オカザキ　ケン   KEN OKAZAKI   岡崎　賢    所属   医学部 医学科（東京女子医科大学病院）    職種   教授・基幹分野長
論文種別	原著
言語種別	英語
査読の有無	査読あり
表題	Adopting the Joint Line Theory for Bone Resection in Cruciate-Retaining Total Knee Arthroplasty to Prevent Flexion Gap Tightness.
掲載誌名	正式名：Orthopaedic surgery 略　 称：Orthop Surg ISSNコード：17577861/17577853
掲載区分	国外
巻・号・頁	14(5),pp.984-989
著者・共著者	Okazaki Ken
担当区分	筆頭著者,責任著者
発行年月	2022/05
概要	BACKGROUND:During a conventional measured resection using the posterior reference method for total knee arthroplasty (TKA) in varus knees, proximal tibia is resected from the lateral joint surface for the same thickness as the implant. Distal femur is resected from the worn medial surface for the same thickness as the implant. Posterior femur is resected using the posterior reference method with an external rotation for appropriate degrees. In this situation, although the joint line of the tibia is leveled to the height of lateral joint surface, the posterior joint line of the femur is leveled to the center of medial and lateral posterior condyle, which is a few millimeters lower than the lateral posterior condyle. This discrepancy between the proximal tibia-posterior femoral joint line causes a tight flexion gap in cruciate-retaining TKA. Therefore, downsizing of the femur is necessary to adjust the posterior joint line to the level of the lateral condyle.PERSPECTIVES:To avoid this circumstance, the postoperative joint line should be leveled to the center of the original medial and lateral joint surface. Proximal tibia is resected from the lateral joint surface 1 mm to 2 mm thicker than the implant. Distal femur is resected from the worn medial surface 1 mm to 2 mm thinner than the implant. Posterior femur is resected using the posterior reference method with an external rotation for appropriate degrees. In this situation, all the joint lines are leveled to the center of the medial and lateral joint surface. Otherwise, use of an anatomically shaped implant with a physiologic joint line is another option to avoid joint line discrepancy.CONCLUSIONS:Adopting joint line theory for bone resection can prevent the flexion gap tightness that likely occurs in cruciate-retaining TKA.
DOI	10.1111/os.13256
PMID	35434965