Residual medial tightness in extension is corrected spontaneously after total knee arthroplasty in varus knees

PurposeAlthough soft tissue balancing is considered important for successful total knee arthroplasty (TKA), it is unclear whether the laxity and balance achieved intraoperatively change postoperatively. A recent study demonstrated anaesthesia significantly influenced knee joint laxity after TKA; however, there has been no comparison of the varus-valgus laxity immediately after TKA and in the postoperative period under the same anesthetic conditions. Therefore, quantitative stress arthrometric studies were conducted under identical conditions to identify changes in coronal ligament laxity after TKA spontaneously.MethodsA consecutive series of 28 knees with varus of more than 5 degrees in 28 patients undergoing staged bilateral TKAs was prospectively evaluated. Postoperative varus-valgus laxity was measured immediately after surgery, with the patient still under spinal anaesthesia; and again at the time of the contralateral TKA, again under anaesthesia. The mean time between the first and second operations was 9.77.3months.ResultsMean medial laxity significantly changed from 2.4 degrees 1.6 degrees just after the first operation under anaesthesia to 3.8 degrees +/- 1.4 degrees just after contralateral TKA under anaesthesia (p<0.001), but no significant change occurred in lateral laxity (5.6 degrees +/- 2.4 degrees just after the first operation and 5.7 degrees +/- 2.1 degrees after contralateral TKA, n.s.). Significant negative correlations were identified between laxity immediately after surgery and the amount of laxity change on both the medial (R=-0.63, p<0.001) and lateral sides (R=-0.53, p<0.001).ConclusionSpontaneous soft tissue correction occurs after TKA. The findings from this study provides a rationale that it is not necessary for surgeons to perform the medial soft tissue release until the soft tissue tension is equalized on both the medial and lateral sides which has the risk of excessive release leading to instability. In situations where the surgeon is confronted with a knee that becomes too tight or too loose depending on the insert thickness, it is recommended to choose the thicker insert with the understanding that the knee will initially have a slightly tighter medial compartment that will loosen over time. The results of this study provide technical considerations that can help a surgeon achieve adequate postoperative stability.Level of evidenceIV.