Effects of suture and tourniquet on intraoperative kinematics in navigated total knee arthroplasty

• Published in: The Journal of arthroplasty Vol. 32; no. 6; pp. 1824 - 1828
• Main Authors: Tsubosaka, Masanori, M.D, Ishida, Kazunari, M.D., PhD, Sasaki, Hiroshi, M.D., PhD, Shibanuma, Nao, M.D., PhD, Kuroda, Ryosuke, M.D., PhD, Matsumoto, Tomoyuki, M.D., PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2017
• Subjects: Aged; Aged, 80 and over; Arthroplasty, Replacement, Knee - instrumentation; Arthroplasty, Replacement, Knee - methods; Biomechanical Phenomena; Female; Femur - surgery; Humans; kinematics; Knee Joint - diagnostic imaging; Knee Joint - surgery; Male; navigation; Orthopedics; Osteoarthritis - surgery; Postoperative Period; Prospective Studies; Range of Motion, Articular; Rotation; soft tissue closure; Surgery, Computer-Assisted; Sutures - adverse effects; Tibia - surgery; Tomography, X-Ray Computed; total knee arthroplasty; tourniquet; Tourniquets - adverse effects; total knee arthroplasty; kinematics; navigation; tourniquet; soft tissue closure
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2017.01.033

Abstract Background To investigate the effects of suture (soft tissue closure) and air tourniquet use on intraoperative kinematics in navigated total knee arthroplasty (TKA). Methods The study included 20 patients with varus-type knee osteoarthritis who underwent primary posterior-stabilized (PS) TKA using computed-tomography (CT)-based navigation. Intraoperative tibiofemoral kinematics from maximum extension to maximum flexion were measured using the CT-based navigation. The measurements were performed three times as follows: Measurement 1: before suture (tourniquet on), Measurement 2: after suture (tourniquet on), and Measurement 3: after tourniquet removal. Details of kinematics including knee joint gap, tibiofemoral rotational angles, and antero-posterior (AP) distance between the femur and tibia were compared among the three measurements and statistically evaluated. Results On the medial side, there was no significant difference among the three measurements in the extension gap, but Measurement 1 showed a significantly larger flexion gap compared to the other two measurements. On the lateral side, there was no significant difference between the extension and flexion gaps in all measurements. The AP distance in Measurement 1 showed that the femur was positioned significantly more anterior to the tibia at 10° and 20° of flexion compared to the other two measurements after suture. There was no significant difference among the three measurements in the tibiofemoral rotation angles. Conclusion These results found that the effect of suture and tourniquet was minimal, and that intraoperative kinematics can effectively evaluate postoperative passive kinematic conditions