degree of varus deformity that allowed neutral alignment but required extensive medial release. The femorotibial mechanical angle in the neutral position before medial release and sex correlated with the mechanical angle in maximum manual valgus stress on the navigation screen after medial release (r = 0.72, p < 0.001). Based on the regression formula, the maximum degree of preoperative varus deformity that allowed neutral alignment by the minimum medial-release procedure was 5.3 degrees for males and 9.1 degrees for females. The magnitude of deformity which has an impact on the ability to correct varus deformity (by minimal soft-tissue release and complete osteophyte removal) was clarified. If the preoperative degree of varus deformity was within 5.3 degrees for males and 9.1 degrees for females, an extensive medial release was not required to obtain neutral alignment.

Keywords

medial release - total knee arthroplasty - varus deformity - navigation - osteoarthritis


Publication History

Received: 15 February 2020

Accepted: 29 November 2020

Article published online:
20 January 2021

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