Balancing of total knee arthroplasty by bone cuts achieves accurately balanced soft tissues without the need for soft tissue releases

Firer, P; Gelbart, Brad

doi:10.1136/jisakos-2018-000217

Cited by 7 publications

(7 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The use of a flexion spacer in total knee arthroplasty allows surgeons to achieve accurate knee balancing only with the use of bone cuts, without the need for soft tissue releases. This was also supported by a recent study reporting clinical and radiological outcomes on 914 consecutive TKAs using bone balancing [3]. At the final follow‐up, the coronal alignment profile produced matches with that of the normal population, confirming that bone balancing improves satisfaction compared to that reported in the literature for mechanically aligned TKAs [3].…”

Section: Discussionsupporting

confidence: 69%

“…This was also supported by a recent study reporting clinical and radiological outcomes on 914 consecutive TKAs using bone balancing [3]. At the final follow‐up, the coronal alignment profile produced matches with that of the normal population, confirming that bone balancing improves satisfaction compared to that reported in the literature for mechanically aligned TKAs [3]. These results appear to be in contrast with the results of a meta‐analysis performed in 2017 in which the authors found that gap balancing techniques resulted in statistically significant improvements in the restoration of mechanical and rotational alignment and mean Knee Society scores and Knee Society function scores two years postoperatively but resulted in greater elevation of the position of the joint line; no statistically significant differences were found in radiographic parameters [8].…”

Section: Discussionsupporting

confidence: 66%

“…All procedures were performed by the senior author. Surgeries were performed without the use of a tourniquet using the bone balancing technique and therefore did not require soft tissue releases [3]. All the patients included in the study were implanted with the same model of knee prosthesis [Vanguard ® cruciate retaining (CR) or posterior stabilized (PS)-Zimmer-Biomet, Warsaw, Indiana, USA].…”

Section: Flexion Spacer and Surgical Techniquementioning

confidence: 99%

See 2 more Smart Citations

Improving radiographic patello-femoral tracking in total knee arthroplasty with the use of a flexion spacer: a case–control study

D’Elicio

Attanasio

Ruffo

et al. 2020

Knee Surg Sports Traumatol Arthrosc

View full text Add to dashboard Cite

Purpose The purpose of this study was to compare the efectiveness of a lexion spacer in the clinical and radiological outcomes of patients who underwent total knee arthroplasty (TKA) and to compare these patients to a group of patients subjected to the same type of surgery but without the use of a lexion spacer. It was hypothesized that patients who underwent TKA using a lexion spacer would have better clinical and radiological outcomes than those without a lexion spacer in both short-and medium-term follow-ups. Methods A consecutive series of patients undergoing TKA were included, yielding 20 patients in the study group. The control group was identiied from the consultant database of the senior author, yielding 21 patients who underwent the same operation. All 41 patients received a Vanguard Knee System (Zimmer-Biomet, Warsaw, Indiana, USA). Cases were deined as those patients who had undergone TKA using a lexion spacer device for gap balancing; controls were deined as patients who had undergone TKA without the support of a lexion spacer device. Patients were clinically and radiographically evaluated at two consecutive follow-ups: T 1 -13.1 ± 1.3 months and T 2 -108 ± 6 months. Clinical evaluation was performed using the Knee Society Scoring System and the Western Ontario, McMaster Universities Osteoarthritis Index score. Radiographic evaluation included the femoral angle (α), the tibial angle (β), the sagittal femoral (γ) angle and the tibial slope (δ). Furthermore, the lateral patellofemoral angle (LPFA) and the Caton-Deschamps index were evaluated. ResultsNo statistically signiicant clinical diferences were found between the two groups at T 1 and T 2 ; moreover, the clinical outcomes of the two groups were stable between the two follow-ups, with no signiicant improvement or worsening. Radiographic evaluation showed no diference in the two groups between T 1 and T 2 ; the only signiicant radiographic diference between the two groups concerned the LPFA (both at 30° and 60°) at each follow-up, which was signiicantly greater in cases than in controls (p = 0.001). Conclusions The current study demonstrates that the use of a lexion spacer signiicantly improves radiographic patellofemoral tracking, although no signiicant clinical diferences were found between the two groups. Level of evidence Case-control study, level III.

show abstract

Section: Discussionsupporting

confidence: 69%

Section: Discussionsupporting

confidence: 66%

Section: Flexion Spacer and Surgical Techniquementioning

confidence: 99%

See 1 more Smart Citation

Improving radiographic patello-femoral tracking in total knee arthroplasty with the use of a flexion spacer: a case–control study

D’Elicio

Attanasio

Ruffo

et al. 2020

Knee Surg Sports Traumatol Arthrosc

View full text Add to dashboard Cite

show abstract

“…Firer et al reported that, in conventional instrumented TKA, no soft tissue releases were secured [ 7 ] when ligament balance was secured completely by bone cuts and implant placement to accommodate the soft tissues. PCL was removed in all patients.…”

Section: Discussionmentioning

confidence: 99%

“…Bone cuts were made based on a template, depending on the degree of deformity calculated from the pre-operative X-ray by using a gap balancing technique for both flexion and extension. However, no objective ligament balancing assessment was conducted intraoperatively due to the debate on what is the appropriate value of tension [ 7 ]. In this study, a balanced knee depended on the ‘surgeons feel factor’ or ‘Surgeon-defined Assessment’ (SDA).…”

Section: Discussionmentioning

confidence: 99%

Incidence of soft tissue releases in robotic assisted cementless TKA with mechanical alignment and flexion gap balancing

2023

View full text Add to dashboard Cite

Background To ensure the success of total knee arthroplasty (TKA), precise bone cuts and a well-balanced soft tissue envelope are crucial. Soft tissue release may be necessary, subject to various factors. Therefore, documenting the type, frequency, and necessity of soft tissue releases can establish a benchmark for comparing different alignment techniques and philosophies and evaluating their outcomes. The purpose of this study was to demonstrate that robotic-assisted knee surgery requires minimal soft tissue release. Methods We prospectively documented and retrospectively reviewed the soft tissue releases employed in securing ligament balance in the first 175 patients who received robotic-assisted TKAs at Nepean Hospital. ROSA was utilized in all surgeries with the aim of restoring mechanical coronal alignment, with a flexion gap balancing technique. Surgeries were performed between December 2019 to August 2021 by a single surgeon who used a standard medial parapatellar approach without a tourniquet, and the cementless persona prosthesis. All patients were followed up for a minimum of 6 months post-surgery. Soft tissue releases included any form of medial release for varus knee, posterolateral release for valgus knee and PCL fenestration or sacrifice. Results There were 131 female and 44 male patients, aged between 48 to 89 years (average 60 years). The preoperative HKA ranged from 22 degrees varus to 28 degrees valgus, with 71% of patients presenting with a varus deformity. For the whole group, the no need for soft tissue release was documented in 123 patients (70.3%), small fenestrated releases of PCL in 27 (15.4%), sacrifice of PCL in 8 (4.5%), medial releases in 4 (2.3%) and posterolateral releases in 13 (7.4%). In 29.7% of patients in whom a soft tissue release was necessary for balance, over half were/received minor fenestrations of the PCL. Outcomes to date included no revisions or impending revisions, 2 MUAs (1%), and Oxford knee scores averaged 40 at 6 months. Conclusion We concluded that Robot technology enhanced the precision of bone cuts and allowed for titration of required soft tissue releases to achieve optimal balance.

show abstract

No difference in postoperative patient satisfaction rates between mechanical and kinematic alignment total knee arthroplasty: A systematic review

Khan,

Leica,

Sava

et al. 2024

J. exp. orthop.

View full text Add to dashboard Cite

PurposeThe purpose of this systematic review was to compare patient satisfaction patient‐reported outcomes (PROMs) levels after mechanically aligned (MA) and kinematically aligned (KA) total knee arthroplasty (TKA).MethodsA systematic literature search following PRISMA guidelines was conducted on PubMed, Embase, Medline and Scopus to identify potentially relevant articles for this review, published from the beginning of March 2013 until the end of October 2023. Only articles reporting satisfaction after KA TKA, MA TKA or both were included, which use valid and reliable tools for the evaluation and reporting of satisfaction after TKA. Title, authors, year of publication, study design, level of evidence, follow‐up period, patients' demographic data, sample size, type of satisfaction score, postoperative satisfaction score, postoperative alignment, statistical significance, as well as other variables, were extracted for analysis. An Agency for Healthcare Research and Quality's (AHRQ) design‐specific scale was used for assessing randomized control trials (RCTs). The nonrandomized control trials were evaluated by using the Joanna Briggs Institute's (JBI) Critical Appraisal Tool. The Newcastle‐Ottawa Scale (NOS) was also used to assess cohort studies, while case series were evaluated using the NIH Quality Assessment Tool for Case Series Studies.ResultsThe initial search identified 316 studies, of which 178 were considered for screening. Eleven studies completely fulfilled the inclusion criteria, including one RCT, five nonrandomized control trials/quasi‐experiments, three case series, and two cohort studies. The total number of patients recruited for MA TKA was 1740. Conversely, 497 patients were enrolled for KA TKA. Five studies used the visual analogue scale (VAS) for assessing postoperative patient satisfaction, four used the Knee Society Score (KSS) 2011 version and two Likert‐based types of scores. Overall, the highest mean satisfaction score of KSS 2011 was 31.5 ± 6.6 in the MA group, and 29.8 ± 80 in the KA group in four studies. All of them showed high postoperative patient satisfaction rates for both MA and KA TKA, but with no statistically significant difference between them (p > 0.05).ConclusionBoth mechanically aligned total knee arthroplasty, as well as kinematically aligned total knee arthroplasty led to high rates of postoperative patient satisfaction, with no statistically significant differences between them.Level of EvidenceLevel III, systematic review.

show abstract

Balancing of total knee arthroplasty by bone cuts achieves accurately balanced soft tissues without the need for soft tissue releases

Cited by 7 publications

References 25 publications

Improving radiographic patello-femoral tracking in total knee arthroplasty with the use of a flexion spacer: a case–control study

Improving radiographic patello-femoral tracking in total knee arthroplasty with the use of a flexion spacer: a case–control study

Incidence of soft tissue releases in robotic assisted cementless TKA with mechanical alignment and flexion gap balancing

No difference in postoperative patient satisfaction rates between mechanical and kinematic alignment total knee arthroplasty: A systematic review

Contact Info

Product

Resources

About