caa a22 4500 605457581 CHVBK 20210128100224.0 cr unu---uuuuu 210128e20151201xx s 000 0 eng 10.1007/s00167-014-3262-4 doi (NATIONALLICENCE)springer-10.1007/s00167-014-3262-4 The implications of mechanical alignment on soft tissue balancing in total knee arthroplasty [Elektronische Daten] [Donald Hohman Jr., Scott Nodzo, Matthew Phillips, Wofgang Fitz] Purpose: We hypothesized that the individual bone geometry is the most important variable to achieve acceptable soft tissue balancing during total knee arthroplasty. Methods: Long-standing 3-foot films and computer navigation data from 90 patients with varus (n=45) or valgus deformity (n=45) were utilized who underwent navigated total knee arthroplasty. Mean age was 65±8years with 50 women and 40 men. Hip-knee-ankle angle (HKA) was measured and ranged from 23° varus to 21.5° of valgus. Three additional measurements were made: lateral distal femoral angle (DFA), the intraarticular angle (IAA), and the medial proximal tibial angle (PTA). Intra-operative computer navigation data were obtained. Knees were then stressed with both a maximum varus/valgus moment in 10° flexion. Values were compared with the angle measurements of 3-foot films. Maximum varus/valgus measurements were correlated with HKA for both varus and valgus knees. Results: Varus knees: Mean HKA measured 9°±5°, and the maximum varus stress measured intraoperatively was 12°±4°. The mean DFA, PTA, and IAA were 88°±2.5°, 84°±3.4°, and 4.5°±2.5°, respectively. If the HKAwas <10°, the deformity was correctable in (16/26) 61%of cases. Positive correlation exists between the HKA, and maximal varus stress obtained intraoperatively (r=0.75, p<0.0001). IAA correlated with increasing HKA (r=0.80, p<0.0001). Mean IAA was significantly greater in the varus than valgus group (4.5±2.6 vs 3.2±2.4, respectively, p=0.01). Valgus knees: Mean HKA measured was 9.4°±4°. The mean DFA, PTA, and IAA were 83°±2°, 89.5°±2°, and 3.2°±2.4°, respectively. If the HKA was more than 10°, maximal varus stress of the knee was able to correct the valgus deformity (15/22) 68%of the time. If the HKA was <10°, the deformity was correctable in(21/23) 91%of cases. Positive correlation exists between the HKA and maximal valgus stress examination (r=0.74, p<0.0001). There was a positive correlation of IAA with increasing HKA (r=0.61, p<0.0001). Mean flexion contracture for varus knees was 6.3°±6.9° compared with 0.8°±7.6° in the valgus group (p=0.0004). Conclusion: These data suggest that soft tissues play more of a role in the varus knee deformity than they do in the valgus knee and that the bony contribution may be the main contributing factor to the overall deformity of the valgus knee. Level of evidence: IV. European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA), 2014 Knee arthroplasty nationallicence Soft tissue balancing nationallicence Ligament balance varus knee nationallicence Valgus knee nationallicence Navigation nationallicence Hohman Jr. Donald Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA aut Nodzo Scott Department of Orthopaedic Surgery, SUNY at Buffalo School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA aut Phillips Matthew Department of Orthopaedic Surgery, SUNY at Buffalo School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA aut Fitz Wofgang Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA aut Knee Surgery, Sports Traumatology, Arthroscopy Springer Berlin Heidelberg 23/12(2015-12-01), 3632-3636 0942-2056 23:12<3632 2015 23 167 https://doi.org/10.1007/s00167-014-3262-4 text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s00167-014-3262-4 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Hohman Jr Donald Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA aut NATIONALLICENCE 700 1- Nodzo Scott Department of Orthopaedic Surgery, SUNY at Buffalo School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA aut NATIONALLICENCE 700 1- Phillips Matthew Department of Orthopaedic Surgery, SUNY at Buffalo School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA aut NATIONALLICENCE 700 1- Fitz Wofgang Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA aut NATIONALLICENCE 773 0- Knee Surgery, Sports Traumatology, Arthroscopy Springer Berlin Heidelberg 23/12(2015-12-01), 3632-3636 0942-2056 23:12<3632 2015 23 167