Sensitivity of knee soft-tissues to surgical technique in total knee arthroplasty

Schirm, Andreas; Jeffcote, Benjamin O.; Nicholls, Rochelle; Jakob, Hilaire; Kuster, Markus S.

doi:10.1016/j.knee.2010.05.005

Cited by 18 publications

(9 citation statements)

References 29 publications

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“…Schirm et al demonstrated in a recent study that a 2 mm increase in tibial insert thickness has been shown to increase compressive forces by 54-131% with effects particularly noted PCL-retaining and mobile bearing prosthesis. 30 Walker et al showed that 2 mm in thickness difference results in a change in force sufficient to correct most imbalances. 31 The current authors believe that instability requiring insertion of a polyethelene with thickness greater than 14 mm in order to achieve medial pivoting biomechanics is not indicated.…”

Section: Surgical Technique For Primary Tka Using Load Sensorsmentioning

confidence: 99%

Intraoperative load-sensing drives the level of constraint in primary total knee arthroplasty: Surgical technique and review of the literature

Risitano

Karamian

Indelli

2017

Journal of Clinical Orthopaedics and Trauma

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Total knee arthroplasty is a traditional surgical procedure aimed to restore function and relief pain in patients with severe knee osteoarthritis. Recently, many medial pivot knee systems were deigned to replicate the normal knee kinematic: a highly congruent medial compartment and a less conforming lateral tibial plateau characterize these devices. A slightly asymmetric soft tissue balancing is mandatory using medial pivot designs to obtain a correct and physiological knee biomechanics leading good outcomes and long survival rates. This article describes a new surgical technique using a modern third generation TKA design combined with wireless load-sensor tibial trials to improve the correct knee load balancing with a minimal conformity of the polyethylene insert. The use of wireless load-sensing tibial trials has several benefits: it is an intraoperative, objective and dynamic tool allowing surgeons to optimize in real time soft tissue balancing. The meaning of a "truly balanced knee" is still a controversial issue in the current literature.

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Section: Surgical Technique For Primary Tka Using Load Sensorsmentioning

confidence: 99%

Intraoperative load-sensing drives the level of constraint in primary total knee arthroplasty: Surgical technique and review of the literature

Risitano

Karamian

Indelli

2017

Journal of Clinical Orthopaedics and Trauma

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“…Soft tissue balancing beyond 90° of flexion has not been indicated in previous TKA procedures [8,33]. Most contemporary TKAs could result in knee flexion, in average, between 100 to 130° [20,24,34].…”

Section: Introductionmentioning

confidence: 99%

In vivo length change patterns of the medial and lateral collateral ligaments along the flexion path of the knee

Hosseini

Tsai

et al. 2014

Knee Surg Sports Traumatol Arthrosc

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Purpose The knowledge of the function of the collateral ligaments – i.e., superficial medial collateral ligament (sMCL), deep medial collateral ligament (dMCL) and lateral collateral ligament (LCL) – in the entire range of knee flexion is important for soft tissue balance during total knee arthroplasty. The objective of this study was to investigate the length changes of different portions (anterior, middle and posterior) of the sMCL, dMCL and LCL during in vivo weightbearing flexion from full extension to maximal knee flexion. Methods Using a dual fluoroscopic imaging system eight healthy knees were imaged while performing a lunge from full extension to maximal flexion. The length changes of each portion of the collateral ligaments were measured along the flexion path of the knee. Results All anterior portions of the collateral ligaments were shown to have increasing length with flexion except that of the sMCL which showed a reduction in length at high flexion. The middle portions showed minimal change in lengths except that of the sMCL which showed a consistent reduction in length with flexion. All posterior portions showed reduction in lengths with flexion. Conclusions These data indicated that every portion of the ligaments may play important roles in knee stability at different knee flexion range. The soft tissue releasing during TKA may need to consider the function of the ligament portions along the entire flexion path including maximum flexion.

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“…In a study of bilateral total knee arthroplasty, it was found that patients preferred the looser knee over the tighter one, although statistical significance was not achieved [18] . At surgery, the tightness is not controlled directly, but a major factor is the thickness of the tibial component which is selected based on reaching full extension [19] . In this series of patients, there was a wide range of total contact forces ranging from 100 to 400 Newtons, but there was no correlation with the functional score.…”

Section: Discussionmentioning

confidence: 99%

Relationship between surgical balancing and outcome measures in total knees

Chu¹,

Meere²,

Oh³

et al. 2019

Arthroplasty Today

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Background The purpose of the study was to investigate the accuracy of balancing which could be achieved at total knee surgery and its relation to functional outcomes. Methods During surgery, the forces on the medial and lateral plateaus were measured at 10-15 degrees flexion in 101 patients, using an instrumented tibial trial, with equal forces being targeted. Of the initial 101 cases, 71 cases completed all follow-up visits to 1 year. At each follow-up visit, the function was measured using the Knee Society Scoring System, and varus and valgus laxity angles were measured. Results The mean medial/(medial + lateral) compartmental force ratio was 0.52, with a standard deviation of 0.09. The total contact force was 217 Newtons, with a standard deviation of 72 Newtons. No correlations were found between the functional scores and the compartmental force ratio or total contact force. However, the mean varus and valgus laxity angles, 2.8 and 2.3 degrees, respectively, were very close to the angles of normal intact knees. Conclusions The likely reason for the lack of correlation of function was that the large majority of the balancing ratios were within the range 0.4-0.6 but with a wide spread of functional scores typical of total knee study groups. However, the normal varus and valgus angles achieved at follow-up indicated that equal balancing in early flexion was a reasonable surgical target. Using instrumented tibial trials enabled accurate and consistent balancing values to be achieved, as well as normal varus and valgus laxity angles, which may be important in obtaining optimal outcomes.

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Sensitivity of knee soft-tissues to surgical technique in total knee arthroplasty

Cited by 18 publications

References 29 publications

Intraoperative load-sensing drives the level of constraint in primary total knee arthroplasty: Surgical technique and review of the literature

Intraoperative load-sensing drives the level of constraint in primary total knee arthroplasty: Surgical technique and review of the literature

In vivo length change patterns of the medial and lateral collateral ligaments along the flexion path of the knee

Relationship between surgical balancing and outcome measures in total knees

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