Short-term results of soft tissue balance obtained with 'manual gap balancing' in varus knees; a prospective study supported by gait analysis

Yıl 2024, , 226 - 233, 01.07.2024

Fırat Doğruöz , Aliekber Yapar , Ömer Faruk Eğerci , Özkan Köse , Özal Özcan

https://doi.org/10.18663/tjcl.1469649

Öz

Aim: The aim of this study was to investigate the contribution of medial ligament release using the manual gap balance method in patients with varus deformity to alignment and functional outcomes.
Materials and Methods: The study included 14 female and 8 male patients who underwent total knee arthroplasty. Telemetric radiographs of the lower extremities and valgus stress radiographs of the knees to be operated on were taken for each patient one day before and 1.5 months after the operation. The functional evaluation of patients was conducted using the HSS (Hospital for Special Surgery, 1970) scoring system. Simultaneously, gait analyses were conducted. The patients were divided into groups based on their stress radiographs.
Results: The mean valgus angle in postoperative static radiographs was 2.5 degrees. A statistically significant change in rotational deformity was observed in both swing and stance phases after surgery compared to preoperative values. Improvement in coronal plane varus knees was statistically significant. No significant change was found in the flexion-extension angles of sagittal plane kinematics. It was found that there was a statistically significant difference in the data for single support, double support, and stance percentage (p<0.05).
Conclusion: In conclusion, it was observed that the soft tissue balance achieved through manual gap balancing without the use of technological equipment was sufficient and satisfactory in terms of functional scores, walking parameters, and alignment data.

Anahtar Kelimeler

manual gap balancing, varus knee, gait analysis

Etik Beyan

Conflict of Interest The authors declare that they have no conflict of interest. Funding No funding has been received for this research. Ethical Approval The study was approved by Institutional Ethics Committee (Approval number:2015/4-100)

Varus dizlerde 'manuel gap balancing' ile elde edilen yumuşak doku dengesinin kısa dönem sonuçları; yürüyüş analiziyle desteklenen prospektif bir çalışma

Öz

Amaç: Bu çalışmanın amacı varus deformitesi bulunan hastalarda ‘manual gap balancing’ yöntemi ile yapılan medial bağ gevşetmesinin, dizilime ve fonksiyonel sonuçlara olan katkısını araştırmaktır.
Gereç ve Yöntemler: Çalışmaya total diz artroplastisi uygulanan 14 kadın, 8 erkek hasta dahil edildi. Her hastanın alt ekstremite koronal plan telemetrik grafileri ve opere edilecek dizlerinin valgus stress grafileri operasyondan 1 gün önce ve operasyondan 1,5 ay sonra çekildi. Hastaların fonksiyonel değerlendirmesi HSS (Hospital for Special Surgery, 1970) skorlama sistemi kullanılarak yapıldı. Eş zamanlı olarak hastaların yürüme analizleri yapıldı. Hastalar stress grafilerine göre gruplara ayrıldı.
Bulgular: Postoperatif statik radiografilerdeki valgus açı ortalaması 2,5 derece idi. Koronal planda varus dizlerdeki düzelme istatistiksel olarak anlamlı idi. Dizdeki rotasyonel deformitedeki değişimin ameliyat sonrası, ameliyat öncesi değerlere göre hem salınım hemde basma fazında istatistiksel olarak anlamlı olduğu görüldü. Sagittal plan kinematiklerinden fleksiyon ekstansiyon açılarında anlamlı bir değişim saptanmadı. Tek destek, çift destek ve stance yüzdesi verilerindeki farklılığın istatistiksel olarak anlamlı olduğu saptandı (p<0,05).
Sonuç: Bu çalışma sonucunda, teknolojik ekipmanlar kullanmadan , ‘manual gap balancing’ ile elde edilen yumuşak doku dengesinin, fonksiyonel skorlar, yürüme parametreleri ve dizilim verileri ışığında yeterli ve tatminkar olduğunu görüldü.

Anahtar Kelimeler

Manuel bağ dengesi, varus diz, yürüme analizi

Kaynakça

• Colyn W, Bruckers L, Scheys L, Truijen J, Smeets K, Bellemans J. Changes in coronal knee-alignment parameters during the osteoarthritis process in the varus knee. J ISAKOS. 2023 Apr;8(2):68-73.
• Fujii T, Sato T, Ariumi A, Omori G, Koga Y, Endo N. A comparative study of weight-bearing and non-weight-bearing 3-dimensional lower extremity alignment in knee osteoarthritis. J Orthop Sci. 2020 Sep;25(5):874-879.
• Matsui Y, Kadoya Y, Uehara K, Kobayashi A, Takaoka K. Rotational deformity in varus osteoarthritis of the knee: analysis with computed tomography. Clin Orthop Relat Res. 2005 Apr;(433):147-51.
• Schwarzkopf R, Hadley S, Abbasi M, Meere PA. Computer-assisted surgery patterns of ligamentous deformity of the knee: a clinical and cadaveric study. J Knee Surg. 2013 Aug;26(4):233-8.
• Karasavvidis T, Pagan Moldenhauer CA, Haddad FS, Hirschmann MT, Pagnano MW, Vigdorchik JM. Current Concepts in Alignment in Total Knee Arthroplasty. J Arthroplasty. 2023 Jul;38(7 Suppl 2):S29-S37. doi: 10.1016/j.arth.2023.01.060. Epub 2023 Feb 10. PMID: 36773657.
• Hohman DW Jr, Nodzo SR, Phillips M, Fitz W. The implications of mechanical alignment on soft tissue balancing in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2015 Dec;23(12):3632-6.
• JN, I., Surgical techniques and instrumentation in total knee arthroplasty. In: Scott WN (Ed), Insal l& Scott’s surgery ofthe knee, 5th ed. Churchill Livingstone, Elsevier, Philadelphia 2012, pp. 39-804.
• Colyn W, Bruckers L, Scheys L, Truijen J, Smeets K, Bellemans J. Changes in coronal knee-alignment parameters during the osteoarthritis process in the varus knee. J ISAKOS. 2023 Apr;8(2):68-73.
• Fang DM, Ritter MA, Davis KE. Coronal alignment in total knee arthroplasty: just how important is it? J Arthroplasty. 2009;24(6 Suppl):39-43.
• Van Rossom S, Wesseling M, Smith CR, Thelen DG, Vanwanseele B, Dieter VA, Jonkers I. The influence of knee joint geometry and alignment on the tibiofemoral load distribution: A computational study. Knee. 2019 Aug;26(4):813-823.
• Stief F, Böhm H, Dussa CU, Multerer C, Schwirtz A, Imhoff AB, Döderlein L. Effect of lower limb malalignment in the frontal plane on transverse plane mechanics during gait in young individuals with varus knee alignment. Knee. 2014 Jun;21(3):688-93.
• Bytyqi D, Shabani B, Lustig S, Cheze L, Karahoda Gjurgjeala N, Neyret P. Gait knee kinematic alterations in medial osteoarthritis: three dimensional assessment. Int Orthop. 2014 Jun;38(6):1191-8.
• Kramers-de Quervain IA, Stüssi E, Müller R, Drobny T, Munzinger U, Gschwend N. Quantitative gait analysis after bilateral total knee arthroplasty with two different systems within each subject. J Arthroplasty. 1997 Feb;12(2):168-79.
• Agarwal A, Miller S, Hadden W, et al. Comparison of gait kinematics in total and unicondylar knee replacement surgery. Ann R Coll Surg Engl. 2019 Jul;101(6):391-398.
• Rahman J, Tang Q, Monda M, Miles J, McCarthy I. Gait assessment as a functional outcome measure in total knee arthroplasty: a cross-sectional study. BMC Musculoskelet Disord. 2015 Mar 22;16:66.
• Levinger P, Menz HB, Morrow AD, et al. Dynamic foot function changes following total knee replacement surgery. Knee. 2012 Dec;19(6):880-5.
• Kaneda K, Harato K, Oki S, et al. Increase in tibial internal rotation due to weight-bearing is a key feature to diagnose early-stage knee osteoarthritis: a study with upright computed tomography. BMC Musculoskelet Disord. 2022 Mar 15;23(1):253.
• Bączkowicz D, Skiba G, Czerner M, Majorczyk E. Gait and functional status analysis before and after total knee arthroplasty. Knee. 2018 Oct;25(5):888-896.
• McClelland JA, Webster KE, Feller JA. Gait analysis of patients following total knee replacement: a systematic review. Knee. 2007 Aug;14(4):253-63.
• Simonsen EB, Contributions to the understanding of gait control. Dan Med J, 2014. 61(4): p. B4823.
• Wu X, Chu L, Xiao L, et al. Early Spatiotemporal Patterns and Knee Kinematics during Level Walking in Individuals following Total Knee Arthroplasty. J Healthc Eng. 2017;2017:7056469. doi: 10.1155/2017/7056469. Epub 2017 Jul 31. PMID: 29065637; PMCID: PMC5554991.
• Umberger BR. Stance and swing phase costs in human walking. J R Soc Interface. 2010 Sep 6;7(50):1329-40.
• Lee TH, Tsuchida T, Kitahara H, Moriya H. Gait analysis before and after unilateral total knee arthroplasty. Study using a linear regression model of normal controls -- women without arthropathy. J Orthop Sci. 1999;4(1):13-21.