Sensor-Assisted Total Knee Arthroplasty: A Narrative Review

Park, Cheol Hee; Song, Sang Jun

doi:10.4055/cios20034

Cited by 11 publications

(10 citation statements)

References 38 publications

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“…First, it should be noted that the definition used to designate a balanced knee was proposed by Gustke et al in a non-evidence-based manner relying on previous biomechanical research on passive condylar pressures, intraoperative observations, and the observed significant drop-off in postoperative patient-reported outcome (PROM) scores with intercompartmental loading differences exceeding 20 lb. Despite so, to our knowledge, there are no validated target load in literature to designate a balanced knee, and this is the more commonly used [ 12 , 30 ]. Second, while the pressure values were obtained during surgery, as reported by Bellemans et al, there is evidence that stress relaxation of the ligaments occurs perioperatively and leads to increased ligament laxity [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

Kinetic Sensors for Ligament Balance and Kinematic Evaluation in Anatomic Bi-Cruciate Stabilized Total Knee Arthroplasty

Sabatini

Bosco

Barberis

et al. 2021

Sensors

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Sensor technology was introduced to intraoperatively analyse the differential pressure between the medial and lateral compartments of the knee during primary TKA using a sensor to assess if further balancing procedures are needed to achieve a “balanced” knee. The prognostic role of epidemiological and radiological parameters was also analysed. A consecutive series of 21 patients with primary knee osteoarthritis were enrolled and programmed for TKA in our unit between 1 September 2020 and 31 March 2021. The VERASENSE Knee System (OrthoSensor Inc., Dania Beach, FL, USA) has been proposed as an instrument that quantifies the differential pressure between the compartments of the knee intraoperatively throughout the full range of motion during primary TKA, designed with a J-curve anatomical femoral design and a PS “medially congruent” polyethylene insert. Thirteen patients (61.90%) showed a “balanced” knee, and eight patients (38.10%) showed an intra-operative “unbalanced” knee and required additional procedures. A total of 13 additional balancing procedures were performed. At the end of surgical knee procedures, a quantitatively balanced knee was obtained in all patients. In addition, a correlation was found between the compartment pressure of phase I and phase II at 10° of flexion and higher absolute pressures were found in the medial compartment than in the lateral compartment in each ROM degree investigated. Moreover, those pressure values showed a trend to decrease with the increase in flexion degrees in both compartments. The “Kinetic Tracking” function displays the knee’s dynamic motion through the full ROM to evaluate joint kinetics. The obtained kinetic traces reproduced the knee’s medial pivot and femoral rollback, mimicking natural knee biomechanics. Moreover, we reported a statistically significant correlation between the need for soft tissue or bone resection rebalancing and severity of the initial coronal deformity (>10°) and a preoperative JLCA value >2°. The use of quantitative sensor-guided pressure evaluation during TKA leads to a more reproducible “balanced” knee. The surgeon, evaluating radiological parameters before surgery, may anticipate difficulties in knee balance and require those devices to achieve the desired result objectively.

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Section: Discussionmentioning

confidence: 99%

Kinetic Sensors for Ligament Balance and Kinematic Evaluation in Anatomic Bi-Cruciate Stabilized Total Knee Arthroplasty

Sabatini

Bosco

Barberis

et al. 2021

Sensors

View full text Add to dashboard Cite

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“…The current study attempted to identify the effect of rotation on measurements of alignment in the lower extremities. The results suggest that knee surgeons should be careful and opt for more sensitive investigations when diagnosing and planning treatment options in certain groups of patients [23,24]. The significance threshold for one-way analysis of variance (ANOVA) was set at P < 0:05.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Position on Radiographic Angle Measurements of the Lower Extremities

Chung

Lee

Han

et al. 2022

BioMed Research International

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Purpose. Accurately measuring an angle on a lower extremity X-ray is essential for the diagnosis and treatment of knee osteoarthritis (KOA). However, the angle is often affected by position, especially with flexion contracture and rotation. To date, there have been no quantitative analyses examining the relationship between lower extremity angle and patient position and no studies targeting patients with deformities. The aim of this study is to quantify the effect of position on angle measurements in lower extremity X-rays and to compare the effect in patients with different deformities. Methods. Computed tomography (CT) data of 131 patients with knee pain were retrospectively analyzed. The subjects were categorized into the following groups: neutral (hip-knee-ankle angle (HKAA) between 175 and 185°), varus (HKAA less than 175°), valgus (HKAA more than 185°), and flexion (flexion contracture more than 10°). CT images were digitally reconstructed to anterior-posterior X-ray images using an average intensity projection algorithm. The process was then repeated while rotating the reconstruction plane from internal 9° to external 9°. In this manner, X-ray images were reconstructed in different rotational states. The following angles were measured from reconstructed X-ray images: HKAA, lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), and femoral valgus angle (FVA). The measurements were then compared according to the degree of rotation. Results. FVA significantly differed according to rotation in all groups ( P < 0.001 ), with a difference of 1.3° (±0.4°). HKAA significantly changed only in the flexion contracture group ( P < 0.001 ), which showed a difference of 1.0° (±0.7°). However, HKAA in the other groups, LDFA, and MPTA did not significantly differ depending on rotation. Conclusions. Radiographic measurement of FVA is subject to change according to rotation. HKAA significantly changed only in the flexion contracture group, so more care should be taken while obtaining X-rays of patients with flexion contracture.

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“…Despite advances in technology and surgical technique, recent evidence indicates that mechanically aligned (MA) total knee arthroplasty (TKA) does not improve residual symptoms, natural knee sensations, or patient satisfaction [ 1 , 2 , 3 , 4 , 5 ]. In addition, neutrally aligned TKA fails to reproduce patient-specific knee kinematics [ 6 , 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Restoration of the Joint Line Configuration Reproduces Native Mid-Flexion Biomechanics after Total Knee Arthroplasty: A Matched-Pair Cadaveric Study

et al. 2022

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Background: Recent evidence supports that restoration of the pre-arthritic condition via total knee arthroplasty (TKA) is associated with improved post-TKA performance and patient satisfaction. However, whether the restored pre-arthritic joint line simulates the native mid-flexion biomechanics remains unclear. Objective: We performed a matched-pair cadaveric study to explore whether restoration of the joint line via kinematically aligned (KA) TKA reproduced native knee biomechanics more accurately than the altered joint line associated with mechanically aligned (MA) TKA. Methods: Sixteen fresh-frozen cadaveric knees (eight pairs) were affixed onto a customized knee-squatting simulator for measurement of femoral rollback and medial collateral ligament (MCL) strain during mid-flexion. One knee from each cadaver was randomly designated to the KA TKA group (with the joint line restored to the pre-arthritic condition) and the other to the MA TKA group (with the joint line perpendicular to the mechanical axis). Optical markers were attached to all knees and rollback was analyzed using motion capture cameras. A video extensometer measured real-time variations in MCL strain. The kinematics and MCL strain prior to and following TKA were measured for all specimens. Results: KA TKA was better for restoring the knee kinematics to the native condition than MA TKA. The mid-flexion femoral rollback and axial rotation after KA TKA were consistently comparable to those of the native knee. Meanwhile, those of MA TKA were similar only at ≤40° of flexion. Furthermore, KA TKA better restored the mid-flexion MCL strain to that of the native knee than MA TKA. Over the entire mid-flexion range, the MCL strain of KA TKA and native knees were similar, while the strains of MA TKA knees were more than twice those of native knees at >20° of flexion. Conclusions: The restored joint line after KA TKA effectively reproduced the native mid-flexion rollback and MCL strain, whereas the altered joint line after MA TKA did not. Our findings may explain why patients who undergo KA TKA experience superior outcomes and more natural knee sensations during daily activities than those treated via MA TKA.

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Sensor-Assisted Total Knee Arthroplasty: A Narrative Review

Cited by 11 publications

References 38 publications

Kinetic Sensors for Ligament Balance and Kinematic Evaluation in Anatomic Bi-Cruciate Stabilized Total Knee Arthroplasty

Kinetic Sensors for Ligament Balance and Kinematic Evaluation in Anatomic Bi-Cruciate Stabilized Total Knee Arthroplasty

The Effect of Position on Radiographic Angle Measurements of the Lower Extremities

Restoration of the Joint Line Configuration Reproduces Native Mid-Flexion Biomechanics after Total Knee Arthroplasty: A Matched-Pair Cadaveric Study

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