Cho Myung-Rae; Do Jung-Suk; Kim Kyung-Tae; Choi Won-Kee

doi:10.4055/jkoa.2019.54.3.254

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Myung-Rae, Jung-Suk, Kyung-Tae, and Won-Kee: Relationship between Knee Function at 1 Year Postoperation and Gap Difference (90˚ Flexion Gap–Extension Gap) in Total Knee Replacement

Original Article

J Korean Orthop Assoc 2019;54(3):254-260.

DOI: https://doi.org/10.4055/jkoa.2019.54.3.254

Relationship between Knee Function at 1 Year Postoperation and Gap Difference (90˚ Flexion Gap–Extension Gap) in Total Knee Replacement

Cho Myung-Rae, M.D., Do Jung-Suk, M.D., Kim Kyung-Tae, M.D., Choi Won-Kee, M.D.

Department of Orthopaedic Surgery, Daegu Catholic University Medical Center, Daegu, Korea

Correspondence to: Won-Kee Choi, M.D. Department of Orthopaedic Surgery, Daegu Catholic University Medical Center, 33 Duryugongwon-ro 17-gil, Nam-gu, Daegu 42472, Korea TEL: +82-53-650-4277 FAX: +82-53-652-4272 E-mail: cwk1009@hanmail.net ORCID: https://orcid.org/0000-0002-4671-5656

Received 28 July 201826 September 2018 Accepted 27 September 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

To evaluate the relationship between the knee function at 1 year postoperation and the gap difference (90˚ flexion gap–extension gap) in total knee replacement.

Materials and Methods:

Eighty-two consecutive osteoarthritis knees that underwent primary total knee replacement using navigation from March 2017 June 2017 were evaluated prospectively. The gap was measured using navigation after reducing the patella with towel clips. After checking the average values of the medial and lateral gaps at extension and 90˚ flexion knee, the gap difference (90˚ flexion gap–extension gap) was calculated. The knees were divided into three groups according to the gap difference (gap difference<0 mm, 0 mm≤gap difference<2 mm, 2 mm≤gap difference). The Knee Society score (KSS) and maximal knee flexion were compared at 1 year postoperation among three groups.

Results:

The numbers of knees according to groups were 37, 29, and 16 knees in regular order. The average of the KSS knee, KSS function, and maximal knee flexion at the 1-year follow-up were 81.21±8.31, 71.34±9.84, and 126.48˚±7.28˚, respectively. No statistically significant difference in KSS was observed among the 3 groups. The third group (2 mm≤gap difference) showed a larger maximal knee flexion than the other groups in the Mann–Whitney test.

Conclusion:

The group of total knee replacement (2 mm≤90˚ flexion gap–extension gap) showed larger maximal knee flexion than the other groups at the 1-year follow-up in statistics.

Keywords: total knee replacement, gap, flexion

References

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Figure 1.

To obtain post total knee arthroplasty status gap, gap after patella reduction was measured using towel clips.

Figure 2.

Soft tissue release and extension-flexion gaps were controlled by viewing the navigation screen displacing the extension and flexion gaps. AP, anteroposterior.

Figure 3.

Distribution of the gap differences (90˚ flexion gap–extension gap).

Table 1.

Patients’∗ Demographic Details

Variable	Value
Sex
Male	8
Female	59
Age (yr)	70.17±5.87
Direction
Right	40
Left	42
Body mass index (kg/m²)	24.27
Preoperation HKA (°)	168.77±6.14
Preoperation KSS knee	38.41
Preoperation KSS function	25.89
Preoperation knee maximal flexion angle (°)	138.78±5.75

Values are presented as number only, mean±standard deviation, and mean only.

^∗ Total 67 persons (82 knees). HKA, hip knee ankle; KSS, Knee Society score.

Table 2.

Gaps Displaced on Navigation after Mounting the Implant

Variable	Value (mm)
Medial gaps of extension	12.85±1.89
Lateral gaps of extension	13.18±1.78
Difference gaps of extension (lateral gaps–medial gap)	0.32±1.13
Average gaps of extension	13.02±1.74
Medial gaps of flexion (90°)	13.52±2.16
Lateral gap of flexion (90°)	13.17±2.18
Difference gaps of flexion (90°) (lateral gaps–medial gap)	-0.34±0.87
Average gaps of flexion (90°)	13.35±2.13
Difference gaps between extension and flexion	0.32±2.09

Values are presented as mean±standard deviation.

Table 3.

Knee Function according to X (90° Flexion Gap–Extension Gap, mm) after 1 Year Postoperation

Variable	X<0	0≤X<2	2≤X	p-value
No. of subject	37	29	16
KSS knee	79.84±8.22	83.03±7.46	81.06±9.81	0.25
KSS function	71.35±10.31	71.38±8.54	71.25±11.47	0.92
Maximal knee flexion (°)	124.86±6.71	127.07±4.91	129.13±10.87	<0.001

Values are presented as number only or mean±standard deviation. KSS, Knee Society score.

Table 4.

Comparison of the Knee Maximal Flexion Degrees at 1 Year Postoperation between the Groups according to X (90˚ Flexion Gap–Extension Gap, mm)

Group 1	Group 2	p-value
X<0	0≤X<2	0.14
X<0	2≤X	<0.001
0≤X<2	2≤X	0.01

Table 5.

Comparison of the Preoperation Variables among the Groups according to X (90˚ Flexion Gap–Extension Gap, mm)

Variables	X<0	0≤X<2	2≤X	p-value
No. of subject	37	29	16
Age (yr)	69.43±1.06	69.62±0.89	72.88±1.46	0.12
Body mass index (kg/m²)	23.82±2.32	24.23±3.12	25.43±3.23	0.36
Preoperation HKA angle (°)	138.65±1.29	138.45±0.56	139.69±0.85	0.94
Preoperation KSS knee	37.92±12.5	39.14±11.23	38.23±10.43	0.65
Preoperation KSS function	26.32±8.42	25.35±5.12	25.89±7.12	0.63
Preoperation maximal knee flexion (°)	138.65±1.29	138.45±0.56	139.69±0.85	0.08

Values are presented as number only or mean±standard deviation. HKA, hip knee ankle; KSS, Knee Society score.

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