Small soft tissue tension changes do not affect patient-reported outcomes one year after primary TKA.

Abstract

Adequate soft tissue tension and balance is paramount to achieve favourable outcomes of total knee arthroplasty (TKA). Implant manufacturers offer 1-mm liner increments to fine-tune ligament tension and balance. In this study, we assessed if soft tissue tension changes introduced by minimal changes in liner thicknesses affect early patient reported outcomes. Eighty-nine patients undergoing 99 primary, elective TKAs by a single surgeon were included. After achieving adequate ligament balance, the first 50 knees received an insert that would allow 2-3mm of medial and lateral opening (control group), whereas the last 49 received an insert which was 1mm thicker, resulting in a slight increase in ligament tension (study group). Sensor technology was used to record compartmental loads. Knee Society Score (KSS), KOOS Jr., and ROM were recorded pre-operatively, sixweeks, four and 12months post-operatively. The Forgotten Joint Score (FJS) was administered four and 12months post-operatively. No differences were observed in demographic variables, pre-operative outcome scores, and ROM measures between groups. Six weeks post-operatively, there was no statistically significant difference in the outcome variables. Four months post-operatively, statistically significant differences were only observed in KOOS Jr. (79 and 73.6; p = 0.05), and FJS (59.9 and 45.5; p < 0.01); all of which favoured the control group. There was no difference in the outcome variables at 12months. Minor changes in soft tissue tension induced by 1-mm changes in liner thickness resulted in clinically meaningful differences favouring the control group four months post-operatively, but in no clinically noticeable differences 12months post-operatively. It is possible that lower soft tissue tension may lead to transient improvement in patient-reported early outcomes.