Can We Predict the Femoral and Tibial Bone Resection Depths Required to Correct Extreme Fixed Flexion Contracture in Total Knee Arthroplasty? A Database Analysis of 127 Cases

5 pages•Published: March 8, 2024

Matthew Hickey, Asim Khan, Joseph Baines, David J Allen, Findlay Welsh, Kamal Deep, Alistair Ewen, François Leitner, Antony J. Hodgson and Frederic Picard

Abstract

One of the goals of total knee arthroplasty (TKA) is to restore of extend the range of motion of the knee joint. A small proportion of patients who are candidates for TKA exhibit fixed flexion contracture (FFC), a condition which prevents the knee from reaching full extension and can be associated with preoperative coronal deformity. In treating FFC, surgeons have two options, either through extensive soft tissue releases or through additional resections of bone on the proximal tibia and distal femur to increase the extension gap. Usually, FFC can be corrected with just soft tissue release, however, sometimes needs to be combined with additional bone resections, especially in cases with varus or valgus coronal deformity. However, additional bone resections beyond 11mm on the femoral side can be associated with knee instability. We therefore asked, is there a relationship between preoperative coronal deformity and intraoperative bone resections required to treat patients with extreme FFC?
We analysed 3922 navigated TKA cases undertaken at our institution between March 2007 and October 2022. From this set, we identified 127 patients with extreme fixed flexion contracture (FFC) of greater than 150 and with post-operative FFC less than 50, indicating that the FFC had been resolved. Using simple linear regression and calculating the Pearson correlation coefficients, we related the preoperative coronal deformity to the maximum femoral and tibial resection depths between the medial and lateral sides. We then calculated the statistical significance and coefficient of determination.
For the 127 cases, the coefficients of determination were calculated to be 0.19 for the proximal tibia and 0.22 for the distal femur (p < 0.025). The correlation coefficients for the relationship between coronal deformity and femoral or tibial resection depths were 0.47 (p< 0.025) and -0.43 (p< 0.025), respectively.
In this study, we determined there was a moderate correlation (indicated as |0.40 – 0.59|) between the tibial and femoral bone resections required to treat extreme FFC in patients with varying degrees of preoperative coronal deformity. In planning to treat extreme FFC, surgeons should pay attention to the preoperative coronal deformity of patients as this will likely be an important factor in determining the required steps in successfully treating the FCC.

Keyphrases: database study, surgical navigation, surgical outcome prediction, surgical planning

In: Joshua W Giles (editor). Proceedings of The 22nd Annual Meeting of the International Society for Computer Assisted Orthopaedic Surgery, vol 6, pages 40-44.

Links:	https://easychair.org/publications/paper/qf5P
	https://doi.org/10.29007/zxh3

BibTeX entry

@inproceedings{CAOS2023:Can_We_Predict_Femoral,
  author    = {Matthew Hickey and Asim Khan and Joseph Baines and David J Allen and Findlay Welsh and Kamal Deep and Alistair Ewen and François Leitner and Antony J. Hodgson and Frederic Picard},
  title     = {Can We Predict the Femoral and Tibial Bone Resection Depths Required to Correct Extreme Fixed Flexion Contracture in Total Knee Arthroplasty? A Database Analysis of 127 Cases},
  booktitle = {Proceedings of The 22nd Annual Meeting of the International Society for Computer Assisted Orthopaedic Surgery},
  editor    = {Joshua W Giles},
  series    = {EPiC Series in Health Sciences},
  volume    = {6},
  publisher = {EasyChair},
  bibsource = {EasyChair, https://easychair.org},
  issn      = {2398-5305},
  url       = {/publications/paper/qf5P},
  doi       = {10.29007/zxh3},
  pages     = {40-44},
  year      = {2024}}

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