Perfect balance in total knee arthroplasty: The elusive compromise

Winemaker, Mitch

doi:10.1054/arth.2002.29321

Cited by 153 publications

(112 citation statements)

References 10 publications

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“…The technique involved inserting a commercial tensor device (Stryker Howmedica Osteonics Corp, Allendale, NJ, USA) with the knee in extension as described by Winemaker and others [3,46,47,58]. The surgeon measured the medial and lateral gaps and made releases as needed to achieve equal medial and lateral gaps to within ± 2 mm.…”

Section: Methodsmentioning

confidence: 99%

Robotic-assisted TKA Reduces Postoperative Alignment Outliers and Improves Gap Balance Compared to Conventional TKA

Song

Seon

Yim

et al. 2013

Clinical Orthopaedics &Amp; Related Research

333

295

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Background Several studies have shown mechanical alignment influences the outcome of TKA. Robotic systems have been developed to improve the precision and accuracy of achieving component position and mechanical alignment. Questions/purposes We determined whether roboticassisted implantation for TKA (1) improved clinical outcome; (2) improved mechanical axis alignment and implant inclination in the coronal and sagittal planes; (3) improved the balance (flexion and extension gaps); and (4) reduced complications, postoperative drainage, and operative time when compared to conventionally implanted TKA over an intermediate-term (minimum 3-year) followup period. MethodsWe prospectively randomized 100 patients who underwent unilateral TKA into one of two groups: 50 using a robotic-assisted procedure and 50 using conventional manual techniques. Outcome variables considered were postoperative ROM, WOMAC scores, Hospital for Special Surgery (HSS) knee scores, mechanical axis alignment, flexion/extension gap balance, complications, postoperative drainage, and operative time. Minimum followup was 41 months (mean, 65 months; range, 41-81 months). Results There were no differences in postoperative ROM, WOMAC scores, and HSS knee scores. The roboticassisted group resulted in no mechanical axis outliers ([ ± 3°from neutral) compared to 24% in the conventional group. There were fewer robotic-assisted knees

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Section: Methodsmentioning

confidence: 99%

Robotic-assisted TKA Reduces Postoperative Alignment Outliers and Improves Gap Balance Compared to Conventional TKA

Song

Seon

Yim

et al. 2013

Clinical Orthopaedics &Amp; Related Research

333

295

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“…Sekiya (&), K. Takatoku, H. Takada, H. Sasanuma, N. Sugimoto Department of Orthopaedics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 3290498, Japan e-mail: HSEKIYA@aol.com varus-deformed knees [7,21,24] and (2) accept some degree of lateral side laxity as long as proper valgus alignment is maintained [13,19]. With the latter strategy, there is a possibility of residual lateral ligamentous laxity after surgery.…”

Section: Introductionmentioning

confidence: 99%

Postoperative Lateral Ligamentous Laxity Diminishes with Time After TKA in the Varus Knee

Sekiya

Takatoku

Takada

et al. 2008

Clin Orthop Relat Res

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For successful TKA, good soft tissue balance is one of the most important factors; however, it is unknown whether the coronal balance immediately after surgery is maintained with time. We hypothesized, if neutral mechanical alignment was achieved at the time of TKA, some degree of lateral ligamentous laxity could be accepted and the laxity would diminish with time. To confirm this hypothesis, we posed two scientific questions: (1) Does the coronal ligament balance measured immediately after TKA change with time? (2) Does the degree of preoperative varus alignment correlate with the lateral or medial ligamentous laxity observed after TKA? We measured coronal lateral or medial ligamentous laxity in 71 knees with varus deformities immediately after surgery and at 3, 6, and 12 months thereafter. The mean mechanical axis was 15.9°varus preoperatively and 0.4°varus postoperatively. The mean medial ligamentous laxity was relatively constant postoperatively from immediately after surgery to 12 months. However, the mean lateral ligamentous laxity was as much as 8.6°immediately after surgery and decreased to 5.1°at 3 months. The lateral ligamentous laxity immediately after surgery correlated with the preoperative varus mechanical axis. Our data show residual lateral ligamentous laxity observed in preoperative varus deformity may be corrected spontaneously after TKA.

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“…Our system is an improvement relative to standard tools, as they are unable to quantify the load that is applied to the joint. This limitation of the Stryker tool has been noted in the past in Winemaker's clinical study [8]. Currently, the commercially available unit can be instrumented with a torque meter on the ratchet handle though there is no literature to date reporting on the use of the load feedback in surgical trials.…”

Section: Discussionmentioning

confidence: 99%

“…This highlights the difficulty in achieving a balanced joint throughout a full range of motion and fuels the debate on proper gap preparation, particularly rotational alignment of the femoral component. Imposing a femoral rotation that creates a square gap when ligaments are stressed is a technique that has been recently addressed [8], [12], [13]. The interdependence of rotational alignment and soft tissue balance in flexion has long been acknowledged, though only recently has ligament tension been suggested as the definitive parameter in deciding femoral rotation.…”

Section: Discussionmentioning

confidence: 99%

“…The tensioning device helped guide balance in a study to determine if proprioception is affected by soft-tissue deformity in 38 patients [7]. More recently, the device achieved results comparable to traditional methods in a clinical study [8]. There remain limitations to the system including the application of an "appropriate" tension to the ligaments by the surgeon.…”

Section: Introductionmentioning

confidence: 99%

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Application of an Intra-operative Load Measuring System for Knee Replacement Surgery

Skrinskas

Viskontas

Ferreira

et al. 2003

Lecture Notes in Computer Science

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Abstract. Joint gap balancing during total knee arthroplasty has been an empirical undertaking to date. Ligament tensioning devices exist to aid soft tissue management, however quantifying tension remains problematic. The purpose of this study was to validate modifications made to a current balancing system, allowing for quantification of joint load using a computer-assisted technique. An additional goal was to determine if the tool would improve joint gap management and consequently load balance in an in-vitro model. The load sensing capability of the tool was validated under known loading conditions. Intraoperative use of the tool relative to current techniques was evaluated in a preliminary in-vitro study using cadaveric knees. There was a trend towards improved joint gap management when using the tensioning device, but this did not translate into a more balanced joint in our knee simulator.

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Perfect balance in total knee arthroplasty: The elusive compromise

Cited by 153 publications

References 10 publications

Robotic-assisted TKA Reduces Postoperative Alignment Outliers and Improves Gap Balance Compared to Conventional TKA

Robotic-assisted TKA Reduces Postoperative Alignment Outliers and Improves Gap Balance Compared to Conventional TKA

Postoperative Lateral Ligamentous Laxity Diminishes with Time After TKA in the Varus Knee

Application of an Intra-operative Load Measuring System for Knee Replacement Surgery

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