{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T22:16:10Z","timestamp":1777414570988,"version":"3.51.4"},"reference-count":27,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2020,4,11]],"date-time":"2020-04-11T00:00:00Z","timestamp":1586563200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2020,4,11]],"date-time":"2020-04-11T00:00:00Z","timestamp":1586563200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springer.com\/tdm"},{"start":{"date-parts":[[2020,4,11]],"date-time":"2020-04-11T00:00:00Z","timestamp":1586563200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>The purpose of this study was to compare the effectiveness of a flexion spacer in the clinical and radiological outcomes of patients who underwent total knee arthroplasty (TKA) and to compare these patients to a group of patients subjected to the same type of surgery but without the use of a flexion spacer. It was hypothesized that patients who underwent TKA using a flexion spacer would have better clinical and radiological outcomes than those without a flexion spacer in both short\u2010 and medium\u2010term follow\u2010ups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A consecutive series of patients undergoing TKA were included, yielding 20 patients in the study group. The control group was identified from the consultant database of the senior author, yielding 21 patients who underwent the same operation. All 41 patients received a Vanguard Knee System (Zimmer\u2010Biomet, Warsaw, Indiana, USA). Cases were defined as those patients who had undergone TKA using a flexion spacer device for gap balancing; controls were defined as patients who had undergone TKA without the support of a flexion spacer device. Patients were clinically and radiographically evaluated at two consecutive follow\u2010ups: <jats:italic>T<\/jats:italic><jats:sub>1<\/jats:sub>\u201413.1\u2009\u00b1\u20091.3\u00a0months and <jats:italic>T<\/jats:italic><jats:sub>2<\/jats:sub>\u2014108\u2009\u00b1\u20096\u00a0months. Clinical evaluation was performed using the Knee Society Scoring System and the Western Ontario, McMaster Universities Osteoarthritis Index score. Radiographic evaluation included the femoral angle (<jats:italic>\u03b1<\/jats:italic>), the tibial angle (<jats:italic>\u03b2<\/jats:italic>), the sagittal femoral (<jats:italic>\u03b3<\/jats:italic>) angle and the tibial slope (<jats:italic>\u03b4<\/jats:italic>). Furthermore, the lateral patellofemoral angle (LPFA) and the Caton\u2010Deschamps index were evaluated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>No statistically significant clinical differences were found between the two groups at <jats:italic>T<\/jats:italic><jats:sub>1<\/jats:sub> and <jats:italic>T<\/jats:italic><jats:sub>2<\/jats:sub>; moreover, the clinical outcomes of the two groups were stable between the two follow\u2010ups, with no significant improvement or worsening. Radiographic evaluation showed no difference in the two groups between <jats:italic>T<\/jats:italic><jats:sub>1<\/jats:sub> and <jats:italic>T<\/jats:italic><jats:sub>2<\/jats:sub>; the only significant radiographic difference between the two groups concerned the LPFA (both at 30\u00b0 and 60\u00b0) at each follow\u2010up, which was significantly greater in cases than in controls (<jats:italic>p<\/jats:italic>\u2009=\u20090.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The current study demonstrates that the use of a flexion spacer significantly improves radiographic patello\u2010femoral tracking, although no significant clinical differences were found between the two groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>Case\u2013control study, level III.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-020-05991-w","type":"journal-article","created":{"date-parts":[[2020,4,11]],"date-time":"2020-04-11T03:02:36Z","timestamp":1586574156000},"page":"586-593","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Improving radiographic patello\u2010femoral tracking in total knee arthroplasty with the use of a flexion spacer: a case\u2013control study"],"prefix":"10.1002","volume":"29","author":[{"given":"Davide Giuseppe","family":"D\u2019Elicio","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> IRCCS Istituto Ortopedico Galeazzi Milan Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco","family":"Attanasio","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> IRCCS Istituto Ortopedico Galeazzi Milan 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