Reduction Osteotomy vs Pie-Crust Technique as Possible Alternatives for Medial Release in Total Knee Arthroplasty and Compared in a Prospective Randomized Controlled Trial

• Published in: The Journal of arthroplasty Vol. 31; no. 7; pp. 1470 - 1475
• Main Authors: Ahn, Ji Hyun, MD, Yang, Tae Yeong, MD, Lee, Jang Yun, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2016
• Subjects: Aged; Aged, 80 and over; Arthroplasty, Replacement, Knee - methods; Female; flexion and extension gaps; Humans; Knee Joint - surgery; ligament balancing; Ligaments - surgery; Male; Middle Aged; Orthopedics; Orthopedics - methods; Osteotomy; pie-crust technique; Prospective Studies; Range of Motion, Articular; reduction osteotomy; total knee arthroplasty; pie-crust technique; reduction osteotomy; total knee arthroplasty; ligament balancing; flexion and extension gaps
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2016.01.018

Abstract Background To compare the gap change between the pie-crust technique and reduction osteotomy to determine their effects on flexion and extension gaps and their success rates in achieving ligament balancing during total knee arthroplasty. Methods In a prospective randomized controlled trial, 106 total knee arthroplasties were allocated to each group with 53 cases. If there was a narrow medial gap with an imbalance of ≥3 mm after the initial limited medial release, either reduction osteotomy or pie-crust technique was performed. The changes of extension and flexion medial gaps along with the success rate of mediolateral balancing were compared. Results There was a significant difference in the change of medial gap in knee extension with mean changes of 3.5 ± 0.5 mm and 2.3 ± 0.8 mm in the reduction osteotomy and pie-crust groups, respectively ( P < .001). For flexion gap, greater change was found in the pie-crust group compared with the reduction osteotomy group; the mean medial gap changes in knee flexion were 1.1 ± 0.5 mm and 2.3 ± 1.2 mm in the reduction osteotomy and pie-crust groups, respectively. The success rates were 90.6% and 67.9% in reduction osteotomy and pie-crust groups, respectively ( P  = .007). Conclusion As an alternative medial release method, reduction osteotomy was more effective in extension gap balancing, and pie-crust technique was more effective in flexion gap balancing. The overall success rate of mediolateral ligament balancing was higher in the reduction osteotomy group than in the pie-crust group.