• Takafumi Hiranaka, Masamune Kamachi, Takuma Hayashi, Ryoma Inoue, Sota Ogino, Motoki Koide, Takaaki Fujishiro, and Koji Okamoto.
• Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, 1-3-13, Kosobe- cho, Takatsuki, Osaka, 569-1192, Japan. Takafumi.hiranaka@gmail.com.
• Arch Orthop Trauma Surg. 2024 Jun 1; 144 (6): 278327882783-2788.

PurposeA well-balanced joint gap is necessary in Oxford unicompartmental knee arthroplasty (OUKA) to prevent mobile-bearing dislocation. While the gaps between 20° (extension) and 100° (flexion) are precisely adjusted using the incremental mill system, there has been insufficient evaluation of gaps in other angles. We hypothesized that the gap is not always the same in other angles. This retrospective study aimed to evaluate the gap in full-extension (0°), mid-flexion (60°) and deep flexion (130°) for comparison with those in extension and flexion gaps.MethodsWe evaluated 119 knees in 83 patients (51 females, 31 males, aged 71.9 years). The full-extension and mid-flexion gaps were compared with the extension gap, and the deep flexion gap was contrasted with the flexion gap. Each gap was classified into isometric, tight or loose, for evaluation of contributing factors.ResultsAlthough the full-extension gap tended to be isometric (45%), the mid-flexion tended to be tight (48%), whereas the deep-flexion was loose in most knees (84%) (P = 0.002). The tight mid-flexion and loose deep flexion gap pattern accounted for 44% of the total knees, especially so with smaller femoral components (P = 0.004).ConclusionOur results highlight the propensity of tight mid-flexion and loose flexion gap despite the adjustment of extension and flexion gaps in OUKA. Although the effect of such a minor gap imbalance is still unknown, the pattern was more prevalent in patients with smaller-sized femoral components. Use of a larger femoral component may equalize the gap throughout the motion arc.© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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