Effect of medial epicondylar osteotomy on soft tissue balancing in total knee arthroplasty

William Mihalko, Kazuhiko Saeki, Leo A. Whiteside

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Balancing and surgical exposure of a severe varus knee during total knee arthroplasty (TKA) can be difficult. Use of a medial epicondylar osteotomy to solve these problems has been reported. This study compared knee stability in cadaveric specimens after TKA, after medial epicondylar osteotomy, and after conventional subperiosteal release of the medial collateral ligament (MCL). Five cadaveric knees were tested after TKA, after medial epicondylar osteotomy, and after repair of the osteotomy to compare the results to 5 cadaveric knees that underwent complete subperiosteal release of the MCL. A retrospective review of clinical cases also was performed of 118 varus knees exposed using the standard medial parapatellar approach and subperiosteal release of the MCL to compare results to the literature using a medial epicondylar osteotomy. Coronal and transverse plane laxity increased significantly at 60° and 90° flexion in the knees after medial epicondylar osteotomy. Suture repair of the osteotomy did not affect stability. The knees with MCL release had a significantly lower degree of coronal and transverse plane laxity at 60° and 90° than knees with an epicondylar osteotomy. The retrospective case review found satisfactory exposure and correct ligament balance was achieved in all cases. The findings of this study question the need for an epicondylar osteotomy in severe varus osteoarthritic knees. Because the knee remains unstable in flexion after this technique, an implant with higher constraint should be used.

Original languageEnglish (US)
JournalOrthopedics
Volume36
Issue number11
DOIs
StatePublished - Nov 1 2013

Fingerprint

Knee Replacement Arthroplasties
Osteotomy
Knee
Collateral Ligaments
Knee Medial Collateral Ligament
Ligaments
Sutures

All Science Journal Classification (ASJC) codes

  • Orthopedics and Sports Medicine

Cite this

Effect of medial epicondylar osteotomy on soft tissue balancing in total knee arthroplasty. / Mihalko, William; Saeki, Kazuhiko; Whiteside, Leo A.

In: Orthopedics, Vol. 36, No. 11, 01.11.2013.

Research output: Contribution to journalArticle

@article{b66ce8793b564afdbb41346dcfa94ceb,
title = "Effect of medial epicondylar osteotomy on soft tissue balancing in total knee arthroplasty",
abstract = "Balancing and surgical exposure of a severe varus knee during total knee arthroplasty (TKA) can be difficult. Use of a medial epicondylar osteotomy to solve these problems has been reported. This study compared knee stability in cadaveric specimens after TKA, after medial epicondylar osteotomy, and after conventional subperiosteal release of the medial collateral ligament (MCL). Five cadaveric knees were tested after TKA, after medial epicondylar osteotomy, and after repair of the osteotomy to compare the results to 5 cadaveric knees that underwent complete subperiosteal release of the MCL. A retrospective review of clinical cases also was performed of 118 varus knees exposed using the standard medial parapatellar approach and subperiosteal release of the MCL to compare results to the literature using a medial epicondylar osteotomy. Coronal and transverse plane laxity increased significantly at 60° and 90° flexion in the knees after medial epicondylar osteotomy. Suture repair of the osteotomy did not affect stability. The knees with MCL release had a significantly lower degree of coronal and transverse plane laxity at 60° and 90° than knees with an epicondylar osteotomy. The retrospective case review found satisfactory exposure and correct ligament balance was achieved in all cases. The findings of this study question the need for an epicondylar osteotomy in severe varus osteoarthritic knees. Because the knee remains unstable in flexion after this technique, an implant with higher constraint should be used.",
author = "William Mihalko and Kazuhiko Saeki and Whiteside, {Leo A.}",
year = "2013",
month = "11",
day = "1",
doi = "10.3928/01477447-20131021-14",
language = "English (US)",
volume = "36",
journal = "Orthopedics",
issn = "0147-7447",
publisher = "Slack Incorporated",
number = "11",

}

TY - JOUR

T1 - Effect of medial epicondylar osteotomy on soft tissue balancing in total knee arthroplasty

AU - Mihalko, William

AU - Saeki, Kazuhiko

AU - Whiteside, Leo A.

PY - 2013/11/1

Y1 - 2013/11/1

N2 - Balancing and surgical exposure of a severe varus knee during total knee arthroplasty (TKA) can be difficult. Use of a medial epicondylar osteotomy to solve these problems has been reported. This study compared knee stability in cadaveric specimens after TKA, after medial epicondylar osteotomy, and after conventional subperiosteal release of the medial collateral ligament (MCL). Five cadaveric knees were tested after TKA, after medial epicondylar osteotomy, and after repair of the osteotomy to compare the results to 5 cadaveric knees that underwent complete subperiosteal release of the MCL. A retrospective review of clinical cases also was performed of 118 varus knees exposed using the standard medial parapatellar approach and subperiosteal release of the MCL to compare results to the literature using a medial epicondylar osteotomy. Coronal and transverse plane laxity increased significantly at 60° and 90° flexion in the knees after medial epicondylar osteotomy. Suture repair of the osteotomy did not affect stability. The knees with MCL release had a significantly lower degree of coronal and transverse plane laxity at 60° and 90° than knees with an epicondylar osteotomy. The retrospective case review found satisfactory exposure and correct ligament balance was achieved in all cases. The findings of this study question the need for an epicondylar osteotomy in severe varus osteoarthritic knees. Because the knee remains unstable in flexion after this technique, an implant with higher constraint should be used.

AB - Balancing and surgical exposure of a severe varus knee during total knee arthroplasty (TKA) can be difficult. Use of a medial epicondylar osteotomy to solve these problems has been reported. This study compared knee stability in cadaveric specimens after TKA, after medial epicondylar osteotomy, and after conventional subperiosteal release of the medial collateral ligament (MCL). Five cadaveric knees were tested after TKA, after medial epicondylar osteotomy, and after repair of the osteotomy to compare the results to 5 cadaveric knees that underwent complete subperiosteal release of the MCL. A retrospective review of clinical cases also was performed of 118 varus knees exposed using the standard medial parapatellar approach and subperiosteal release of the MCL to compare results to the literature using a medial epicondylar osteotomy. Coronal and transverse plane laxity increased significantly at 60° and 90° flexion in the knees after medial epicondylar osteotomy. Suture repair of the osteotomy did not affect stability. The knees with MCL release had a significantly lower degree of coronal and transverse plane laxity at 60° and 90° than knees with an epicondylar osteotomy. The retrospective case review found satisfactory exposure and correct ligament balance was achieved in all cases. The findings of this study question the need for an epicondylar osteotomy in severe varus osteoarthritic knees. Because the knee remains unstable in flexion after this technique, an implant with higher constraint should be used.

UR - http://www.scopus.com/inward/record.url?scp=84889584891&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84889584891&partnerID=8YFLogxK

U2 - 10.3928/01477447-20131021-14

DO - 10.3928/01477447-20131021-14

M3 - Article

VL - 36

JO - Orthopedics

JF - Orthopedics

SN - 0147-7447

IS - 11

ER -