Balancing mobile-bearing unicondylar knee arthroplasty in vitro

Heyse, Thomas J.; Slane, Joshua; Peersman, Geert; Dworschak, Philipp; Fuchs-Winkelmann, Susanne; Scheys, Lennart

doi:10.1007/s00167-016-4241-8

Cited by 19 publications

(25 citation statements)

References 24 publications

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“…However, the lateral compartment pressure was not increased even in over-stuffed knees. 21 In our study, balancing the knee in the HL position did restore kinematics, which was closer to the native knee on Var-Val and rotational testing on area under the curve analysis. It has been our experience that balancing the knee in flexion is more difficult in the SL position.…”

Section: Discussionsupporting

confidence: 53%

“…There is no consensus on what constitutes a well-balanced UKA due to a paucity of clinical and biomechanical data. 21 It has been proven in a cadaveric model that mobile bearing UKA leads to better restoration of kinematics in the unloaded state. Also, the presence of a mobile insert is likely to be beneficial during passive and squatting motion by preventing abnormal posterior translation of the medial femoral compartment.…”

Section: Discussionmentioning

confidence: 99%

“…Also, the presence of a mobile insert is likely to be beneficial during passive and squatting motion by preventing abnormal posterior translation of the medial femoral compartment. 22 In another cadaveric study, Heyse et al 21 underlined the importance of optimal balancing. They recommended against over-stuffing the joint as this led to larger kinematic changes compared to the native condition and caused excess strain in the superficial medial collateral ligament.…”

Section: Discussionmentioning

confidence: 99%

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Limb position influences component orientation in Oxford mobile bearing unicompartmental knee arthroplasty

Tapasvi¹,

Shekhar²,

Patil

et al. 2020

Bone & Joint Research

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Aims The mobile bearing Oxford unicompartmental knee arthroplasty (OUKA) is recommended to be performed with the leg in the hanging leg (HL) position, and the thigh placed in a stirrup. This comparative cadaveric study assesses implant positioning and intraoperative kinematics of OUKA implanted either in the HL position or in the supine leg (SL) position. Methods A total of 16 fresh-frozen knees in eight human cadavers, without macroscopic anatomical defects, were selected. The knees from each cadaver were randomized to have the OUKA implanted in the HL or SL position. Results Tibial base plate rotation was significantly more variable in the SL group with 75% of tibiae mal-rotated. Multivariate analysis of navigation data found no difference based on all kinematic parameters across the range of motion (ROM). However, area under the curve analysis showed that knees placed in the HL position had much smaller differences between the pre- and post-surgery conditions for kinematics mean values across the entire ROM. Conclusion The sagittal tibia cut, not dependent on standard instrumentation, determines the tibial component rotation. The HL position improves accuracy of this step compared to the SL position, probably due to better visuospatial orientation of the hip and knee to the surgeon. The HL position is better for replicating native kinematics of the knee as shown by the area under the curve analysis. In the supine knee position, care must be taken during the sagittal tibia cut, while checking flexion balance and when sizing the tibial component.

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Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Limb position influences component orientation in Oxford mobile bearing unicompartmental knee arthroplasty

Tapasvi¹,

Shekhar²,

Patil

et al. 2020

Bone & Joint Research

View full text Add to dashboard Cite

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“…Generally, ligament balance is subjectively assessed by the surgeon [13] and can be modified by altering the thickness of the polyethylene bearing. If chosen improperly by using either an under-or oversized polyethylene insert, the resulting tibiofemoral kinematics, contact pressure, and wear properties can be altered [14,15].While previous studies have documented the effect of bearing thickness on unicompartmental implants [16,17], there have been no studies documenting the influence on BCR TKA.…”

Section: Introductionmentioning

confidence: 98%

The influence of polyethylene bearing thickness on the tibiofemoral kinematics of a bicruciate retaining total knee arthroplasty

et al. 2017

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“…Different soft-tissue balancing based on implant positioning affects the kinematics of the knee in vitro . 25 …”

Section: Discussionmentioning

confidence: 99%

Robotic arm-assistedversusconventional unicompartmental knee arthroplasty

Blyth

Anthony

Rowe

et al. 2017

Bone & Joint Research

108

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ObjectivesThis study reports on a secondary exploratory analysis of the early clinical outcomes of a randomised clinical trial comparing robotic arm-assisted unicompartmental knee arthroplasty (UKA) for medial compartment osteoarthritis of the knee with manual UKA performed using traditional surgical jigs. This follows reporting of the primary outcomes of implant accuracy and gait analysis that showed significant advantages in the robotic arm-assisted group.MethodsA total of 139 patients were recruited from a single centre. Patients were randomised to receive either a manual UKA implanted with the aid of traditional surgical jigs, or a UKA implanted with the aid of a tactile guided robotic arm-assisted system. Outcome measures included the American Knee Society Score (AKSS), Oxford Knee Score (OKS), Forgotten Joint Score, Hospital Anxiety Depression Scale, University of California at Los Angeles (UCLA) activity scale, Short Form-12, Pain Catastrophising Scale, somatic disease (Primary Care Evaluation of Mental Disorders Score), Pain visual analogue scale, analgesic use, patient satisfaction, complications relating to surgery, 90-day pain diaries and the requirement for revision surgery.ResultsFrom the first post-operative day through to week 8 post-operatively, the median pain scores for the robotic arm-assisted group were 55.4% lower than those observed in the manual surgery group (p = 0.040).At three months post-operatively, the robotic arm-assisted group had better AKSS (robotic median 164, interquartile range (IQR) 131 to 178, manual median 143, IQR 132 to 166), although no difference was noted with the OKS.At one year post-operatively, the observed differences with the AKSS had narrowed from a median of 21 points to a median of seven points (p = 0.106) (robotic median 171, IQR 153 to 179; manual median 164, IQR 144 to 182). No difference was observed with the OKS, and almost half of each group reached the ceiling limit of the score (OKS > 43). A greater proportion of patients receiving robotic arm-assisted surgery improved their UCLA activity score.Binary logistic regression modelling for dichotomised outcome scores predicted the key factors associated with achieving excellent outcome on the AKSS: a pre-operative activity level > 5 on the UCLA activity score and use of robotic-arm surgery. For the same regression modelling, factors associated with a poor outcome were manual surgery and pre-operative depression.ConclusionRobotic arm-assisted surgery results in improved early pain scores and early function scores in some patient-reported outcomes measures, but no difference was observed at one year post-operatively. Although improved results favoured the robotic arm-assisted group in active patients (i.e. UCLA ⩾ 5), these do not withstand adjustment for multiple comparisons.Cite this article: M. J. G. Blyth, I. Anthony, P. Rowe, M. S. Banger, A. MacLean, B. Jones. Robotic arm-assisted versus conventional unicompartmental knee arthroplasty: Exploratory secondary analysis of a randomised controlled trial. Bone J...

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Balancing mobile-bearing unicondylar knee arthroplasty in vitro

Cited by 19 publications

References 24 publications

Limb position influences component orientation in Oxford mobile bearing unicompartmental knee arthroplasty

Limb position influences component orientation in Oxford mobile bearing unicompartmental knee arthroplasty

The influence of polyethylene bearing thickness on the tibiofemoral kinematics of a bicruciate retaining total knee arthroplasty

Robotic arm-assistedversusconventional unicompartmental knee arthroplasty

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