Highly Satisfied Total Knee Arthroplasty Patients Display a Wide Range of Soft Tissue Balance

McAuliffe, Michael J.; O'Connor, Patrick B.; Major, Lisa; Garg, Gautam; Whitehouse, Sarah L.; Crawford, Ross

doi:10.1055/s-0039-1677873

Cited by 10 publications

(6 citation statements)

References 29 publications

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“…It has been previously noted that highly satisfied and well-functioning knees have a wide variation in laxity parameters. 10,31 In our subjects, when comparing those knees with perfect satisfaction and subjectively normal feeling knees with others in the study group, they were not distinguished by their laxity parameters. These findings may explain in part why kinematic alignment that predominantly alters coronal plane tissues has demonstrated limited objective differences in outcome when compared with mechanical alignment techniques.…”

Section: Discussionmentioning

confidence: 59%

Which Pre- and Postoperative Coronal Plane Laxity Parameters Influence Patient Satisfaction and Function after Primary Total Knee Arthroplasty?

et al. 2020

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Soft tissue balancing, while accepted as crucial to total knee arthroplasty (TKA) outcomes, is incompletely defined as the subject of broad recommendations. We analyzed 120 computer-assisted, posterior stabilized TKA undertaken for osteoarthritis. Coronal plane laxity was measured, in the 91 varus and 29 valgus knees, prior to any bone resection or soft tissue release, and again after implant insertion. Soft tissue laxity parameters were correlated to the American Knee Society Score (2011) at a minimum follow-up of 12 months with a focus on patient function and satisfaction. Thirteen specific laxity parameters showed a significant correlation to satisfaction, one parameter correlated to function, and another to both functional and satisfaction outcomes. Most correlations were weak, the strongest related to postoperative decreases in coronal plane laxity. Greater preoperative varus but not valgus deformity was associated with higher satisfaction scores. Additionally, 30 patients who reported 40 of 40 satisfaction and that their TKA knee felt normal at all times did not have soft tissue balancing parameters distinguishing them from other subjects. Patient satisfaction and function outcomes demonstrated limited correlation to coronal plane soft tissue parameters. It appears that optimizing TKA satisfaction and function is not as simple as producing a narrow range of coronal laxity parameters. The ongoing debate around optimal coronal plane alignment and its subsequent effect on coronal plane soft tissues may not be as independently important as currently argued. Soft tissue balance may need to be considered as a more complex global envelope.

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Section: Discussionmentioning

confidence: 59%

Which Pre- and Postoperative Coronal Plane Laxity Parameters Influence Patient Satisfaction and Function after Primary Total Knee Arthroplasty?

et al. 2020

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“…GB having greater laxity than rKA is likely attributed to surgeon preference as soft tissue balancing is inherently subjective [15, 22, 29]. During early use of the robotic system, the GB surgeon observed the final laxity was often tighter than desired in extension and began targeting a looser knee.…”

Section: Discussionmentioning

confidence: 99%

Restricted kinematic alignment achieves similar relative lateral laxity and greater joint line obliquity compared to gap balancing TKA

Orsi¹,

Wakelin

Plaskos

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose The purpose of this study was to compare ligament balance and laxity proiles achieved throughout lexion in restricted kinematic alignment (rKA) and gap balancing (GB). rKA and GB both aim to improve soft tissue balance and reduce ligament releases in total knee arthroplasty (TKA). Methods One surgeon performed 68 rKA, another performed 73 GB TKAs using the same CR implant and robotic system. rKA limited femoral valgus and tibial varus to 6°, with tibial recuts performed to achieve balance. GB limited tibial varus and femoral valgus to 2°, with femoral resections adjusted to achieve mediolateral balance throughout lexion using predictive-gap planning software. Final joint laxity was measured using a robotic ligament tensioner. Statistical analyses were performed to compare diferences in mediolateral balance and joint laxity throughout lexion. Further analyses compared alignment, joint line elevation and orientation (JLO), and frequency of ligament releases and bone recuts. Results Both techniques reported greater lateral laxity throughout lexion, with GB reporting improved mediolateral balance from 10° to 45° lexion. GB resected 1.7 mm more distal femur (p ≤ 0.001) and had greater overall laxity than rKA throughout lexion (p ≤ 0.01). rKA increased JLO by 2.5° and 3° on the femur and tibia (p ≤ 0.001). Pre-operative and post-operative coronal alignment were similar across both techniques. rKA had a higher tibial recut rate: 26.5% vs 1.4%, p < 0.001. Conclusions rKA and GB both report lateral laxity but with diferent JLO and elevation. Use of a predictive-gap GB worklow resulted in greater mediolateral gap symmetry with fewer recuts. Level of evidence III, retrospective cohort study.

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“…Good knee balancing is traditionally related to an excellent clinical outcome [ 23 ]. However, there is no direct correlation between a balanced prosthesis and an excellent clinical result [ 21 , 24 ]. For objectivity, we used the principles of symmetry and congruence between the flexion and extension gaps to establish the comparison between the groups.…”

Section: Discussionmentioning

confidence: 99%

Computer-Assisted Surgery Enables Beginner Surgeons, Under Expert Guidance, to Achieve Long-Term Clinical Results not Inferior to Those of a Skilled Surgeon in Knee Arthroplasty

Larraínzar-Garijo

Molanes-López

Cañones-Martín

et al. 2022

JOIO

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Purpose The purpose of this study is to determine whether the use of a surgical navigation system in total knee replacement (TKR) enables beginner and intermediate surgeons to achieve clinical PROM outcomes as good as those conducted by expert surgeons in the long term. Methods We enrolled 100 consecutive patients whose total navigated knee arthroplasty (TKA) was performed in our institution from 2008 to 2010. According to the principal surgeon's surgical experience, the patients were divided into three groups: (1) beginner surgeons, with no more than 30 previous knee replacement performances, (2) intermediate surgeons, with more than 30 but not more than 300, and (3) expert surgeons, with more than 300 knee replacements. Demographic data collected on the cohort included gender, laterality, age, and body mass index (BMI). The outcome measures assessed were Forgotten Joint Score (FJS), implant positioning, limb alignment, and prosthesis survival rate. A margin of equivalence of ± 18.5 points in the FJS scale was prespecified in terms of the minimal clinically important difference (MCID) to compare the FJS results obtained in the long period between the groups of interest. Results The mean follow-up was 11.10 ± 0.78, 10.86 ± 0.66, and 11.30 ± 0.74 years, respectively, for each of the groups. The long-term FJS mean score was 80.86 ± 21.88, 81.36 ± 23.87, and 90.48 ± 14.65 for each group. The statistical analysis proved noninferiority and equivalence in terms of the FJS results reported in the long term by patients in Groups 1 or 2 compared to those in Group 3. More specifically, it has been proved that the mean difference between groups is within the interval of equivalence defined in terms of the MCID. The overall prostheses survival rate was 93.7%. Conclusion Navigated assisted TKA, under expert guidance, can be as effective when performed by beginner or intermediate surgeons as performed by senior surgeons regarding the accuracy of implant positioning, limb alignment, and long-term clinical outcome.

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Highly Satisfied Total Knee Arthroplasty Patients Display a Wide Range of Soft Tissue Balance

Cited by 10 publications

References 29 publications

Which Pre- and Postoperative Coronal Plane Laxity Parameters Influence Patient Satisfaction and Function after Primary Total Knee Arthroplasty?

Which Pre- and Postoperative Coronal Plane Laxity Parameters Influence Patient Satisfaction and Function after Primary Total Knee Arthroplasty?

Restricted kinematic alignment achieves similar relative lateral laxity and greater joint line obliquity compared to gap balancing TKA

Computer-Assisted Surgery Enables Beginner Surgeons, Under Expert Guidance, to Achieve Long-Term Clinical Results not Inferior to Those of a Skilled Surgeon in Knee Arthroplasty

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