Accuracy of Balancing at Total Knee Surgery Using an Instrumented Tibial Trial

Meere, Patrick; Schneider, Svenja; Walker, Peter S.

doi:10.1016/j.arth.2016.02.050

Cited by 34 publications

(24 citation statements)

References 20 publications

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“…In conclusion, the authors revealed that PROMs were unrelated to mediolateral balance of the knee, as determined by medial and lateral TFCF. Meere et al 27 reported that the FR was 0.52% + 0.14 throughout ROM using Triathlon knee (PCL retaining or sacrificing TKA (Stryker)) with VERASENSE system, while the FR was 0.44% + 0.22 in the current study. This is because the lateral TFCF was higher than medial TFCF from 10 to 60 of flexion.…”

supporting

confidence: 43%

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

Kaneko

Kono

Mochizuki

et al. 2020

J Orthop Surg (Hong Kong)

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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

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supporting

confidence: 43%

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

Kaneko

Kono

Mochizuki

et al. 2020

J Orthop Surg (Hong Kong)

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“…In summary, the target for setting the tibial force when balancing a mechanically aligned TKA has been controversial. 4,5,19,24,34,39 In contrast, the target when performing calipered KA TKA is to adjust component positions without ligament release until the tibial force matches the native knee as a tibial force 30 lb greater than native knee causes a loss of extension, loss of flexion, and anterior translation of the tibia at 90 degrees of flexion.…”

Section: Figmentioning

confidence: 99%

A Total Knee Arthroplasty Is Stiffer When the Intraoperative Tibial Force Is Greater than the Native Knee

2018

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We hypothesized that a total knee arthroplasty (TKA) with an intraoperative tibial force greater than the tibial force of the native knee has signs of stiffness as measured by loss of extension and flexion, and anterior translation of the tibia. Intraoperative forces in the medial and lateral tibial compartments were measured during passive motion in 71 patients treated with calipered kinematically aligned TKA. Maximum extension, flexion, and the anterior–posterior position of the tibia with respect to the distal femur at 90 degrees of flexion were measured. Measurements were repeated after exchanging to a 2 mm thicker insert. The sum of the average of the medial and lateral compartment forces at 0, 45, and 90 degrees of flexion represented the tibial force through a 90-degree motion arc. For the implanted insert, the tibial force averaged 28 ± 17 lb, which is comparable to the 20 ± 7 lb reported for the native knee. At 6 months, patients reported an average 40 point Oxford Knee and 15 point Western Ontario and McMaster Universities Osteoarthritis (WOMAC) score. For the 2 mm thicker insert, the tibial force averaged 50 ± 28 lb. A 30 lb tibial force greater than native generated a 3-degree loss of extension, a 3-degree loss of flexion, and 3-mm anterior translation of the tibia. Because a TKA with a tibial force greater than native has signs of stiffness, a strategy for lowering this risk is to match the tibial force of the native knee when balancing a TKA as this restored high function.

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“…However, dynamic effects in slow and constant motions, such as walking, stair climbing or getting up out of a chair, might play a minor role. The muscles and soft-tissues are very simplified or neglected because of the model's simplicity, although they have a strong impact on joint loading [39,40]. Model definitions were partly modified to allow a patient-specific adaption based on AP long-leg radiographs recorded in the standard clinical routine of TKA, which might contradict the original author's intention.…”

Section: Limitationsmentioning

confidence: 99%

Evaluation and validation of 2D biomechanical models of the knee for radiograph-based preoperative planning in total knee arthroplasty

et al. 2020

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Thorough preoperative planning in total knee arthroplasty is essential to reduce implant failure by proper implant sizing and alignment. The "gold standard" in conventional preoperative planning is based on anterior-posterior long-leg radiographs. However, the coronal component alignment is still an open discussion in literature, since studies have reported contradictory outcomes on survivorship, indicating that optimal individual alignment goals still need to be defined. Two-dimensional biomechanical models of the knee have the potential to predict joint forces and, therefore, objectify therapy planning. Previously published two-dimensional biomechanical models were evaluated and validated for the first time in this study by comparison of model predictions to corresponding in vivo measurements obtained from telemetric implants for a one-and two-leg stance. Model input parameters were acquired from weight-bearing anterior-posterior long-leg radiographs and statistical assumptions for patient-specific model adaptation. The overall time from initialization to load prediction was in the range of 7-8 minutes per patient for all models. However, no model could accurately predict the correct trend of knee joint forces over patients. Two dimensional biomechanical models of the knee have the potential to improve preoperative planning in total knee arthroplasty by providing additional individual biomechanical information to the surgeon. Although integration into the clinical workflow might be performed with acceptable costs, the models' accuracy is insufficient for the moment. Future work is needed for model optimization and more sophisticated modelling approaches.

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Accuracy of Balancing at Total Knee Surgery Using an Instrumented Tibial Trial

Cited by 34 publications

References 20 publications

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

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

A Total Knee Arthroplasty Is Stiffer When the Intraoperative Tibial Force Is Greater than the Native Knee

Evaluation and validation of 2D biomechanical models of the knee for radiograph-based preoperative planning in total knee arthroplasty

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