Sensor-Based Soft Tissue Balancing in Total Knee Arthroplasty

Chow, Jimmy; Law, Tsun Yee

doi:10.1007/978-981-13-1396-7_25

Cited by 8 publications

(4 citation statements)

References 26 publications

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“…Wood et al28 found no difference in clinical outcomes at 1 year in a randomized trial comparing sensor to manual balancing techniques. Chow et al29 demonstrated a greater rate of improvement in Knee Society Scores and Oxford Knee Scores in a case-matched study of 57 manually balanced versus 57 sensor-balanced TKA at 6 months. Conversely, Song et al30 found no difference in range of motion, Knee Society Scores and Western Ontario and McMaster Universities Osteoarthritis Index at 6 months when comparing 50 TKA performed with manual and sensor balancing techniques, respectively.…”

Section: Discussionmentioning

confidence: 98%

Sensor-guided Knee Balancing in Posterior-stabilized Total Knee Arthroplasty: A Surgical Description and Report of Medium-term Patient Outcomes

Cohen

Wood

MacDessi

2021

Techniques in Orthopaedics

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Background: Intraoperative pressure sensors provide the ability to quantify soft tissue balance (STB) and guide balancing interventions in total knee arthroplasty (TKA). The purpose of this study was to validate a sensor-guided knee balancing algorithm for posterior-stabilized TKA and then report medium-term patient-reported outcome measures from a consecutive series of surgeries using this algorithm. Materials and Methods: An algorithm is described for sensor-guided soft tissue releases and bone recuts aiming for quantitative knee balance. The coprimary endpoints were the proportion of TKAs in which quantitative STB was achieved using the sensor-guided balancing algorithm and the number of balancing interventions required. Secondary outcomes included change in Knee injury and Osteoarthritis Outcome Score (KOOS) components, rates of manipulations for stiffness, and revision surgery. Results: In a consecutive series of 210 knees, quantitative STB was achieved in 91.9% of cases. Balancing procedures were required in 57.2% (n=120), with 84.3% (n=177) requiring up to 2 balancing interventions to achieve balance. Angular bone recuts were required in 22.9% (n=48) of TKAs. At a minimum of 2 years, there was a statistically significant, clinically meaningful increase in mean KOOS4 of 40.8 (SD=17.5). All ΔKOOS subscales improved. The incidence of manipulation for stiffness and revision surgery at up to 4 years were 3.3% (7/210) and 1.4% (3/210), respectively. Conclusions: Quantitative sensor-guided assessment allows precise attainment of STB using a balancing algorithm of both bone recuts and soft tissue releases. Excellent medium-term improvement in patient-reported outcome measures was achieved with posterior-stabilized TKA using intraoperative sensor-guided balancing interventions.

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Section: Discussionmentioning

confidence: 98%

Sensor-guided Knee Balancing in Posterior-stabilized Total Knee Arthroplasty: A Surgical Description and Report of Medium-term Patient Outcomes

Cohen

Wood

MacDessi

2021

Techniques in Orthopaedics

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“…In some respects, the use of sensors to measure inter-prosthesis pressure can indirectly reflect soft tissue tension. Sensor technology has been reported to balance the medial-lateral space and the flexion-extension space in TKA, allowing for more precise surgery ( Chow et al, 2018 ; van der Linde et al, 2018 ). The potential benefit of sensors is the ability to obtain real in vivo measurements, and smart implants embedded with sensor technology offer the opportunity to improve surgical outcomes ( Kelmers et al, 2023 ).…”

Section: Introductionmentioning

confidence: 99%

Intraoperative sensor technology quantifies inter-prosthesis pressure for predicting lower limb alignment after Oxford unicompartmental knee arthroplasty

Sun

Liu

et al. 2023

Front. Bioeng. Biotechnol.

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Purpose: The aim of this study is to quantify inter-prosthetic pressures at different knee angles in Oxford unicompartmental knee arthroplasty (OUKA) and its correlation with postoperative lower limb alignment.Methods: This study included 101 patients (122 knees) who underwent OUKA from March 2022 to July 2022. The previously designed matrix flexible force sensor was used to measure the inter-prosthesis pressure of different knee joint angles during the UKA operation, and the force variation trend and gap balance difference were obtained. The correlation between inter-prosthesis pressure and postoperative lower limb alignment index including hip-knee-ankle angle (HKAA) and posterior tibial slope (PTS) was analyzed. The effect of PTS change (ΔPTS) on the inter-prosthesis pressure and the range of motion (ROM) of the knee joint was analyzed. Radiographic and short-term clinical outcomes of included patients were assessed.Results: The inter-prosthesis pressure of the different knee joint angles during the operation was not consistent. The mean inter-prosthesis pressure and gap balance difference were 73.68.28 ± 41.65N and 36.48 ± 20.58N. The inter-prosthesis pressure at 0° and 20° was positively correlated with postoperative HKAA (p < 0.001). ΔPTS was positively correlated with the pressure at the end of knee extension and negatively correlated with the pressure at the end of knee flexion (p < 0.001). The HKAA, ROM, degree of fixed knee flexion deformity, and knee society score of the included patients were significantly improved compared with those before the operation (p < 0.001).Conclusion: The inter-prosthesis pressure measured at the knee extension position can predict postoperative HKAA to some degree. Changes in PTS will affect the inter-prosthesis pressure at the end of flexion and end of knee extension, but this change is not related to the range of motion of the knee joint.

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“…Pressure sensors have been used to provide a quantitative measure of soft tissue tension in TKAs, assisting surgeons in achieving an appropriate balancing of the flexion and extension gap and satisfactory clinical outcomes [11][12][13][14][15]. Regarding UKA, Sun et al [16] reported the use of a pressure sensor beneath the UKA trial bearing on processed fresh frozen cadaveric specimens; Mentink et al [17] embedded a sensor within the bearing of MB-UKA and determined its electrical and mechanical characteristics by in-vitro test.…”

Section: Introductionmentioning

confidence: 99%

Can mobile-bearing unicompartmental knee arthroplasty achieve natural gap-balancing? An observational study with a novel pressure sensor

et al. 2022

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Background Mobile-bearing unicompartmental knee arthroplasty (MB-UKA) is an effective treatment for anteromedial knee osteoarthritis. Meticulous intraoperative soft tissue balancing remains challenging yet consequential for a successful operation. Currently, surgeons rely mostly on their experience during soft tissue balancing, yielding unreproducible results. The purpose of this study was to quantified measure the soft tissue tension of medial compartment and determine if an optimal "target" tension values with the natural state exists. Methods This was an observational study of 24 consecutive patients. All 30 UKAs were performed by a single surgeon. The piezoresistive sensor was custom designed to fit in the medial compartment gap. Contact pressures were measured at 5 angular positions of the knee intraoperatively: 0°, 20°, 45°, 90°, and 110° of flexion. The change in pressure from extension (20° position) and flexion (110° position) was also calculated (E-FPD). Data on age, sex, body mass index, operative side, and bearing size were collected. Outcome measures were measured at baseline and at the 6-month postoperative follow-up; Oxford Knee Score, visual analog scale score, and range of motion were compared to evaluate clinical outcomes. Results There was a significant improvement in patients in all measured outcomes at 6 months from baseline (P < 0.05). The E-FPD of 14.9 N (8.9, 24.6) was indicative of appropriate soft tissue balancing throughout the functional range of knee motion. Of 30 knees, 22 were 3-mm bearing and 8 were 4- or 5-mm bearing. The pressure data of the 3-mm bearing group was larger than that of the non-3-mm bearing group for each knee flexion degree, but the difference was not statistically significant (P > 0.05). Conclusions Objective data from sensor output may assist surgeons in decreasing loading variability during MB-UKA. The data suggested that MB-UKA could not accurately restore soft tissue tension to the natural state, which was related to the inability of MB-UKA surgical instruments to fine adjust the bone cut and soft tissue release. Study registration Chinese Clinical Trial Registry (http://www.chictr.org.cn): ChiCTR1900024146.

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Sensor-Based Soft Tissue Balancing in Total Knee Arthroplasty

Cited by 8 publications

References 26 publications

Sensor-guided Knee Balancing in Posterior-stabilized Total Knee Arthroplasty: A Surgical Description and Report of Medium-term Patient Outcomes

Sensor-guided Knee Balancing in Posterior-stabilized Total Knee Arthroplasty: A Surgical Description and Report of Medium-term Patient Outcomes

Intraoperative sensor technology quantifies inter-prosthesis pressure for predicting lower limb alignment after Oxford unicompartmental knee arthroplasty

Can mobile-bearing unicompartmental knee arthroplasty achieve natural gap-balancing? An observational study with a novel pressure sensor

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