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Kokubu Y, Kawahara S, Mizu‐Uchi H, Hamai S, Akasaki Y, Sato T, Ishibashi S, Konishi T, Nakashima Y. Component rotational mismatch in the standing position is a potential risk factor for unfavourable functional outcomes after total knee arthroplasty. J Exp Orthop 2024; 11:e12069. [PMID: 38957227 PMCID: PMC11217670 DOI: 10.1002/jeo2.12069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 05/20/2024] [Accepted: 06/11/2024] [Indexed: 07/04/2024] Open
Abstract
Purpose This study assessed rotational mismatch between components after total knee arthroplasty (TKA) in the supine and standing positions and aimed to investigate the effect of rotational mismatch in the standing position on postoperative patient-reported outcome measures (PROMs). Methods Seventy-one patients (71 knees) who underwent TKA for medial knee osteoarthritis were used to investigate rotational mismatches between components. Rotational mismatches between components were examined on postoperative standing whole-leg and supine knee radiographs using a three-dimensional-to-two-dimensional model image registration technique, and the angles between the reference axes of the components were measured. Component alignment was evaluated using postoperative computed tomography images, and a questionnaire (2011 version of the Knee Society Score: [KSS 2011]) was mailed to investigate postoperative PROMs. Results In the entire cohort, rotational mismatches in the supine and standing positions were similar (p = 0.9315). In 15% of patients, the mismatch was large (>5°) in the supine position but small (<5°) in the standing position (overestimated group). However, in 23% of patients, the mismatch was small (<5°) in the supine position and large (>5°) in the standing position (underestimated group). The underestimated group had severe preoperative varus deformity, resulting in external rotation of both femoral and tibial components. Rotational mismatch in the standing position (p = 0.0032) was a significant risk factor for unfavourable PROMs. Patients with a mismatch in the standing position had significantly lower scores than those without a mismatch (p = 0.0215), exceeding the minimal clinically important difference values. Conclusions The underestimated group is clinically important because the surgical procedure and intraoperative assessment of component placement are performed in the supine position. In cases of severe preoperative varus deformity, care should be taken not to place the component in malrotation to avoid rotational mismatch in the standing position. Level of Evidence Ⅳ, Case series.
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Affiliation(s)
- Yasuhiko Kokubu
- Department of Orthopaedic Surgery, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Shinya Kawahara
- Department of Orthopaedic Surgery, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Hideki Mizu‐Uchi
- Department of Orthopaedic Surgery, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
- Department of Orthopaedic SurgerySaiseikai Fukuoka General HospitalFukuokaJapan
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Yukio Akasaki
- Department of Orthopaedic Surgery, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Taishi Sato
- Department of Orthopaedic Surgery, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Shojiro Ishibashi
- Department of Orthopaedic Surgery, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
- Department of Orthopaedic SurgerySaiseikai Fukuoka General HospitalFukuokaJapan
| | - Toshiki Konishi
- Department of Orthopaedic Surgery, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
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Hoveidaei AH, Esmaeili S, Ghaseminejad-Raeini A, Pirahesh K, Fallahi MS, Sandiford NA, Citak M. Robotic assisted Total Knee Arthroplasty (TKA) is not associated with increased patient satisfaction: a systematic review and meta-analysis. INTERNATIONAL ORTHOPAEDICS 2024; 48:1771-1784. [PMID: 38705892 DOI: 10.1007/s00264-024-06206-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 04/25/2024] [Indexed: 05/07/2024]
Abstract
PURPOSE Total knee arthroplasty (TKA) is a common orthopedic surgery, yet postoperative dissatisfaction persists in around 20% of cases. Robotic total knee arthroplasty (rTKA) promises enhanced precision, but its impact on patient satisfaction compared to conventional TKA remains controversial (cTKA). This systematic review aims to evaluate patient satisfaction post-rTKA and compare outcomes with cTKA. METHODS Papers from the following databases were identified and reviewed: PubMed, Scopus, Web of Science, and the Cochrane Online Library, using keywords like "Knee replacement," "Total knee arthroplasty," "Robotic," and "Patient satisfaction." Extracted data included patient satisfaction measures, Knee Society Score, Oxford Knee Score, Forgotten Joint Score, SF-36, HSS, and KOOS. Statistical analysis, including odds ratio and 95% CI was performed using R software. Heterogeneity was assessed using Cochrane's Q test. RESULTS The systematic review included 17 articles, involving 1148 patients (571 in the rTKA group and 577 in the cTKA group) assessing patient satisfaction following rTKA. An analysis of proportions reveals rTKA satisfaction rate was 95%, while for cTKA, it was 91%. A meta-analysis comparing rTKA and cTKA found no statistically significant difference in patient satisfaction. Additionally, various patient-reported outcome measures (PROMs) were examined, showing mixed results across different studies and follow-up periods. CONCLUSIONS The results of this study found no difference in patient satisfaction outcomes in the short to mid-term for rTKA compared to conventional methods. This study does not assert superiority for the robotic approach, highlighting the need for careful consideration of various factors influencing outcomes in knee arthroplasty.
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Affiliation(s)
- Amir Human Hoveidaei
- International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Sina Esmaeili
- Sina University Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Kasra Pirahesh
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Nemandra A Sandiford
- Joint Reconstruction Unit, Southland Teaching Hospital, Invercargill, New Zealand
| | - Mustafa Citak
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg Holstenstrasse 2, 22767, Hamburg, Germany.
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Matziolis G, Layher F, Vogt S, Bergner L, Wassilew G, Kirschberg J. Spacer rotation technique allows precise evaluation of gap balance in total knee arthroplasty. Arch Orthop Trauma Surg 2024; 144:2267-2271. [PMID: 38587669 PMCID: PMC11093784 DOI: 10.1007/s00402-024-05253-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 02/17/2024] [Indexed: 04/09/2024]
Abstract
The symmetry of the flexion and extension gap influences the functional and long-term outcome after total knee arthroplasty (TKA). Most surgeons check it by applying varus and valgus stress using spacers. This technique has limited accuracy and could be easily extended by rotational movement of the spacer. The objective was to determine the detection threshold and interobserver reliability of this technique. In an in vitro setting with a human cadaveric knee, gap asymmetries were simulated by different medially and laterally applied forces. Using an optical measurement system, the pivot point of the spacer was calculated as a function of the gap symmetry in the first part of the experiment. In the second part, the detection threshold and interobserver reliability of 4 surgeons were determined. For this purpose, gap asymmetries were adjusted to between 0 and 120N in a blinded trial. With a symmetrical gap, the centre of rotation of the spacer was located in the centre of the tibia. With increasing gap asymmetry, the centre of rotation of the spacer shifted to the tight side. This shift was approximately linearly dependent on the force difference. A perfectly balanced gap was detected by the examiners in 50% of the cases. From a force difference of 40N, all examiners identified the gap asymmetry in all cases (ICC = 1.0). The method of spacer rotation described is suitable for reliably detecting gap differences at ≥ 40N, independently of the examiner.
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Affiliation(s)
- Georg Matziolis
- Orthopaedic Department, University Hospital Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany.
| | - Frank Layher
- Orthopaedic Department, University Hospital Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
| | - Sophia Vogt
- Orthopaedic Department, University Hospital Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
| | - Leah Bergner
- Orthopaedic Department, University Hospital Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
| | - Georgi Wassilew
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, 17475, Greifswald, Germany
| | - Julia Kirschberg
- Orthopaedic Department, University Hospital Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
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Ollivier B, Wakelin E, Plaskos C, Vandenneucker H, Luyckx T. Widening of tibial resection boundaries increases the rate of femoral component valgus and internal rotation in functionally aligned TKA. Knee Surg Sports Traumatol Arthrosc 2024; 32:953-962. [PMID: 38444096 DOI: 10.1002/ksa.12118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 02/12/2024] [Accepted: 02/15/2024] [Indexed: 03/07/2024]
Abstract
PURPOSE The purpose of this study was to investigate the influence of increasing the tibial boundaries in functional alignment on femoral component orientation in total knee arthroplasty (TKA). METHODS A retrospective review of a database of robotic-assisted TKAs using a digital joint tensioning device was performed (BalanceBot®; Corin). A total of 692 TKAs with correctable deformity were included. Functional alignment with a tibia-first balancing technique was simulated by performing an anatomic tibial resection to recreate the native medial proximal tibial angle within certain boundaries (A, 87-90°; B, 86-90°; C, 84-92°), while accounting for wear. After balancing the knee, the resulting amount of femoral component outliers in the coronal and axial plane was calculated for each group and correlated to the coronal plane alignment of the knee (CPAK) classification. RESULTS The proportion of knees with high femoral component varus (>96°) or valgus (<87°) alignment increased from 24.5% (n = 170) in group A to 26.5% (n = 183) in group B and 34.2% (n = 237) in group C (p < 0.05). Similarly, more knees with high femoral component external rotation (>6°) or internal rotation (>3°) were identified in group C (33.4%, n = 231) than in group B (23.7%, n = 164) and A (18.4%, n = 127) (p < 0.05). There was a statistically significant (p < 0.01) overall increase in knees with both femoral component valgus <87° and internal rotation >3° from group A (4.0%, n = 28) to B (7.7%, n = 53) and C (15.8%, n = 109), with CPAK type I and II showing a 12.9- and 2.9-fold increase, respectively. CONCLUSION Extending the tibial boundaries when using functional alignment with a tibia-first balancing technique in TKA leads to a statistically significant higher percentage of knees with a valgus lateral distal femoral angle < 87° and >3° internal rotation of the femoral component, especially in CPAK type I and II. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Britt Ollivier
- Department of Orthopaedics, University Hospitals Leuven, Leuven, Belgium
| | | | | | - Hilde Vandenneucker
- Department of Orthopaedics, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, University of Leuven, Leuven, Belgium
| | - Thomas Luyckx
- Department of Orthopaedic Surgery, AZ Delta, Roeselare, Belgium
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Sharma AK, Plaskos C, Shalhoub S, Lawrence D, Vigdorchik JM, Lawrence JM. Ligament Tension and Balance before and after Robotic-Assisted Total Knee Arthroplasty - Dynamic Changes with Increasing Applied Force. J Knee Surg 2024; 37:128-134. [PMID: 36731502 DOI: 10.1055/s-0042-1760390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The optimal force applied during ligament balancing in total knee arthroplasty (TKA) is not well understood. We quantified the effect of increasing distraction force on medial and lateral gaps throughout the range of knee motion, both prior to and after femoral resections in tibial-first gap-balancing TKA. Twenty-five consecutive knees in 21 patients underwent robotic-assisted TKA. The posterior cruciate ligament was resected, and the tibia was cut neutral to the mechanical axis. A digital ligament tensioning tool recorded gaps and applied equal mediolateral loads of 70 N (baseline), 90 N, and 110 N from 90 degrees to full extension. A gap-balancing algorithm planned the femoral implant position to achieve a balanced knee throughout flexion. After femoral resections, gap measurements were repeated under the same conditions. Paired t-tests identified gap differences between load levels, medial/lateral compartments, and flexion angle. Gaps increased from 0 to 20 degrees in flexion, then remain consistent through 90 degrees of flexion. Baseline medial gap was significantly smaller than lateral gap throughout flexion (p <0.05). Increasing load had a larger effect on the lateral versus medial gaps (p <0.05) and on flexion versus extension gaps. Increasing distraction force resulted in non-linear and asymmetric gap changes mediolaterally and from flexion to extension. Digital ligament tensioning devices can give better understanding of the relationship between joint distraction, ligament tension, and knee stiffness throughout the range of flexion. This can aid in informed surgical decision making and optimal soft tissue tensioning during TKA.
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Affiliation(s)
- Abhinav K Sharma
- Department of Orthopaedic Surgery, University of California, Irvine, School of Medicine, Orange, California
| | | | | | - Dylan Lawrence
- Department of Orthopaedic and Rehabilitation, University of Wisconsin, Madison, Wisconsin
| | | | - Jeffrey M Lawrence
- Center of Orthopaedic Surgery, Gundersen Health System, Viroqua, Wisconsin
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Yang Y, Wang Y, Chen Y, Wang J, Lu B, Zhu W, Zhu J, Zhu C, Zhang X. Tracing the evolution of robotic-assisted total knee arthroplasty: a bibliometric analysis of the top 100 highly cited articles. J Robot Surg 2023; 17:2973-2985. [PMID: 37882976 DOI: 10.1007/s11701-023-01742-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 10/06/2023] [Indexed: 10/27/2023]
Abstract
Robotic-assisted surgical systems hold promise in enhancing total knee arthroplasty (TKA) outcomes and patients' quality of life. This study aims to comprehensively analyze the literature on robot-assisted total knee arthroplasty (r-TKA), providing insights into its current development, clinical application, and research trends. A systematic search was conducted in the Web of Science Core Collection (WOSCC) to identify relevant articles. Data were collected from the top 100 highly cited articles. Article evidence levels were assessed following established guidelines. Statistical analyses and visualizations were performed to reveal publication trends, citations, research hotspots, and collaborative networks. The analysis covered 100 highly cited articles meeting the research criteria, with a focus on the last five years. The United States emerged as a major contributor, with most publications and citations in the Journal of Knee Surgery and Knee Surgery Sports Traumatology Arthroscopy. Research priorities revolved around clinical outcomes, accuracy, and alignment of r-TKA. Notably, higher evidence levels correlated with more citations, indicating greater attention. Interest in and research on r-TKA is steadily increasing, with a few countries at the forefront of these endeavors. While numerous studies have already reported short- to medium-term follow-up results, it is crucial to conduct longer-term investigations to gain a more comprehensive understanding of the clinical benefits that r-TKA offers compared to conventional techniques. Through ongoing research and a greater embrace of robotic technology, we can continue to improve the quality of life for patients undergoing knee arthroplasty.
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Affiliation(s)
- Yao Yang
- Department of Orthopedics, The Second Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui Province, China
- Division of Life Sciences and Medicine, Department of Orthopedics, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
| | - Yingjie Wang
- Department of Orthopedics, The Second Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui Province, China
- Division of Life Sciences and Medicine, Department of Orthopedics, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
| | - Yuan Chen
- Department of Orthopedics, The Second Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui Province, China
- Division of Life Sciences and Medicine, Department of Orthopedics, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
| | - Junjie Wang
- Department of Orthopedics, The Second Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui Province, China
- Division of Life Sciences and Medicine, Department of Orthopedics, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
| | - Baoliang Lu
- Division of Life Sciences and Medicine, Department of Orthopedics, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
- Graduate School of Bengbu Medical College, Bengbu, China
| | - Wanbo Zhu
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China.
| | - Junchen Zhu
- Department of Orthopedics, The Second Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui Province, China.
| | - Chen Zhu
- Division of Life Sciences and Medicine, Department of Orthopedics, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China.
| | - Xianzuo Zhang
- Division of Life Sciences and Medicine, Department of Orthopedics, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China.
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Wakelin EA, Ponder CE, Randall AL, Koenig JA, Plaskos C, DeClaire JH, Lawrence JM, Keggi JM. Intra-operative laxity and balance impact 2-year pain outcomes in TKA: a prospective cohort study. Knee Surg Sports Traumatol Arthrosc 2023; 31:5535-5545. [PMID: 37837574 DOI: 10.1007/s00167-023-07601-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/20/2023] [Indexed: 10/16/2023]
Abstract
PURPOSE The objective of this study was to determine if intra-operatively measured joint gaps are associated with 2-year pain outcomes in total knee arthroplasty (TKA) and whether balance and laxity windows could be defined throughout flexion to optimize 2-year pain outcomes. Our hypothesis is that intra-operative joint gaps are associated with 2 year post-operative pain outcome. METHODS A prospective study investigating 310 robotically assisted TKAs was performed. Final intra-operative joint gap data were recorded using a digital tensioner and component alignment data were recorded by the robotics system. Patient demographics and Knee Injury and Osteoarthritis Outcome Score (KOOS) were recorded pre-operatively and KOOS and Hospital for Special Surgery (HSS) satisfaction were recorded at 2 years post-op. A random search Simulated Annealing (SANN) optimisation algorithm was used to determine global optimum laxity and balance windows at different flexion angles which maximized the 2-year KOOS pain scores. The windows were combined to determine the impact of achieving optimal laxity and balance throughout flexion. To improve clinical utility, boundaries identified by the SANN algorithm were rounded to the nearest 0.5 mm before statistical analysis. RESULTS Laxity and balance windows were defined in extension (Med lax: -2.0 to 2.5 mm, Lat lax: -0.5 to 2.5 mm, Balance: -3.0 to 0.0 mm), mid-flexion (Med lax: -1.0 to 2.5 mm, Lat lax: -0.5 to 3.0 mm, Balance: -2.0 to 2.0 mm), and flexion (Med lax: -2.0 to 3.5 mm, Lat lax: -2.0 to 1.5 mm, Balance: -3.0 to 3.0 mm). When all windows were satisfied, the greatest difference in KOOS pain score was observed (100.0 vs 94.4, p < 0.0001). The highest percentage of knees satisfying the Patient Acceptable Symptom State (PASS) for KOOS pain was also observed in knees which satisfied all windows compared to knees which did not (93% vs 71%, p = 0.0009). The proportion of knees which satisfy the PASS threshold decreased in knees which only satisfied 1-3 (29%) or 4-6 (69%) windows (p ≤ 0.0018). No optimal windows were found between component alignment and KOOS pain outcome (p ≥ 0.1180). High satisfaction was found across all groups (≥ 95%). CONCLUSION Intra-operatively measured joint gaps are associated with all KOOS sub-score outcomes at 2 years after TKA. Optimal windows for a clinically relevant improvement in post-operative KOOS pain were defined for laxity and balance but not for alignment indicating balance may have a greater impact on outcome than alignment. LEVEL OF EVIDENCE II.
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Affiliation(s)
| | - Corey E Ponder
- Oklahoma Sports and Orthopedics Institute, Edmond, OK, USA
| | | | - Jan A Koenig
- Department of Orthopedic Surgery, NYU Langone Hospital, Long Island, NY, USA
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Kinsey TL, Melton C, Mahoney OM. Posterior Compartment Debridement and Varus Deformity Correction in Total Knee Arthroplasty. J Arthroplasty 2023; 38:S164-S168. [PMID: 37019315 DOI: 10.1016/j.arth.2023.03.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 03/26/2023] [Accepted: 03/26/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Restoration of joint-line position and deformity correction remain important tenets for preserving stability and function after total knee arthroplasty (TKA). We sought to characterize the role of posterior osteophytes in the correction of alignment deformity during TKA. METHODS We evaluated 57 patients (57 TKAs) who participated in a trial of robotic-arm assisted TKA outcomes. Weight-bearing and fixed preoperative alignment was measured using long-standing radiographs and tools of the robotic-arm tracking system, respectively. Total volume (cm2) of posterior osteophytes was quantified using preoperative planning computed tomography scans. Joint line position was evaluated using bone resection thicknesses measured using a caliper. RESULTS The mean (minimum to maximum) initial fixed deformity was 4 degrees (range, 0 to 11) of varus. All patients showed asymmetric posterior osteophytes. Mean total osteophyte volume was 3 cm3 (range, 1 to 9). Total osteophyte volume was positively correlated with severity of fixed deformity (r=0.48, P=0.0001). Removal of osteophytes allowed for the correction of functional alignment to within three degrees of neutral in all cases (mean 0 deg), with none requiring release of the superficial medial collateral ligament. Tibial joint line position was restored to within 3 millimeters in all but 2 cases (mean increase of height, 0.6 (range, -4 to +5)). CONCLUSION In the end-stage diseased knee, posterior osteophytes typically occupy space in the posterior capsule on the concave side of the deformity. Thorough debridement of posterior osteophytes may help facilitate management of modest varus deformity with decreased need for soft-tissue releases or adjustments to planned bone resection.
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Affiliation(s)
- Tracy L Kinsey
- Athens Orthopedic Clinic, Athens, GA; Department of Orthopedics, Medical College of Georgia, Augusta GA
| | - Chris Melton
- Department of Orthopedics, Medical College of Georgia, Augusta GA
| | - Ormonde M Mahoney
- Athens Orthopedic Clinic, Athens, GA; Department of Orthopedics, Medical College of Georgia, Augusta GA.
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Geller JA, deMeireles AJ, Gazgalis A, Santos W, Neuwirth AL, Shah RP, Cooper HJ. Collateral Ligament Tension and Balance Alone Does Not Ensure Improved Outcome after Total Knee Arthroplasty. J Arthroplasty 2023; 38:S196-S203. [PMID: 36963528 DOI: 10.1016/j.arth.2023.03.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 03/09/2023] [Accepted: 03/13/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND It is hypothesized that suboptimal soft tissue and collateral ligament balance is a cause of patient dissatisfaction following total knee arthroplasty (TKA). This analysis examined the association between compartment pressures during TKA and patient reported outcome measurements (PROMs). METHODS This single-institution, retrospective cohort study of prospectively collected compartment pressure data measured during TKA comprised 145 patients who underwent surgery between 2015 and 2021 and completed 1-year follow-up PROMs. The primary outcome included pressures, in pounds (lbs), of the medial and lateral compartments in extension (5°), mid-flexion (45°), and flexion (90°), and associated PROMs. The difference been the 1-year and pre-operative PROMs was used to separate the top 25% from the bottom 75% performers. Pressures were compared using Student's T-tests and multivariate linear regressions, while controlling for preoperative deformity. A subgroup analysis of the most popular implant was performed. RESULTS Higher medial compartment pressures were seen in our total cohort (Knee Society Score (KSS) mid-flexion 24 vs 18lbs, P=.03, flexion 24 vs 17lbs p=.01) and within our subgroup analysis (Short form- Mental (SF-M) extension 32 vs 21lbs P=0.01, KSS mid-flexion 27 vs 16lbs P=.005, extension 31 vs 20lbs P=.003). This trend persisted in the subgroup analysis when controlling for pre-operative deformity (KSS extension +16.22lbs P=<.001, mid-flexion +17.6lbs. P=.001, and flexion +9.2lbs, P=.005). CONCLUSION Several groups demonstrated higher medial versus lateral pressures. However, this pattern was not consistent across PROMs, suggesting that compartment pressures at the time of TKA are an important factor, but not the sole predictor of patient satisfaction.
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Affiliation(s)
- Jeffrey A Geller
- Columbia University Irving Medical Center, Department of Orthopaedics, New York, NY.
| | - Alirio J deMeireles
- Columbia University Irving Medical Center, Department of Orthopaedics, New York, NY
| | - Anastasia Gazgalis
- Columbia University Irving Medical Center, Department of Orthopaedics, New York, NY
| | - Walkania Santos
- Columbia University Irving Medical Center, Department of Orthopaedics, New York, NY
| | - Alexander L Neuwirth
- Columbia University Irving Medical Center, Department of Orthopaedics, New York, NY
| | - Roshan P Shah
- Columbia University Irving Medical Center, Department of Orthopaedics, New York, NY
| | - H John Cooper
- Columbia University Irving Medical Center, Department of Orthopaedics, New York, NY
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10
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Functional Alignment Philosophy in Total Knee Arthroplasty-Rationale and Technique for the Valgus Morphotype Using an Image Based Robotic Platform and Individualized Planning. J Pers Med 2023; 13:jpm13020212. [PMID: 36836446 PMCID: PMC9961945 DOI: 10.3390/jpm13020212] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 01/15/2023] [Accepted: 01/19/2023] [Indexed: 01/27/2023] Open
Abstract
Functional alignment (FA) is a novel philosophy to deliver a total knee arthroplasty (TKA) that respects individual bony and soft tissue phenotypes within defined limitations. The purpose of this paper is to describe the rationale and technique of FA in the valgus morphotype with the use of an image-based robotic-platform. For the valgus phenotype the principles are personalized pre-operative planning, reconstitution of native coronal alignment without residual varus or valgus of more than 3°, restoration of dynamic sagittal alignment within 5° of neutral, implant sizing to match anatomy, and achievement of defined soft tissue laxity in extension and flexion through implant manipulation within the defined boundaries. An individualized plan is created from pre-operative imaging. Next, a reproducible and quantifiable assessment of soft tissue laxity is performed in extension and flexion. Implant positioning is then manipulated in all three planes if necessary to achieve target gap measurements and a final limb position within a defined coronal and sagittal range. FA is a novel TKA technique that aims to restore constitutional bony alignment and balance the laxity of the soft tissues by placing and sizing implants in a manner that respects variations in individual anatomy and soft tissues within defined limits.
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11
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Koenig JA, Wakelin EA, Passano B, Shalhoub S, Plaskos C. Impact of a Digital Balancing Tool on Femur and Tibial First Total Knee Arthroplasty: A Prospective Nonrandomized Controlled Trial. Arthroplast Today 2022; 17:172-178. [PMID: 36186676 PMCID: PMC9519394 DOI: 10.1016/j.artd.2022.06.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/21/2022] [Accepted: 06/29/2022] [Indexed: 11/25/2022] Open
Abstract
Background Recent developments in intra-operative sensor technology provide surgeons with predictive and real-time feedback on joint balance. It remains unknown, however, whether these technologies are better suited to femur-first or tibia-first workflows. This study investigates the balance accuracy, precision and early patient outcomes between the femur-first and tibial-first workflows using a digital gap-balancing tool. Methods One-hundred six patients had posterior cruciate ligament sacrificing total knee arthroplasty using a digital joint tensioner. The participants were divided into 4 groups with different visibility to balance data 1) Femur-first blinded data, 2) Femur-first not blinded data, 3) Tibia-first blinded data, 4) Tibia-first not blinded data with predictive balancing. Knee Injury and Osteoarthritis Outcome Score and University of California at Los Angeles activity level were recorded at 1-year. Results Group 4 reported less midflexion imbalance (40°) compared to all other groups (1: 1.5 mm, 2: 1.7 mm, 3: 1.6 mm, 4: 1.0 mm, P < .031) and reduced variance compared to all other groups at 40° and 90° (P < .012), resulting in an increased frequency of joints balanced within 2 mm throughout flexion in group 4 (1: 69%, 2: 65%, 3: 67%, 4: 91%, P < .006). No differences were found between 3-month, 6-month, or 1-year outcome scores between technique. Conclusions Improvements in balance were observed in midflexion instability and balance variability throughout flexion when a tibia-first approach in combination with a digital balancing tool was used. The combination of a digital balancing tool and a tibia-first approach allowed a target joint balance to be achieved more accurately compared to a non-sensor augmented or femur-first approach.
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Affiliation(s)
- Jan A. Koenig
- Department of Orthopedic Surgery, NYU Langone Hospital Long Island, Mineola, NY, USA
| | | | - Brandon Passano
- Department of Orthopedic Surgery, NYU Langone Hospital Long Island, Mineola, NY, USA
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The evolution of robotic systems for total knee arthroplasty, each system must be assessed for its own value: a systematic review of clinical evidence and meta-analysis. Arch Orthop Trauma Surg 2022; 143:3369-3381. [PMID: 36153769 DOI: 10.1007/s00402-022-04632-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 09/18/2022] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Robotic systems have been introduced to improve the precision of total knee arthroplasty. However, different robotic systems are available, each with unique features used to plan and execute the surgery. As such, due to this diversity, the clinical evaluation of each robotic platform should be separated. METHODS An extensive literature search of PubMed, Medline, Embase and Web of Science was conducted with subsequent meta-analysis. Randomised controlled trials, comparative studies, and cohort studies were included regarding robot-assisted total knee arthroplasty. Evaluated outcomes included clinical results, surgical precision, ligament balance, surgical time, learning curve, complications and revision rates. These were split up based on the robot-specific brand: ROBODOC (T-SOLUTION ONE), OMNIBOT, MAKO, NAVIO (CORI) and ROSA. RESULTS With a follow-up of more than 10 years, no improved clinical outcomes have been noted with the ROBODOC system compared to the conventional technique. If available, other platforms only present short-term clinical outcomes. Radiological outcomes are published for most robotic setups, demonstrating improved surgical precision compared to the conventional technique. Gap balance assessment is performed differently between all systems, leading to heterogeneous outcomes regarding its relationship on clinical outcomes. There is a similar learning curve based on operative time for all robotic platforms. In most studies, robot assistance requires longer operative time compared to the conventional technique. Complications and revision rates are published for ROBODOC and MAKO, without clear differences to conventional total knee arthroplasty. CONCLUSION The main finding of this systematic review is that the current evidence regarding each robotic system is diverse in quantity and quality. Each system has its own specificities and must be assessed for its own value. Regarding scientific literature, the generic term of robotic should be banned from the general conclusion. LEVEL OF EVIDENCE Systematic review level IV.
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Plancher KD, Briggs KK, Chinnakkannu K, Dotterweich KA, Commaroto SA, Wang KH, Petterson SC. Isolated Lateral Tibiofemoral Compartment Osteoarthritis: Survivorship and Patient Acceptable Symptom State After Lateral Fixed-Bearing Unicompartmental Knee Arthroplasty at Mean 10-Year Follow-up. J Bone Joint Surg Am 2022; 104:1621-1628. [PMID: 35766399 DOI: 10.2106/jbjs.21.01523] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Lateral unicompartmental knee arthroplasty (UKA) is an excellent option to alleviate disability and restore function in patients with lateral compartment knee osteoarthritis (OA). The purpose of the present study was to determine the survivorship and long-term outcomes in both younger/middle-aged and older patients with lateral compartment OA following non-robotically-assisted, fixed-bearing lateral UKA and to determine if an acceptable symptom state can be achieved. METHODS All patients were managed with fixed-bearing lateral UKA by a single surgeon utilizing a lateral parapatellar approach without robotic assistance. The primary outcome variables were the Knee injury and Osteoarthritis Outcome Score (KOOS) Activities of Daily Living (ADL) and Sport subscale scores. In addition, the other KOOS subscores, the Lysholm score, the achievement of the Patient Acceptable Symptom State (PASS), and the Veterans RAND (VR-12) Physical Component Summary score (PCS) and Mental Component Summary score (MCS) were collected. Failure was defined as conversion to total knee arthroplasty (TKA). Patients were divided into 2 cohorts: younger/middle-aged patients (<60 years of age) and older patients (≥60 years of age). RESULTS A cohort of 256 patients underwent medial (n = 193) or lateral (n = 63) UKA. Sixty-one patients met the inclusion criteria. At mean of 10 years (range, 4 to 17 years) of follow-up, there were no significant differences between the groups in terms of any patient-reported outcome measures (p > 0.05). The percentage of patients in whom PASS was achieved on the KOOS ADL and Sport subscores was 82% and 88%, respectively, in the younger cohort and 80% and 80%, respectively, in the older cohort. The mean survival estimate of the prothesis was 15.3 years (95% confidence interval [CI], 14.5 to 16.2 years) for the entire cohort. The estimated rate of implant survival in the younger cohort was 100% at 5 and 10 years, and the estimated rate of implant survival in the older cohort was 98% at 5 years and 96% at 10 years. CONCLUSIONS Lateral fixed-bearing, non-robotic UKA for the treatment of isolated lateral compartment OA resulted in >80% of patients reaching an acceptable symptom state in terms of both activities of daily living and sporting activities. UKA provides an excellent option that provides longevity with high PASS rates and return to activities with a low risk of complications and failure. LEVEL OF EVIDENCE Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Kevin D Plancher
- Department of Orthopaedic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY.,Department of Orthopaedic Surgery, Weill Cornell Medical College, New York, NY.,Plancher Orthopaedics & Sports Medicine, New York, NY.,Orthopaedic Foundation, Stamford, Connecticut
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Orsi AD, Wakelin EA, Plaskos C, Petterwood J, Coffey S. Restricted kinematic alignment achieves similar relative lateral laxity and greater joint line obliquity compared to gap balancing TKA. Knee Surg Sports Traumatol Arthrosc 2022; 30:2922-2930. [PMID: 35067777 DOI: 10.1007/s00167-022-06863-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 12/31/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to compare ligament balance and laxity profiles achieved throughout flexion in restricted kinematic alignment (rKA) and gap balancing (GB). rKA and GB both aim to improve soft tissue balance and reduce ligament releases in total knee arthroplasty (TKA). METHODS One surgeon performed 68 rKA, another performed 73 GB TKAs using the same CR implant and robotic system. rKA limited femoral valgus and tibial varus to 6°, with tibial recuts performed to achieve balance. GB limited tibial varus and femoral valgus to 2°, with femoral resections adjusted to achieve mediolateral balance throughout flexion using predictive-gap planning software. Final joint laxity was measured using a robotic ligament tensioner. Statistical analyses were performed to compare differences in mediolateral balance and joint laxity throughout flexion. Further analyses compared alignment, joint line elevation and orientation (JLO), and frequency of ligament releases and bone recuts. RESULTS Both techniques reported greater lateral laxity throughout flexion, with GB reporting improved mediolateral balance from 10° to 45° flexion. GB resected 1.7 mm more distal femur (p ≤ 0.001) and had greater overall laxity than rKA throughout flexion (p ≤ 0.01). rKA increased JLO by 2.5° and 3° on the femur and tibia (p ≤ 0.001). Pre-operative and post-operative coronal alignment were similar across both techniques. rKA had a higher tibial recut rate: 26.5% vs 1.4%, p < 0.001. CONCLUSIONS rKA and GB both report lateral laxity but with different JLO and elevation. Use of a predictive-gap GB workflow resulted in greater mediolateral gap symmetry with fewer recuts. LEVEL OF EVIDENCE III, retrospective cohort study.
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Affiliation(s)
- Alexander D Orsi
- Corin Ltd, Clinical Research, 480 Paramount Drive, Raynham, MA, 02767, USA.
| | - Edgar A Wakelin
- Corin Ltd, Clinical Research, 480 Paramount Drive, Raynham, MA, 02767, USA
| | | | - Josh Petterwood
- Department of Surgery, Royal Hobart Hospital, Hobart, TAS, 7000, Australia
| | - Simon Coffey
- Department of Orthopaedics, Nepean Hospital, Penrith, NSW, 2750, Australia
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Orsi AD, Wakelin EA, Plaskos C, Gupta S, Sullivan JA. 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. Arthroplast Today 2022; 16:1-8. [PMID: 35620585 PMCID: PMC9126743 DOI: 10.1016/j.artd.2022.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/24/2022] [Accepted: 03/30/2022] [Indexed: 11/28/2022] Open
Abstract
Background To understand the extent and frequency of soft-tissue adjustment required to achieve mediolateral (ML) balance in measured resection (MR) vs gap-balancing (GB) total knee arthroplasty, this study compared ML balance and joint laxity throughout flexion between the 2 techniques. The precision of predictive GB in achieving ML balance and laxity was also assessed. Methods Two surgeons performed 95 robot-assisted GB total knee arthroplasties with predictive balancing, limiting tibial varus to 3° and adjusting femoral positioning to optimize balance. A robotic ligament tensioner measured joint laxity. Planned MR (pMR) was simulated by applying neutral tibial and femoral coronal resections and 3° of external femoral rotation. ML balance, laxity, component alignment, and resection depths were compared between planned GB (pGB) and pMR. ML balance and laxity were compared between pGB and final GB (fGB). Results The proportion of knees with >2 mm of ML imbalance in flexion or extension ranged from 3% to 18% for pGB vs 50% to 53% for pMR (P < .001). Rates of ML imbalance >3 mm ranged from 0% to 9% for pGB and 30% to 38% for MR (P < .001). The mean pMR laxity was 1.9 mm tighter medially and 1.1 mm tighter laterally than pGB throughout flexion. The mean fGB laxity was greater than the mean pGB laxity by 0.5 mm medially and 1.2 mm laterally (P < .001). Conclusion MR led to tighter joints than GB, with ML gap imbalances >3 mm in 30% of knees. GB planning improved ML balance throughout flexion but increased femoral posterior rotation variability and bone resection compared to MR. fGB laxity was likely not clinically significantly different than pGB.
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Affiliation(s)
| | | | | | - Sanjeev Gupta
- Department of Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - James A. Sullivan
- Department of Surgery, Macquarie University Hospital, Sydney, New South Wales, Australia
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Takahashi T, Sugimoto K, Ae R, Saito T, Kimura Y, Kubo T, Handa M, Takeshita K. Can tibia-first total knee arthroplasty using computer-assisted system improve anterior and posterior knee stability? Technol Health Care 2022; 30:1147-1154. [PMID: 35599511 DOI: 10.3233/thc-213535] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Total knee arthroplasty (TKA) is a widely performed procedure to alleviate pain and restore function of patients with end-stage knee osteoarthritis. OBJECTIVE The study aim was to determine if tibia-first (TF) total knee arthroplasty (TKA) using a novel computer-assisted surgery (CAS) system can yield better anterior and posterior (AP) knee stability. METHODS Patients with knee osteoarthritis with obvious varus knee who met the indication for and underwent TKA from May 2019 to November 2020 were included. Forty-one measured resection (MR)-TKAs and 32 TF-TKAs were compared. The varus-valgus ligament balance and joint tension at a joint center-gap setting equal to the tibial-baseplate thickness were measured, and appropriate polyethylene inserts with 0∘, 30∘, 45∘, 60∘, 90∘, and 120∘ of knee flexion were placed. A Kneelax 3 arthrometer was used to measure knee AP laxity in the postoperative anesthetized patients with 30∘ and 90∘ of knee flexion. RESULTS The horizontal gap balance was significantly closer in the TF-TKA group than the MR-TKA group for 0∘, 30∘, 45∘, and 60∘ of knee flexion. In contrast, no significant differences were observed for 90∘ and 120∘ of knee flexion. No significant differences in joint-gap tensions among all knee-flexion angles were observed. Translation was significantly smaller in the TF-TKA group than the MR-TKA group for AP laxity with 30∘ of knee flexion (8.8 ± 2.9 mm vs. 10.7 ± 3.1 mm, P= 0.0079). In contrast, no significant AP laxity was observed with 90∘ of knee flexion (7.2 ± 2.8 mm vs. 7.2 ± 3.5 mm). CONCLUSION TF-TKA using a novel CAS system provided better AP knee stability with close to horizontal gap balances.
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Affiliation(s)
- Tsuneari Takahashi
- Department of Orthopedic Surgery, Ishibashi General Hospital, Shimotsuke, Japan
| | | | - Ryusuke Ae
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Tomohiro Saito
- Department of Orthopedic Surgery, Tochigi Medical Cener Shimotsuga, Tochigi, Japan
| | - Yuya Kimura
- Department of Orthopedic Surgery, Tochigi Medical Cener Shimotsuga, Tochigi, Japan
| | - Tatsuya Kubo
- Department of Orthopedic Surgery, Shin Kaminokawa Hospital, Kaminokawa, Japan
| | - Mikiko Handa
- Department of Orthopedic Surgery, Ishibashi General Hospital, Shimotsuke, Japan
| | - Katsushi Takeshita
- Department of Orthopedic Surgery, Jichi Medical University, Shimotsuke, Japan
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Sun C, Zhao Z, Lee WG, Ma Q, Zhang X, Zhu J, Cai X. Sensor-guided gap balance versus manual gap balance in primary total knee arthroplasty: a meta-analysis. J Orthop Surg Res 2022; 17:243. [PMID: 35440065 PMCID: PMC9020069 DOI: 10.1186/s13018-022-03129-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 04/10/2022] [Indexed: 11/10/2022] Open
Abstract
Background Despite Vast improvements in technology and surgical technique in total knee arthroplasty (TKA), approximately 15–25% TKAs, have suboptimal subjective clinical outcomes. Our study sought to evaluate if sensor-guided balancing improves postoperative clinical outcomes compared to a conventional gap balancing technique. Methods We searched Web of Science, Embase, PubMed, Cochrane Controlled Trials Register, Cochrane Library, Highwire, CBM, CNKI, VIP, and Wanfang database in March 2022 to identify studies involving sensor-guided balancing versus conventional gap balancing technique in TKA. Finally, we identified 2147 knees assessed in nine studies. Results Compared with manual gap balancing, Sensor-guided gap balancing resulted in less rate of Manipulation under anesthesia (MUA) (P = 0.02), however more rate of intraoperative additional procedures (P = 0.0003). There were no significant differences in terms of KSS (P = 0.21), KSS Function score (P = 0.36), OKS (P = 0.61), KOOS (P = 0.78), operative time (P = 0.17), Mechanical axis (P = 0.69) and rate of reoperation between two groups. Conclusion Compared with conventional manual gap balancing techniques, sensors have more balancing procedures being performed. However, it did result in a reduction in the rate of MUA. More extensive, high-quality RCTs are required to verify our findings further.
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Affiliation(s)
- Changjiao Sun
- Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No. 168 Litang Road, Dongxiaokou Town, Changping District, Beijing, 102218, China.
| | - Zhe Zhao
- Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No. 168 Litang Road, Dongxiaokou Town, Changping District, Beijing, 102218, China
| | - Woo Guan Lee
- FRCS (Edinburgh), Kuching Specialist Hospital, Tabuan Stutong Commercial Centre, 93350, Kuching, Sarawak, Malaysia
| | - Qi Ma
- Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No. 168 Litang Road, Dongxiaokou Town, Changping District, Beijing, 102218, China
| | - Xiaofei Zhang
- Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No. 168 Litang Road, Dongxiaokou Town, Changping District, Beijing, 102218, China
| | - Jianjin Zhu
- Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No. 168 Litang Road, Dongxiaokou Town, Changping District, Beijing, 102218, China
| | - Xu Cai
- Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No. 168 Litang Road, Dongxiaokou Town, Changping District, Beijing, 102218, China.
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Shatrov J, Battelier C, Sappey-Marinier E, Gunst S, Servien E, Lustig S. Functional Alignment Philosophy in Total Knee Arthroplasty – Rationale and technique for the varus morphotype using a CT based robotic platform and individualized planning. SICOT J 2022; 8:11. [PMID: 35363136 PMCID: PMC8973302 DOI: 10.1051/sicotj/2022010] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 03/07/2022] [Indexed: 12/19/2022] Open
Abstract
Introduction: Alignment techniques in total knee arthroplasty (TKA) continue to evolve. Functional alignment (FA) is a novel technique that utilizes robotic tools to deliver TKA with the aim of respecting individual anatomical variations. The purpose of this paper is to describe the rationale and technique of FA in the varus morphotype with the use of a robotic platform. Rationale: FA reproduces constitutional knee anatomy within quantifiable target ranges. The principles are founded on a comprehensive assessment and understanding of individual anatomical variations with the aim of delivering personalized TKA. The principles are functional pre-operative planning, reconstitution of native coronal alignment, restoration of dynamic sagittal alignment within 5° of neutral, maintenance of joint-line-obliquity and height, implant sizing to match anatomy and a joint that is balanced in flexion and extension through manipulation of implant positioning rather than soft tissue releases. Technique: An individualized plan is created from pre-operative imaging. Next, a reproducible and quantifiable method of soft tissue laxity assessment is performed in extension and flexion that accounts for individual variation in soft tissue laxity. A dynamic virtual 3D model of the joint and implant position that can be manipulated in all three planes is modified to achieve target gap measurements while maintaining the joint line phenotype and a final limb position within a defined coronal and sagittal range. Conclusion: Functional alignment is a novel knee arthroplasty technique that aims to restore constitutional bony alignment and balance the laxity of the soft tissues by placing and sizing implants in a manner that it respects the variations in individual anatomy. This paper presents the approach for the varus morphotype.
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Affiliation(s)
- Jobe Shatrov
- Department of Orthopaedics, Croix Rousse Hospital, University of Lyon 1 69004 Lyon France
- Sydney Orthopaedic Research Institute Chatswood 2065 Australia
| | - Cécile Battelier
- Department of Orthopaedics, Croix Rousse Hospital, University of Lyon 1 69004 Lyon France
- Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406 69622 Lyon France
| | - Elliot Sappey-Marinier
- Department of Orthopaedics, Croix Rousse Hospital, University of Lyon 1 69004 Lyon France
- Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406 69622 Lyon France
| | - Stanislas Gunst
- Department of Orthopaedics, Croix Rousse Hospital, University of Lyon 1 69004 Lyon France
- Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406 69622 Lyon France
| | - Elvire Servien
- Department of Orthopaedics, Croix Rousse Hospital, University of Lyon 1 69004 Lyon France
- Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406 69622 Lyon France
| | - Sebastien Lustig
- Department of Orthopaedics, Croix Rousse Hospital, University of Lyon 1 69004 Lyon France
- Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406 69622 Lyon France
- Corresponding author:
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Lambrechts A, Wirix-Speetjens R, Maes F, Van Huffel S. Artificial Intelligence Based Patient-Specific Preoperative Planning Algorithm for Total Knee Arthroplasty. Front Robot AI 2022; 9:840282. [PMID: 35350703 PMCID: PMC8957999 DOI: 10.3389/frobt.2022.840282] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/07/2022] [Indexed: 11/24/2022] Open
Abstract
Previous studies have shown that the manufacturer's default preoperative plans for total knee arthroplasty with patient-specific guides require frequent, time-consuming changes by the surgeon. Currently, no research has been done on predicting preoperative plans for orthopedic surgery using machine learning. Therefore, this study aims to evaluate whether artificial intelligence (AI) driven planning tools can create surgeon and patient-specific preoperative plans that require fewer changes by the surgeon. A dataset of 5409 preoperative plans, including the manufacturer's default and the plans corrected by 39 surgeons, was collected. Features were extracted from the preoperative plans that describe the implant sizes, position, and orientation in a surgeon- and patient-specific manner. Based on these features, non-linear regression models were employed to predict the surgeon's corrected preoperative plan. The average number of corrections a surgeon has to make to the preoperative plan generated using AI was reduced by 39.7% compared to the manufacturer's default plan. The femoral and tibial implant size in the manufacturer's plan was correct in 68.4% and 73.1% of the cases, respectively, while the AI-based plan was correct in 82.2% and 85.0% of the cases, respectively, compared to the surgeon approved plan. Our method successfully demonstrated the use of machine learning to create preoperative plans in a surgeon- and patient-specific manner for total knee arthroplasty.
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Affiliation(s)
- Adriaan Lambrechts
- Materialise NV, Leuven, Belgium
- Department of Electrical Engineering (ESAT), STADIUS Center for Dynamical Systems, Signal Processing and Data Analytics, KU Leuven, Leuven, Belgium
| | | | - Frederik Maes
- Department of Electrical Engineering (ESAT), Processing Speech and Images (PSI), KU Leuven, Leuven, Belgium
- Medical Imaging Research Center, UZ Leuven, Leuven, Belgium
| | - Sabine Van Huffel
- Department of Electrical Engineering (ESAT), STADIUS Center for Dynamical Systems, Signal Processing and Data Analytics, KU Leuven, Leuven, Belgium
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