International Orthopaedics January 2016, Volume 40, Issue 1, pp 41–49

Intra-operative gaps affect outcome and postoperative kinematics in vivo following cruciate-retaining total knee arthroplasty

Fujimoto, E., Sasashige, Y., Tomita, T. et al.


The following investigation evaluates the effect of intra-operative gaps after posterior cruciate ligament-retaining total knee arthroplasty using two-dimensional/three-dimensional registration and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).


Patients were divided into two groups according to their 90°-0° component gap changes using a device designed by our laboratory. The wide gap group was defined as more than 3 mm (4.3 ± 0.7 mm), and the narrow gap group was defined as less than 3 mm (1.3 ± 1.3 mm).


Under non-WB (weight bearing) conditions, the wide flexion gap group (N = 10) showed a significant anterior displacement of the medial femoral condyle as compared with the narrow flexion gap group (N = 20). Despite no significant differences observed under WB conditions, both femoral condyle positions during flexion were significantly more posterior than during extension. WOMAC of the tight gap group showed worse scores for two functional items demanding knee flexion (bending to floor and getting on/off toilet).


The large flexion gap could influence the late rollback under non-WB conditions and better WOMAC functional scores in the flexion items. Three to four millimetre laxity at 90°–0° component gaps may be adequate and might be necessary to carry out daily life activities.

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