Effects of Cementing on Ligament Balance During Total Knee Arthroplasty

Abstract

Complications related to joint imbalance may contribute to some of the most predominant modes of failure in total knee arthroplasty (TKA). These complications include instability, aseptic loosening, asymmetric component wear, and idiopathic pain. Fixation may represent a step that introduces unchecked variability into the procedure and may contribute to the incidence of joint imbalance-related complications. The ability to quantify in vivo loading in the medial and lateral compartments would allow for the ability to confirm balance after fixation and prior to wound closure. This retrospective study sought to capture any variability and imbalance associated with cementing technique. A total of 93 patients underwent sensor-assisted TKA. All patients were confirmed to have quantifiably balanced joints prior to cementation. After cementing and final component placement, the sensor was reinserted into the joint to capture any cementation-induced changes in loading. Imbalance was observed in 44% of patients after cementation. There was no difference in the proportion of imbalance due to surgeon experience (P=.456), cement type (P=.429), or knee system (P=.792). A majority of knees exhibited loading increase in the medial compartment. It was concluded that cementation technique contributes to a significant amount of balance-related variability at the fixation stage of the procedure. The use of the sensor in this study allowed for the correction of all instances of imbalance prior to closure. More objective methods of balance verification may be important for ensuring optimal surgical outcomes. [Orthopedics. 2017; 40(3):e455-e459.].

Variability between the trial and final implant measurements during the sensor-guided total knee arthroplasty

“…Therefore, the results of our study call into question the validity of the use of an intraoperative tibial sensor in the assessment of soft tissue balance and component rotational alignment. Previous studies yielded similar results [2, 15, 16, 18]. Nodzo et al [16] reported on a change in the load in the lateral compartment after cementation.…”

“…However, many of the above‐mentioned studies were conducted by the designers of the sensor technology, and the follow‐up periods were relatively short [4, 21]. Furthermore, several issues related to the variability of measurements have been noted, such as movement of the sensor in the trial compartment and a mismatched point in the tibial contact location [2, 15, 16, 18]. Most of these studies also included a relatively low number of patients or biomechanical parameters.…”

Intraoperative Load Sensing in Total Knee Arthroplasty Leads to a Functional but Not Clinical Difference: A Comparative, Gait Analysis Evaluation

“…However, their actual effectiveness is still debated and most of the studies currently available have short follow-ups (FUs) [ 6 , 7 , 8 ]. In addition, some authors have questioned the cost/benefit ratio of these devices [ 9 , 10 , 11 ].…”

Gap Deviation after Cementation in Computer Assisted Navigation TKA

“…Chow et al [20] collected data from the patient who underwent sensorassisted total knee replacement, this data shown 44% of patient has imbalanced loading pattern after cementation (P < 0.001). 84% of imbalanced knee exhibited heavier loads on the medial side, which induced by increasing cement mantle thickness.…”