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Flexion Instability

  • Giles R. Scuderi
  • Zachary P. BerlinerEmail author
  • José A. Rodriguez
  • Gregg R. Klein
  • Michael A. KellyEmail author
Chapter

Abstract

The primary goal of total knee arthroplasty (TKA) is to create a well-aligned and well-balanced knee. Femoral sizing and component alignment, as well as the balance of the extension and flexion gap, are requirements for a well-functioning TKA. Distal femoral preparation, sizing, and component placement, with attention to proper alignment in the coronal, sagittal and rotational planes, are essential in creating a well-balanced implant. The intent is to create a consistent flexion gap and restoring posterior condylar offset. The etiology of instability is due to failure to balance the flexion and extension gaps, and flexion instability develops when the flexion gap is larger than the extension gap [1].

References

  1. 1.
    Clarke HD, Scuderi GR. Flexion instability in primary total knee replacement. J Knee Surg. 2003;16(2):123–8.PubMedGoogle Scholar
  2. 2.
    Schwab JH, Haidukewych GJ, Hanssen AD, Jacofsky DJ, Pagnano MW. Flexion instability without dislocation after posterior stabilized total knees. Clin Orthop Relat Res. 2005;440:96–100.CrossRefPubMedGoogle Scholar
  3. 3.
    Pagnano MW, Hanssen AD, Lewallen DG, Stuart MJ. Flexion instability after primary posterior cruciate retaining total knee arthroplasty. Clin Orthop Relat Res. 1998;(356):39–46.Google Scholar
  4. 4.
    Deshmane PP, Rathod PA, Deshmukh AJ, Rodriguez JA, Scuderi GR. Symptomatic flexion instability in posterior stabilized primary total knee arthroplasty. Orthopedics. 2014;37(9):768–74.CrossRefGoogle Scholar
  5. 5.
    Parratte S, Pagnano MW. Instability after total knee arthroplasty. J Bone Joint Surg Am. 2008;90(1):184–94.PubMedGoogle Scholar
  6. 6.
    Vince KG, Abdeen A, Sugimori TJ. The unstable total knee arthroplasty: causes and cures. Arthroplasty. 2006;21(4 Suppl 1):44–9.CrossRefGoogle Scholar
  7. 7.
    Rodriguez-Merchan EC. Instability following total knee arthroplasty. HSS J. 2011;7(3):273–8.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Abdel MP, Haas SB. The unstable knee: wobble and buckle. Bone Joint J. 2014;96-B(11 Suppl A):112–4.CrossRefPubMedGoogle Scholar
  9. 9.
    Deshmane PP, Rathod PA, Deshmukh AJ, Rodriguez JA, Scuderi GR. Symptomatic flexion instability in posterior stabilized primary total knee arthroplasty. Orthopedics. 2014;37(9):e768–74.CrossRefPubMedGoogle Scholar
  10. 10.
    Romero J, Stähelin T, Binkert C, Pfirrmann C, Hodler J, Kessler O. The clinical consequences of flexion gap asymmetry in total knee arthroplasty. J Arthroplasty. 2007;22(2):235–40.CrossRefPubMedGoogle Scholar
  11. 11.
    Engh GA, Koralewicz LM, Pereles TR. Clinical results of modular polyethylene insert exchange with retention of total knee arthroplasty components. J Bone Joint Surg Am. 2000;82(4):516–23.CrossRefPubMedGoogle Scholar
  12. 12.
    Brooks DH, Fehring TK, Griffin WL, Mason JB, McCoy TH. Polyethylene exchange only for prosthetic knee instability. Clin Orthop Relat Res. 2002;405:182–8.CrossRefGoogle Scholar
  13. 13.
    Willson SE, Munro ML, Sandwell JC, Ezzet KA, Colwell CW Jr. Isolated tibial polyethylene insert exchange outcomes after total knee arthroplasty. Clin Orthop Relat Res. 2010;468(1):96–101.CrossRefPubMedGoogle Scholar
  14. 14.
    Fehring TK, Valadie AL. Knee instability after total knee arthroplasty. Clin Orthop Relat Res. 1994;(299):157–62.Google Scholar
  15. 15.
    Moreland JR. Mechanisms of failure in total knee arthroplasty. Clin Orthop Relat Res. 1988;(226):49–64.Google Scholar
  16. 16.
    Warren PJ, Olanlokun TK, Cobb AG, Walker PS, Iverson BF. Laxity and function in knee replacements. A comparative study of three prosthetic designs. Clin Orthop Relat Res. 1994;305:200–8.CrossRefGoogle Scholar
  17. 17.
    McAuley JP, Engh GA, Ammeen DJ. Treatment of the unstable total knee arthroplasty. Instr Course Lect. 2004;53:237–41.PubMedGoogle Scholar
  18. 18.
    Azzam K, Parvizi J, Kaufman D, Purtill JJ, Sharkey PF, Austin MS. Revision of the unstable total knee arthroplasty: outcome predictors. J Arthroplasty. 2011;26(8):1139–44.CrossRefPubMedGoogle Scholar
  19. 19.
    Kannan A, O’Connell RS, Kalore N, Curtin BM, Hull JR, Jiranek WA. Revision TKA for flexion instability improves patient reported outcomes. J Arthroplasty. 2015;30(5):818–21.CrossRefPubMedGoogle Scholar
  20. 20.
    Sharkey PF, Hozack WJ, Rothman RH, Shastri S, Jacoby SM. Insall Award paper. Why are total knee arthroplasties failing today? Clin Orthop Relat Res. 2002;(404):7–13.Google Scholar
  21. 21.
    van Kempen RW, Schimmel JJ, van Hellemondt GG, Vandenneucker H, Wymenga AB. Reason for revision TKA predicts clinical outcome: prospective evaluation of 150 consecutive patients with 2-years followup. Clin Orthop Relat Res. 2013;471(7):2296–302.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Grayson CW, Warth LC, Ziemba-Davis MM, Michael Meneghini R. Functional improvement and expectations are diminished in total knee arthroplasty patients revised for flexion instability compared to aseptic loosening and infection. J Arthroplasty. 2016;31(10):2241–6.CrossRefPubMedGoogle Scholar
  23. 23.
    Hofmann AA, Tkach TK, Evanich CJ, Camargo MP. Posterior stabilization in total knee arthroplasty with use of an ultracongruent polyethylene insert. J Arthroplasty. 2000;15(5):576–83.CrossRefPubMedGoogle Scholar
  24. 24.
    Kelly MA. Ligament instability in total knee arthroplasty. Instr Course Lect. 2001;50:399–401.PubMedGoogle Scholar
  25. 25.
    Vince KG. Why knees fail. J Arthroplasty. 2003;18(3 Suppl 1):39–44.CrossRefPubMedGoogle Scholar
  26. 26.
    Abdel MP, Pulido L, Severson EP, Hanssen AD. Stepwise surgical correction of instability in flexion after total knee replacement. Bone Joint J. 2014;96-B(12):1644–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Giles R. Scuderi
    • 1
  • Zachary P. Berliner
    • 2
    Email author
  • José A. Rodriguez
    • 2
  • Gregg R. Klein
    • 3
  • Michael A. Kelly
    • 3
    Email author
  1. 1.Northwell Health Orthopedic InstituteNew YorkUSA
  2. 2.Department of OrthopaedicsLenox Hill HospitalNew YorkUSA
  3. 3.Department of Orthopedic SurgeryHackensack University Medical CanterHackensackUSA

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