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Publication:

Surgical Technology International XVII - Cardiovascular Surgery

Article title:

Midflexion Instability in Revision Total Knee Arthroplasty

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Author(s)

Edward J. McPherson, M.D., F.A.C.S.
Director, Los Angeles Orthopaedic Institute, Los Angeles, California, USA

John Cuckler, M.D.
Professor and Director, Division of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA

Adolph V. Lombardi, Jr., M.D., F.A.C.S.
Senior Associate, Joint Implant Surgeons, Inc., New Albany, Ohio, USA, Clinical Assistant Professor, Department of Orthopaedics, Ohio State University, Columbus, Ohio, USA, Clinical Assistant Professor, Department of Biomedical Engineering, Ohio State University, Columbus, Ohio, USA, President of Medical Staff Services, Mount Carmel New Albany Surgical Hospital, New Albany, Ohio, USA

Abstract

Midflexion instability is a new concept associated with revision total knee arthroplasty. It appears as rotational instability with combined external rotation and valgus stress in a knee flexed between 45° and 90°. Three main factors contribute to this instability: anterior medial collateral ligament attenuation, femoral-tibial articular geometry, and tibial post-femoral box geometry. Rotational stress should be included when assessing stability intraoperatively to identify those patients who may require additional constraint.