The influence of tibiofemoral joint forces on patient-reported outcome measurements after bicruciate stabilized total knee arthroplasty

Abstract

Objective: Insall advocated that a successful clinical outcome of total knee arthroplasty (TKA) depends on soft tissue balance procedure. Spacer blocks, balancer, and instrumented tibial sensor (VERESENSE, OrthoSensor, Dania, Florida, USA) are the current methods of soft tissue balancing during TKA. The purpose of the study is to assess intraoperative medial and lateral tibiofemoral compressive force (TFCF) using novel insert sensor and investigate the relationship between TFCF and patient-reported outcome measurements (PROMs). Methods: Twenty-five patients who underwent bicruciate stabilized (BCS) TKA were evaluated retrospectively. We measured intraoperative medial and lateral TFCF in neutral position as well as the force ratio (FR %:medial TFCF/medial + lateral TFCF) in varus and valgus position using the novel insert sensor throughout the range of motion (ROM) and assessed the relationship between intraoperative medial and lateral TFCF and PROM at 6 months after TKA. Results: Medial TFCF increased and lateral TFCF decreased throughout ROM. The mean FR was 0.44% ± 0.22 throughout ROM. Medial and lateral TFCF differences at 60° of ROM in neutral position showed a positive correlation with physical function in Western Ontario and McMaster Universities scores ( r = 0.60, p < 0.05). Medial and lateral TFCF differences at 30° and 140° of ROM in valgus stress test showed a positive correlation with symptoms in 2011 Knee Society Scores ( r = 0.49, p < 0.05; r = 0.51, p < 0.05). Conclusion: The present study revealed that BCS TKA reproduces the coronal laxity, which is similar to healthy knee. These results suggest that intraoperative medial stability is important for function and symptoms, therefore, surgeons should not release medial soft tissue for achieving better clinical outcomes after BCS TKA. Level of Evidence: II

Verasense sensor-assisted total knee arthroplasty showed no difference in range of motion, reoperation rate or functional outcomes when compared to manually balanced total knee arthroplasty: a systematic review

“…1 (Additional file 2). Median MINORS for non-comparative studies value was 11.5 (11)(12), and for comparative studies 18.2 (13)(14)(15)(16)(17)(18)(19)(20)(21). Median Jadad Scale score was 3.6 (2)(3)(4)(5).…”

“…Nine studies examined the rate of MUA as an assessment of postoperative arthrofibrosis (Table 2 ). Geller et al reported that the rate of MUA in the MB TKA group was higher than in the VA TKA group, and that the period between TKA and MUA was on average 13.5 weeks and 7.5 weeks, respectively [ 15 ]. Some of the other studies also showed higher rates of MUA in the MB TKA group, but with no significant differences.…”

“…Several other sensors are available on the market (e.g. eLibra, Omnibot), to which our findings may not apply [ 6 , 15 ]. The number of available studies reporting on outcomes following these sensors is low though, and there is none comparing those outcomes to the ones following MB TKA.…”

Novel Force Measurement System for Soft Tissue Balance in Total Knee Arthroplasty Based on Flexible Pressure Sensor Arrays

“…[10] This is because soft tissue balance is a key factor that affects the lifetime of the knee prosthesis and the postoperative mobility of the patient's knee joint. [11][12][13][14] It is noted that soft tissue balance measurement is also a key factor affecting TKA surgery performed using knee joint replacement surgery robots. Thus, an accurate measurement of soft tissue balance plays a vital role in TKA.…”