Can Intraoperative Sensors Determine the “Target” Ligament Balance? Early Outcomes in Total Knee Arthroplasty

Meneghini, R. Michael; Ziemba-Davis, Mary; Lovro, Luke R.; Ireland, Phillip H.; Damer, Brent M.

doi:10.1016/j.arth.2016.03.046

Cited by 95 publications

(75 citation statements)

References 31 publications

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“…The sum of the average of the medial and lateral compartment forces at 0, 45, and 90 degrees of flexion represented the tibial force through a 90 degrees arc of motion. 24 The repeatability of force measurements is high as the intraclass correlation coefficient (ICC) ranged from 0.82 to 0.95 at full extension, 45, and 90 degrees of flexion for the medial and lateral compartments. 34 Patient-reported Oxford Knee Score and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were obtained 6-month postoperatively.…”

Section: Parametersmentioning

confidence: 99%

“…In summary, the target for setting the tibial force when balancing a mechanically aligned TKA has been controversial. 4,5,19,24,34,39 In contrast, the target when performing calipered KA TKA is to adjust component positions without ligament release until the tibial force matches the native knee as a tibial force 30 lb greater than native knee causes a loss of extension, loss of flexion, and anterior translation of the tibia at 90 degrees of flexion.…”

Section: Figmentioning

confidence: 99%

“…19 Therefore, the intraoperative use of an instrumented tibial insert provides the surgeon with real-time feedback to lower compartment forces by fine-tuning implant positions and releasing ligaments which minimizes the risk of stiffness, tibial component overload, and insert wear. 16,[20][21][22][23][24] Because a 'balanced' TKA can have a tibial force five to six times greater than the native knee, and because a 13 lb tibial compartment force suggests over-tensioning of knee ligaments, the present study determined whether a TKA with an intraoperative tibial force greater than native has signs of stiffness as measured by a loss of extension, loss of flexion, and anterior translation of the tibia.…”

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confidence: 99%

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A Total Knee Arthroplasty Is Stiffer When the Intraoperative Tibial Force Is Greater than the Native Knee

2018

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We hypothesized that a total knee arthroplasty (TKA) with an intraoperative tibial force greater than the tibial force of the native knee has signs of stiffness as measured by loss of extension and flexion, and anterior translation of the tibia. Intraoperative forces in the medial and lateral tibial compartments were measured during passive motion in 71 patients treated with calipered kinematically aligned TKA. Maximum extension, flexion, and the anterior–posterior position of the tibia with respect to the distal femur at 90 degrees of flexion were measured. Measurements were repeated after exchanging to a 2 mm thicker insert. The sum of the average of the medial and lateral compartment forces at 0, 45, and 90 degrees of flexion represented the tibial force through a 90-degree motion arc. For the implanted insert, the tibial force averaged 28 ± 17 lb, which is comparable to the 20 ± 7 lb reported for the native knee. At 6 months, patients reported an average 40 point Oxford Knee and 15 point Western Ontario and McMaster Universities Osteoarthritis (WOMAC) score. For the 2 mm thicker insert, the tibial force averaged 50 ± 28 lb. A 30 lb tibial force greater than native generated a 3-degree loss of extension, a 3-degree loss of flexion, and 3-mm anterior translation of the tibia. Because a TKA with a tibial force greater than native has signs of stiffness, a strategy for lowering this risk is to match the tibial force of the native knee when balancing a TKA as this restored high function.

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Section: Parametersmentioning

confidence: 99%

Section: Figmentioning

confidence: 99%

mentioning

confidence: 99%

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A Total Knee Arthroplasty Is Stiffer When the Intraoperative Tibial Force Is Greater than the Native Knee

2018

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“…Functionality of TKA is highly dependent on compromises between stability and flexibility which can be provided by adequate ligament alignment techniques. Several proven methods have been established to guarantee component alignment and position in knee surgery, however, ligament balancing still remains more art than science and is performed based on the assessment of the surgeon according to tactile feedback [3]. …”

Section: Introductionmentioning

confidence: 99%

“…It is estimated that about 40% of knee replacement failures can be avoided with proper fixation and optimal balancing at the time of surgery [4]. Nowadays, in spite of comprehensive studies on the importance and significance of a balanced TKA, optimal balance is not fully quantified [3]. In fact, lack of information about in vivo force reactions, which represent the force loads experienced by the patients, preclude establishing a comprehensive correlation of intraoperative loading to postoperative loading [3, 6].…”

Section: Introductionmentioning

confidence: 99%

Parametric analysis of electromechanical and fatigue performance of total knee replacement bearing with embedded piezoelectric transducers

Safaei

Meneghini

Anton

2017

Smart Mater. Struct.

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Total knee arthroplasty (TKA) is a common procedure in the United States; it has been estimated that about 4 million people are currently living with primary knee replacement in this country. Despite huge improvements in material properties, implant design, and surgical techniques, some implants fail a few years after surgery. A lack of information about in vivo kinetics of the knee prevents the establishment of a correlated intra- and postoperative loading pattern in knee implants. In this study, a conceptual design of an ultra high molecular weight (UHMW) knee bearing with embedded piezoelectric transducers is proposed, which is able to measure the reaction forces from knee motion as well as harvest energy to power embedded electronics. A simplified geometry consisting of a disk of UHMW with a single embedded piezoelectric ceramic is used in this work to study the general parametric trends of an instrumented knee bearing. A combined finite element and electromechanical modeling framework is employed to investigate the fatigue behavior of the instrumented bearing and the electromechanical performance of the embedded piezoelectric. The model is validated through experimental testing and utilized for further parametric studies. Parametric studies consist of the investigation of the effects of several dimensional and piezoelectric material parameters on the durability of the bearing and electrical output of the transducers. Among all the parameters, it is shown that adding large fillet radii results in noticeable improvement in the fatigue life of the bearing. Additionally, the design is highly sensitive to the depth of piezoelectric pocket. Finally, using PZT-5H piezoceramics, higher voltage and slightly enhanced fatigue life is achieved.

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Enhancing soft tissue balance: Evaluating robotic‐assisted functional positioning in varus knees across flexion and extension with quantitative sensor‐guided technology

Erard,

Olivier,

Kafelov

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeFunctional implant positioning (FIP) for total knee arthroplasty (TKA) is an evolution of kinematic alignment based on preoperative CT scan and robotic‐assisted technology. This study aimed to assess the ligament balancing of image‐based robotic‐assisted TKA in extension, mid‐flexion and flexion with an FIP using intraoperative sensor‐guided technology. The hypothesis was that image‐based robotic‐assisted TKA performed by FIP would achieve ligament balancing all along the arc of knee flexion.MethodsThis prospective monocentric study included 47 consecutive patients with varus knees undergoing image‐based robotic‐assisted TKA performed with FIP. After robotic‐assisted bone cuts, trial components were inserted, and soft tissue balance was assessed using sensor‐guided technology at 10°, 45° and 90° of knee flexion. A mediolateral balanced knee was defined by an intercompartmental pressure difference (ICPD) ≤ 15 lbf and medial and lateral compartment pressure ≤60 lbf. The mean age was 71.6 years old ±6.7, the mean BMI was 29.0 kg/m2 ± 4.9 and the mean preoperative HKA was 174° ± 5 [159; 183].ResultsThe mean postoperative knee alignment was 177.0° ± 2.2° [172; 181]. There were 93.6% of balanced knees (n = 44) at 10 and 90° of knee flexion versus 76.6% (n = 36) at 45° of knee flexion with a significant difference (p = 0.014). Median ICPD at 10, 45 and 90° of knee flexion were, respectively, 7.0 (interquartile range [IQR]: 9), 11.0 (IQR: 9.5) and 8.0 (IQR: 9.0). Pairwise analyses revealed differences for ICPD at 45° versus ICPD at 10° (p = 0.003) and ICPD at 90° versus ICPD at 45° (p = 0.007).ConclusionFIP with an image‐based robotic‐assisted system allowed the restoration of a well‐balanced knee at 10° and 90° of flexion in varus knees. Nevertheless, some discrepancies occurred in midflexion, and more work is needed to understand ligament behaviour all along the arc of knee flexion.Level of EvidenceLevel II.

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Can Intraoperative Sensors Determine the “Target” Ligament Balance? Early Outcomes in Total Knee Arthroplasty

Cited by 95 publications

References 31 publications

A Total Knee Arthroplasty Is Stiffer When the Intraoperative Tibial Force Is Greater than the Native Knee

A Total Knee Arthroplasty Is Stiffer When the Intraoperative Tibial Force Is Greater than the Native Knee

Parametric analysis of electromechanical and fatigue performance of total knee replacement bearing with embedded piezoelectric transducers

Enhancing soft tissue balance: Evaluating robotic‐assisted functional positioning in varus knees across flexion and extension with quantitative sensor‐guided technology

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