The Effect of Sequencial Insertion of Tibial Polyethelene to the Stability of Total Knee Arthroplasty
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2010-02-09
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The Thai Journal of Orthopaedic Surgery
Abstract
Stability of the knee after total knee arthroplasty(TKA) is very important. Good alignment may not be maintained in case with unstable knee. Furthermore, knee instability may result in abnormal motions of femoral condyle on tibial surface (slipping) in all direction such as ; anteroposterior, rotation, varus and valgus tilting. This will result to the rapid wear and tear on polyethelene surface and lead to implant failure in later stage. This paper present the investigation to show that the sequencial tibial polyethelene insertion can effect the knee stability after TKA. The experimental model of TKA was performed on saw bone with three difference tibial polyethelene inserting techniques; group I, tibial polyethelene is inserted before femoral part, group II tibia polyethelene is inserted after femoral part with push and pull and group III tibia polyethelene is inserted after femoral part with subluxated tibia.Varus and valgus stress test, drawer tests were done on saw bone after saw bone operation. The study was also performed in 70 knees from 65 patients. The stability test after TKA at ; immediate, 3, 6 months and 1 year after operation was performed. There were 50 knees in group I, 16 knees in group II and 4 knees in group III. Varus and valgus stress, drawer tests were positive grade1 or more in all knees in group II \& III but none in group I both in saw bone and in the studied patients. From the study both in experimental model and in the study patients it was found that the sequential of tibial inserting may have important effect in knee stability for TKA. This effect has not been reported and is not recognized by most surgeons.
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The Thai Journal of Orthopaedic Surgery; Volume 32 Number 1-2 March-September 2007; 14 - 19