Skip to main content

Advertisement

SpringerLink
Log in

Tension controlled ligament balanced total knee arthroplasty: 5-year results of a soft tissue orientated surgical technique

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Posterior cruciate ligament (PCL)-retaining prostheses give good outcomes and are commonly used. This retrospective study investigated outcomes from total knee arthroplasty (TKA) using the ligament balancing technique to implant a PCL-retaining knee prosthesis (balanSys™ knee system) with either a mobile or a fixed bearing polyethylene inlay.

Materials and methods

A retrospective study was performed on patients treated with TKA at one surgical centre between 1997 and 2001. In this period 182 surgeries were performed. Clinical assessments of the implant used the Knee Society Score (KSS). Subjective assessments used visual analogue scale (VAS) for pain and patient satisfaction. The Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC) was used to assess pain, stiffness and function of the knee. Radiographic analysis was performed to determine frontal and sagittal alignment and loosening.

Results

A total of 109 knee implants in 95 patients (26 men; 69 women) were followed up. Seventy-three cases were not available for follow-up due to bad health or death of the patient; 74% of 109 reviewed implants had fixed bearings and 26% had mobile bearings. The mean age at surgery was 72.9 ± 7.35 years (range 54.7–92.4). The mean KSS was 160 ± 28.3 points. The KSS was greater for men and was significantly reduced when another disease was present. The type of bearing, surgical approach, and pre-operative alignment for patients affected by varus or valgus gonarthrosis had no significant impact on KSS and ROM. According to VAS the mean scores for pain and satisfaction were 1.48 (0 = no pain) and 9.2 (10 = very satisfied), respectively. The WOMAC mean scores for pain (87.0), stiffness (82.3) and function (78.6) were high (best outcome score of 100). There were no revisions due to aseptic loosening or wear.

Conclusion

Total knee arthroplasty performed with a PCL-retaining prosthesis implanted by using a soft tissue oriented surgical technique is a safe procedure and was associated with good results. So far, there were few complications and no need for revision due to aseptic loosening. In addition, most of the patients reported little pain and were satisfied with the outcome. These good outcomes are comparable with other studies reporting on PCL-retaining prostheses.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Bal BS, Greenberg DD, Buhrmester L, Aleto TJ (2006) Primary TKA with a zirconia ceramic femoral component. J Knee Surg 19:89–93

    PubMed  Google Scholar 

  2. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW (1988) Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 15:1833–1840

    PubMed  CAS  Google Scholar 

  3. Bozic KJ, Kinder J, Meneghini RM, Zurakowski D, Rosenberg AG, Galante JO (2005) Implant survivorship and complication rates after total knee arthroplasty with a third-generation cemented system: 5 to 8 years followup. Clin Orthop Relat Res 435:277

    Article  PubMed  Google Scholar 

  4. Callaghan JJ (2001) Mobile-bearing knee replacement: clinical results: a review of the literature. Clin Orthop Relat Res 392:221–225

    Article  PubMed  Google Scholar 

  5. Callahan CM, Drake BG, Heck DA, Dittus RS (1994) Patient outcomes following tricompartmental total knee replacement. A meta-analysis. JAMA 271:1349–1357

    Article  PubMed  CAS  Google Scholar 

  6. Conditt MA, Noble PC, Bertolusso R, Woody J, Parsley BS (2004) The PCL significantly affects the functional outcome of total knee arthroplasty. J Arthroplasty 19:107–112

    Article  PubMed  Google Scholar 

  7. Dennis DA, Little L (2005) Mobile bearings in total knee arthroplasty. Curr Opin Orthop 16:29–34

    Article  Google Scholar 

  8. Emerson RH Jr, Hansborough T, Reitman RD, Rosenfeldt W, Higgins LL (2002) Comparison of a mobile with a fixed-bearing unicompartmental knee implant. Clin Orthop Relat Res 404:62–70

    Article  PubMed  Google Scholar 

  9. Emerson RH Jr, Higgins LL (2004) A comparison of highly instrumented and minimally instrumented unicompartmental knee prostheses. Clin Orthop Relat Res 428:153–157

    Article  PubMed  Google Scholar 

  10. Figgie HE 3rd, Goldberg VM, Heiple KG, Moller HS 3rd, Gordon NH (1986) The influence of tibial-patellofemoral location on function of the knee in patients with the posterior stabilized condylar knee prosthesis. J Bone Joint Surg Am 68:1035–1040

    PubMed  Google Scholar 

  11. Gioe TJ, Killeen KK, Grimm K, Mehle S, Scheltema K (2004) Why are total knee replacements revised?: analysis of early revision in a community knee implant registry. Clin Orthop Relat Res 428:100–106

    Article  PubMed  Google Scholar 

  12. Goldberg VM, Kraay M (2004) The outcome of the cementless tibial component: a minimum 14-year clinical evaluation. Clin Orthop Relat Res 428:214–220

    Article  PubMed  Google Scholar 

  13. Haaker RG, Stockheim M, Kamp M, Proff G, Breitenfelder J, Ottersbach A (2005) Computer-assisted navigation increases precision of component placement in total knee arthroplasty. Clin Orthop Relat Res 433:152–159

    Article  PubMed  Google Scholar 

  14. Insall JN, Binazzi R, Soudry M, Mestriner LA (1985) Total knee arthroplasty. Clin Orthop Relat Res 192:13–22

    PubMed  Google Scholar 

  15. Jones RE, Skedros JG, Chan AJ, Beauchamp DH, Harkins PC (2001) Total knee arthroplasty using the S-ROM mobile-bearing hinge prosthesis. J Arthroplasty 16:279–287

    Article  PubMed  CAS  Google Scholar 

  16. Keblish PA (2003) The lateral approach for total knee arthroplasty. J Knee Surg 16:62–68

    PubMed  Google Scholar 

  17. Kim YH, Kook HK, Kim JS (2001) Comparison of fixed-bearing and mobile-bearing total knee arthroplasties. Clin Orthop Relat Res 392:101–115

    Article  PubMed  Google Scholar 

  18. Klein GR, Parvizi J, Rapuri VR, Austin MS, Hozack WJ (2004) The effect of tibial polyethylene insert design on range of motion: evaluation of in vivo knee kinematics by a computerized navigation system during total knee arthroplasty. J Arthroplasty 19:986–991

    PubMed  Google Scholar 

  19. Lingard EA, Katz JN, Wright EA, Sledge CB (2004) Predicting the outcome of total knee arthroplasty. J Bone Joint Surg Am 86A:2179–2186

    Google Scholar 

  20. Matsuda Y, Ishii Y, Noguchi H, Ishii R (2005) Varus-valgus balance and range of movement after total knee arthroplasty. J Bone Joint Surg Br 87:804–808

    Article  PubMed  CAS  Google Scholar 

  21. Mihalko WM, Whiteside LA, Krackow KA (2003) Comparison of ligament-balancing techniques during total knee arthroplasty. J Bone Joint Surg Am 85A (Suppl 4):132–135

    Google Scholar 

  22. Miner AL, Lingard EA, Wright EA, Sledge CB, Katz JN (2003) Knee range of motion after total knee arthroplasty: how important is this as an outcome measure? J Arthroplasty 18:286–294

    Article  PubMed  Google Scholar 

  23. Moreland JR (1988) Mechanisms of failure in total knee arthroplasty. Clin Orthop Relat Res 226:49–64

    PubMed  Google Scholar 

  24. Morgan-Jones RL, Roger GJ, Solis G, Parish EN, Cross MJ (2003) Meniscal bearing uncemented total knee arthroplasty: early clinical results at a minimum 2-year review. J Arthroplasty 18:41–44

    Article  PubMed  CAS  Google Scholar 

  25. Nelson C (1999) Total knee arthroplasty woth preservation of the posterior cruciate ligament. Univ Pa Orthop J 12:96–100

    Google Scholar 

  26. Nilsson KG, Dalén T, Broström LA, Kärrholm J (1997) In vivo kinematics in knee replacments with fixed or mobile polyethylene bearings. In: 43rd Annual meeting, San Francisco

  27. Partington PF, Sawhney J, Rorabeck CH, Barrack RL, Moore J (1999) Joint line restoration after revision total knee arthroplasty. Clin Orthop Relat Res 367:165–171

    Article  PubMed  Google Scholar 

  28. Price AJ, Rees JL, Beard D, Juszczak E, Carter S, White S, de Steiger R, Dodd CA, Gibbons M, McLardy-Smith P, Goodfellow JW, Murray DW (2003) A mobile-bearing total knee prosthesis compared with a fixed-bearing prosthesis. A multicentre single-blind randomised controlled trial. J Bone Joint Surg Br 85:62–67

    Article  PubMed  CAS  Google Scholar 

  29. Ritter MA, Eizember L, Keating EM, Faris PM (1995) The influence of age and gender on the outcome of total knee arthroplasty. Todays OR Nurse 17:10–15

    CAS  Google Scholar 

  30. Ritter MA, Thong AE, Davis KE, Berend ME, Meding JB, Faris PM (2004) Long-term deterioration of joint evaluation scores. J Bone Joint Surg Br 86:438–442

    Article  PubMed  CAS  Google Scholar 

  31. Sansone V, da Gama Malcher M (2004) Mobile-bearing total knee prosthesis: a 5- to 9-year follow-up of the first 110 consecutive arthroplasties. J Arthroplasty 19:678–685

    Article  PubMed  Google Scholar 

  32. Schunck J, Jerosch J (2003) [Knee arthroplasty. Mobile- and fixed-bearing design]. Orthopade 32:477–483

    PubMed  CAS  Google Scholar 

  33. Scuderi GR, Insall JN (1992) Total knee arthroplasty. Current clinical perspectives. Clin Orthop Relat Res 276:26–32

    PubMed  Google Scholar 

  34. Sheng P, Lehto M, Kataja M, Halonen P, Moilanen T, Pajamaki J (2004) Patient outcome following revision total knee arthroplasty: a meta-analysis. Int Orthop 28:78–81

    Article  PubMed  Google Scholar 

  35. Stockl B, Nogler M, Rosiek R, Fischer M, Krismer M, Kessler O (2004) Navigation improves accuracy of rotational alignment in total knee arthroplasty. Clin Orthop Relat Res 426:180–186

    Article  PubMed  Google Scholar 

  36. Tew M, Waugh W (1985) Tibiofemoral alignment and the results of knee replacement. J Bone Joint Surg Br 67:551–556

    PubMed  CAS  Google Scholar 

  37. Total knee replacement (2003) Evid Rep Technol Assess (Summ), pp 1–8

  38. Trepte CT, Pfanzelt K (2003) [Soft tissue balancing in total condylar knee arthroplasty]. Zentralbl Chir 128:70–73

    Article  PubMed  CAS  Google Scholar 

  39. Wehrli U, Schuster A, Christen B (2002) Soft tissue related implantation of TKR. In: 10th European Society of Sports Traumatology, Knee Surgery and Arthroscopy Congress, Rome

  40. Woolson ST, Northrop GD (2004) Mobile- vs. fixed-bearing total knee arthroplasty: a clinical and radiologic study. J Arthroplasty 19:135–140

    Article  PubMed  Google Scholar 

  41. Wright RJ, Sledge CB, Poss R, Ewald FC, Walsh ME, Lingard EA (2004) Patient-reported outcome and survivorship after Kinemax total knee arthroplasty. J Bone Joint Surg Am 86A:2464–2470

    Google Scholar 

  42. Wymenga A (2002) Ligament balancing and femoral component rotation in total knee arthroplasty. A symposium organised by the ‘Knee unit’ of the St. Maartenskliniek Nijmegen, Netherlands, 16th November 2001 Knee 9:357–358

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Spital Bern Ziegler, 3001, Bern, Switzerland

    Tobias Wyss, Andreas J. Schuster & Ulrich Wehrli

  2. Salem Spital, Bern, Switzerland

    Bernhard Christen

Authors
  1. Tobias Wyss
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andreas J. Schuster
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bernhard Christen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ulrich Wehrli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tobias Wyss.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wyss, T., Schuster, A.J., Christen, B. et al. Tension controlled ligament balanced total knee arthroplasty: 5-year results of a soft tissue orientated surgical technique . Arch Orthop Trauma Surg 128, 129–135 (2008). https://doi.org/10.1007/s00402-007-0541-2

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-007-0541-2

Keywords

Search

Navigation