Predictive Gap-balancing Reduces the Extent of Soft-tissue Adjustment Required After Bony Resection in Robot-assisted Total Knee Arthroplasty—A Comparison With Simulated Measured Resection

Orsi, Alexander; Wakelin, Edgar A.; Plaskos, Christopher; Gupta, Sanjeev; Sullivan, James Anthony

doi:10.1016/j.artd.2022.03.025

Cited by 3 publications

(2 citation statements)

References 28 publications

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“…Using the navigation system planning software, component position was simulated post hoc according to previously described alignment philosophies. These included unbounded KA [21, 22], restricted kinematic alignment (rKA) [47, 50], restricted inverse kinematic alignment (riKA) [49, 50], gap balancing (GB) [36, 37] and MA [23, 37]. The simulations used the tibiofemoral laxity data and bone morphology data collected intraoperatively to plan each case.…”

Section: Methodsmentioning

confidence: 99%

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Personalized alignment techniques better restore the native trochlear groove compared to systematic alignment techniques in total knee arthroplasty

Orsi,

Shatrov,

Plaskos

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe relationship between constitutional coronal alignment and implant positioning on trochlear groove restoration in total knee arthroplasty (TKA) is poorly understood. This study aimed to determine whether the choice of alignment philosophy significantly affects the restoration of the trochlea groove.MethodsSixty‐one imageless robotic TKAs performed by a single orthopaedic surgeon were retrospectively reviewed. In each case, the entire native trochlea was digitized to generate the native femoral anatomy, and implants were planned according to a functional alignment (FA) technique. Final implant position was recorded using the validated bone resection planes from the navigation system. Simulated femoral component positions were generated according to previously described alignment techniques: mechanical alignment (MA), gap balancing (GB), kinematic alignment (KA), restricted kinematic alignment (rKA) and restricted inverse kinematic alignment (riKA). Trochlear angle (TA), trochlear under/overstuffing and mediolateral sulcus offset were compared between the six simulated alignment techniques, as well as the final implanted technique. Further analyses investigated the effect of preoperative coronal alignment on trochlear position. Comparisons were assessed with an analysis of variance and Welch's t‐tests or Wilcoxon's rank‐sum tests with Bonferroni corrections.ResultsThe implanted and simulated techniques all resulted in greater TA valgus compared to the native groove (p < 0.001). The implanted technique, KA and rKA were closer to the native TA than GB, MA and riKA (p > 0.001). All alignment philosophies understuffed the native trochlea groove. KA and rKA understuffed less than all other techniques (p < 0.001), and GB understuffed more than all other techniques (p < 0.001). In extension, all techniques shifted the trochlear sulcus laterally, while in flexion, they medialized it. These effects were most prominent in GB and MA.ConclusionPersonalized alignment techniques such as KA and rKA, which consider variations in individual anatomy, best restore the native patellar groove compared to systematic alignment techniques when using a standardized femoral component.Level of EvidenceLevel III, retrospective review.

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Section: Methodsmentioning

confidence: 99%

“…These included unbounded KA [21,22], restricted kinematic alignment (rKA) [47,50], restricted inverse kinematic alignment (riKA) [49,50], gap balancing (GB) [36,37] and MA [23,37]. The simulations used the tibiofemoral laxity data and bone morphology data collected intraoperatively to plan each case.…”

Section: Simulationsmentioning

confidence: 99%