Is it possible to predict the final component gap in flexion before femoral posterior condylar osteotomy in cruciate-retaining and posterior-stabilized total knee arthroplasty?

Background: In total knee arthroplasty (TKA) with posterior condylar osteotomy using anatomical landmarks, predicting the final flexion gap is impossible, as it differs with the presence or absence of the posterior cruciate ligament. We compared the predicted flexion gap, based on pre-femoral posterior condylar osteotomy measurements, with the postsurgical final flexion gap in cruciate-retaining (CR) and posterior-stabilized (PS) TKA.

Methods: One hundred knees of patients with osteoarthritis were included: 35 underwent CR, and 65 PS TKA. Distal femoral and proximal tibial osteotomy using the measured resection technique was performed. An anterior and posterior femoral osteotomy guide was set parallel to the surgical epicondylar axis, and the predicted flexion gap was measured using a seesaw tensor attached to the guide. After all procedures, the final component gap in flexion was measured using a similar seesaw tensor at the patella reduction position and was compared with the predicted gap.

Results: The correlation coefficients for predicted vs. final component gap were 0.45 (P < 0.05) in CR and 0.82 (P < 0.001) in PS. The mean differences between predicted and final gaps were 1.8 mm for CR and 1.0 mm for PS. In 34.3% of CR cases, the gap difference was more than 2 mm.

Conclusion: It is possible to predict the final flexion gap before femoral posterior condylar osteotomy, with a strong correlation observed between predicted and final component gaps in PS TKA. However, in CR, more than 30% of the cases showed unexpectedly large final flexion gaps.