An Algorithmic, Pie-Crusting Medial Soft Tissue Release Reduces the Need for Constrained Inserts Patients With Severe Varus Deformity Undergoing Total Knee Arthroplasty

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• 作者：Kaveh Goudarz Mehdikhani ; MD ; Beatriz Morales Moreno ; MD ; Jeremy J. Reid ; MD ; Ana de Paz Nieves ; MD ; Yuo-Yu Lee ; BS ; Alejandro Gonzá ; lez Della Valle ; MD
• 关键词：total knee arthroplasty ; varus deformity ; pie crusting ; results ; constrained insert
• 刊名：The Journal of Arthroplasty
• 出版年：2016
• 出版时间：July 2016
• 年：2016
• 卷：31
• 期：7
• 页码：1465-1469
• 全文大小：489 K

文摘

We studied the need to use a constrained insert for residual intraoperative instability and the 1-year result of patients undergoing total knee arthroplasty (TKA) for a varus deformity. In a control group, a “classic” subperiosteal release of the medial soft tissue sleeve was performed as popularized by pioneers of TKA. In the study group, an algorithmic approach that selectively releases and pie-crusts posteromedial structures in extension and anteromedial structures in flexion was used.

Methods

All surgeries were performed by a single surgeon using measured resection technique, and posterior-stabilized, cemented implants. There were 228 TKAs in the control group and 188 in the study group. Outcome variables included the use of a constrained insert, and the Knee Society Score at 6 weeks, 4 months, and 1 year postoperatively. The effect of the release technique on use of constrained inserts and clinical outcomes were analyzed in a multivariate model controlling for age, sex, body mass index, and severity of deformity.

Results

The use of constrained inserts was significantly lower in study than in control patients (8% vs 18%; P = .002). There was no difference in the Knee Society Score and range of motion between the groups at last follow-up. No patient developed postoperative medial instability.

Conclusion

This algorithmic, pie-crusting release technique resulted in a significant reduction in the use of constrained inserts with no detrimental effects in clinical results, joint function, and stability. As constrained TKA implants are more costly than nonconstrained ones, if the adopted technique proves to be safe in the long term, it may cause a positive shift in value for hospitals and cost savings in the health care system.