Internal femoral component rotation adversely influences load transfer in total knee arthroplasty: a cadaveric navigated study using the Verasense device

Manning, William; Ghosh, Kanishka M.; Blain, Alasdair; Longstaff, Lee M.; Rushton, Steven; Deehan, David J.

doi:10.1007/s00167-017-4640-5

Cited by 12 publications

(17 citation statements)

References 49 publications

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“…Skin and subcutaneous tissue were then dissected carefully from the proximal half of the thigh and the quadriceps and hamstring muscle groups were separated. Loading of the individual flexor and extensor muscle groups has been previously reported and was performed within previously accepted safe loads in an open chain fashion [ 12 , 22 , 28 ]. Navigation arrays were then secured to the tibia and femur in accordance with the MAKO TKA Surgical Guide.…”

Section: Methodsmentioning

confidence: 99%

Improved mediolateral load distribution without adverse laxity pattern in robot-assisted knee arthroplasty compared to a standard manual measured resection technique

Manning

Ghosh

Wilson

et al. 2019

Knee Surg Sports Traumatol Arthrosc

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Purpose Robot-assisted total knee arthroplasty (rTKA) remains in its infancy, is expensive but offers the promise of improved kinematic performance through precise bone cuts, with minimal soft tissue disruption, based on pre-resection soft tissue behaviour. This cadaveric study examined load transfer, soft tissue performance and radiographic indices for conventional (sTKA) versus rTKA. The null hypothesis was there would be no difference between the two modes of implantation. Methods Whole (ten) cadaveric limbs were randomised to receive either robotic (rTKA, N = 5) or conventional measured resection (sTKA, N = 5) knee arthroplasty. Laxity patterns were established using validated fixed sensors (Verasense) with manual maximum displacement for six degrees of freedom. Tibiofemoral load and contact points were determined dynamically using remote sensor technology for medial and lateral compartments through a functional arc of motion (0-110 degrees of motion). Final component position was assessed using pre-and post-implantation CT. Results No significant intergroup differences for laxity were found (n.s.). The rTKA group exhibited consistently balanced mediolateral load throughout the full arc with significantly reduced overall total load across the joint (for distinct points of measurement, p < 0.05). Despite using flexion-extension and mediolateral gap balancing with measured resection, the sTKA group failed to achieve balance in at least three points of the flexion arc. Post-operative CT confirmed satisfactory component alignment with no significant differences for positioning between the two groups. Conclusion This work found improved load sharing for rTKA when compared to conventional surgery for same donor knees. Laxity and CT determined final component positioning was not significantly different. The work supports the contention that robot-assisted TKA delivers improved tibiofemoral load sharing in time zero studies under defined conditions but such offers the promise of improved clinical performance and reduced implant wear.

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Section: Methodsmentioning

confidence: 99%

Improved mediolateral load distribution without adverse laxity pattern in robot-assisted knee arthroplasty compared to a standard manual measured resection technique

Manning

Ghosh

Wilson

et al. 2019

Knee Surg Sports Traumatol Arthrosc

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“…There remains debate about the role of frontal plane single-stance optimal biomechanical alignment in achieving perfect balance [23, 35]. Optimal performance through a full arc of motion is dependent upon consistent load distribution across the mediolateral articulation [17, 21]. Any direct correlation between equivalence of gap balancing, especially when as is standard only performed at two distinct points of motion remains unproven [22, 33].…”

Section: Introductionmentioning

confidence: 99%

A load-measuring device can achieve fine-tuning of mediolateral load at knee arthroplasty but may lead to a more lax knee state

Manning

Blain

Longstaff

et al. 2018

Knee Surg Sports Traumatol Arthrosc

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Purpose A balanced knee arthroplasty should optimise survivorship and performance. Equilibration of medial and lateral femorotibial load requires guided judicious pericapsular ligament release. The null hypothesis was that there would be no difference between use of a tensiometer device and a remote load sensor final load transfer across the joint through functional arc of motion. Methods A cadaveric study, using eight knees, was performed to define the impact of an established gap distraction device against load sensor-aimed soft tissue release in a TKA setting. Using validated measures of laxity in six degrees of freedom and true real-time load sensing four states were examined: native knee, TKA using spacer blocks (TKA), TKA with soft tissue release aided by a monogram tensiometer (TKA-T) and finally where load across the tibiofemoral articulation remains unbalanced final soft tissue release using a sensor device (TKA-OS). Results The laxity pattern was equivalent for TKA-T and TKA-OS. However, in only four of these seven knees despite the tensiometer confirming equivalence of rectangular flexion–extension gap dimensions and centralisation of collateral ligament distraction, there remained a > 15lb medial to lateral load difference for at least one point of the flexion arc. This was corrected by further final soft tissue release guided by the OS sensor device in the final three knees. Conclusion Tensiometer-guided soft tissue release at two points of flexion failed to achieve balance for three out of seven knee arthroplasty procedures. Sensor technology guided final soft tissue balancing to equilibrate load across the joint through full arc of motion. This work argues for the role of continuous sensor readings to guide the soft tissue balancing during total knee arthroplasty.

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“…However, there are limited studies investigating quantification of what effect posterior femoral osteophytes have on the soft-tissue envelope in TKA. One method of measuring soft-tissue strain and balance of the flexion and extension gaps is the use of pressure-sensing technology which quantifies joint contact forces as a surrogate for soft-tissue tension and balance [14,15,16,17,18,19] The purpose of the present study is to evaluate the effect of posterior femoral osteophytes on tension and balance of flexion and extension gaps during TKA in a cadaveric model. Our study was meant to quantify knee contact forces at multiple flexion angles with and without the presence of posterior osteophytes of differing size.…”

Section: Introductionmentioning

confidence: 99%

What is the Effect of Posterior Osteophytes on Flexion and Extension Gaps in Total Knee Arthroplasty? A Cadaveric Study

et al. 2021

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Background: Posterior compartment knee osteophytes may pose a challenge in achieving soft-tissue balance during total knee arthroplasty (TKA). Obtaining symmetry of flexion and extension gaps involves balance of both bony and soft-tissue structures. We hypothesize that space-occupying posteromedial femoral osteophytes affect soft-tissue balance. Methods: Five cadaveric limbs were acquired. Computed tomography scans were obtained to define the osseous contours. Three-dimensionally printed, specimen-specific synthetic posterior femoral osteophytes were fabricated in 10-mm and 15-mm sizes. TKAs were implanted. Medial and lateral compartment contact forces were measured during passive knee motion using pressure-sensing technology. For each specimen, trials were completed without osteophytes and with 10-mm and 15-mm osteophytes affixed to the posteromedial femoral condyle. Contact forces were obtained at full extension, 10 , 30 , 45 , 60 , and 90 of flexion. These were recorded across each specimen in each condition for three trials. Tukey post hoc tests were used with a repeated measures ANOVA for statistical data analysis. Results: The presence of posteromedial osteophytes increased asymmetric loading from full extension to 45 of flexion, with statistically significant differences observed at full extension and 30 . A reduction in lateral compartment forces was noted. The 25%-75% bounds of variability in the contact force was less than 3.5 lbs. Conclusions: Posteromedial femoral osteophytes caused an asymmetric increase in medial contact forces from full extension continuing into mid-flexion. The soft-tissue imbalance created from these osteophytes supports their removal before performing ligament releases to obtain desired soft-tissue balancing during TKA.

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Internal femoral component rotation adversely influences load transfer in total knee arthroplasty: a cadaveric navigated study using the Verasense device

Cited by 12 publications

References 49 publications

Improved mediolateral load distribution without adverse laxity pattern in robot-assisted knee arthroplasty compared to a standard manual measured resection technique

Improved mediolateral load distribution without adverse laxity pattern in robot-assisted knee arthroplasty compared to a standard manual measured resection technique

A load-measuring device can achieve fine-tuning of mediolateral load at knee arthroplasty but may lead to a more lax knee state

What is the Effect of Posterior Osteophytes on Flexion and Extension Gaps in Total Knee Arthroplasty? A Cadaveric Study

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