Does the Use of Intraoperative Pressure Sensors for Knee Balancing in Total Knee Arthroplasty Improve Clinical Outcomes? A Comparative Study With a Minimum Two-Year Follow-Up

MacDessi, Samuel J.; Cohen, Daniel; Wood, Jil A.; Diwan, Ashish D.; Harris, Ian A.

doi:10.1016/j.arth.2020.08.025

Cited by 15 publications

(22 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[ 12 ] have found improved outcomes with the use of joint-pressure-sensing devices; however, MacDessi et al. [ 13 ] and Song et al. [ 14 ] did not demonstrate an improvement.…”

Section: Discussionmentioning

confidence: 99%

Impact of a Digital Balancing Tool on Femur and Tibial First Total Knee Arthroplasty: A Prospective Nonrandomized Controlled Trial

Koenig¹,

Wakelin²,

Passano³

et al. 2022

Arthroplasty Today

View full text Add to dashboard Cite

“…[ 12 ] have found improved outcomes with the use of joint-pressure-sensing devices; however, MacDessi et al. [ 13 ] and Song et al. [ 14 ] did not demonstrate an improvement.…”

Section: Discussionmentioning

confidence: 99%

Impact of a Digital Balancing Tool on Femur and Tibial First Total Knee Arthroplasty: A Prospective Nonrandomized Controlled Trial

Koenig¹,

Wakelin²,

Passano³

et al. 2022

Arthroplasty Today

View full text Add to dashboard Cite

“…Surgeons have observed significant improvements in soft tissue balancing with the use of sensor-assisted knee replacement [ 19 ]. The correlation between a soft tissue balance, achieved with the use of sensor technology, and postoperative outcomes is inconsistent; while Golladay et al [ 20 ] reported higher patient satisfaction with soft tissue balancing, Macdessi et al [ 21 ] did not identify better short-term outcomes. Sun et al [ 16 ] previously reported on a pressure sensor that was inserted under the bearing of the trial component which increased the actual thickness of the bearing, so their design produced relatively large fluctuations in pressure measurements within a certain range.…”

Section: Discussionmentioning

confidence: 99%

Can mobile-bearing unicompartmental knee arthroplasty achieve natural gap-balancing? An observational study with a novel pressure sensor

et al. 2022

View full text Add to dashboard Cite

Background Mobile-bearing unicompartmental knee arthroplasty (MB-UKA) is an effective treatment for anteromedial knee osteoarthritis. Meticulous intraoperative soft tissue balancing remains challenging yet consequential for a successful operation. Currently, surgeons rely mostly on their experience during soft tissue balancing, yielding unreproducible results. The purpose of this study was to quantified measure the soft tissue tension of medial compartment and determine if an optimal "target" tension values with the natural state exists. Methods This was an observational study of 24 consecutive patients. All 30 UKAs were performed by a single surgeon. The piezoresistive sensor was custom designed to fit in the medial compartment gap. Contact pressures were measured at 5 angular positions of the knee intraoperatively: 0°, 20°, 45°, 90°, and 110° of flexion. The change in pressure from extension (20° position) and flexion (110° position) was also calculated (E-FPD). Data on age, sex, body mass index, operative side, and bearing size were collected. Outcome measures were measured at baseline and at the 6-month postoperative follow-up; Oxford Knee Score, visual analog scale score, and range of motion were compared to evaluate clinical outcomes. Results There was a significant improvement in patients in all measured outcomes at 6 months from baseline (P < 0.05). The E-FPD of 14.9 N (8.9, 24.6) was indicative of appropriate soft tissue balancing throughout the functional range of knee motion. Of 30 knees, 22 were 3-mm bearing and 8 were 4- or 5-mm bearing. The pressure data of the 3-mm bearing group was larger than that of the non-3-mm bearing group for each knee flexion degree, but the difference was not statistically significant (P > 0.05). Conclusions Objective data from sensor output may assist surgeons in decreasing loading variability during MB-UKA. The data suggested that MB-UKA could not accurately restore soft tissue tension to the natural state, which was related to the inability of MB-UKA surgical instruments to fine adjust the bone cut and soft tissue release. Study registration Chinese Clinical Trial Registry (http://www.chictr.org.cn): ChiCTR1900024146.

show abstract

“…It is hoped that improving soft tissue balance will result in enhanced PROMs and longer duration of implant survival. No difference has been reported in overall complications or revision within 1 year [ 51 , 59 ••, 64 ]. To date, there are no studies comparing implant survival of sensor-assisted versus manual TKA beyond 2 years.…”

Section: Intra-operative Technique and Supporting Evidencementioning

confidence: 99%

“…Two industry-sponsored reports suggested that ‘balanced’ knees were associated with greater improvement in PROMs and satisfaction [ 50 , 65 ]. However, several retrospective and prospective studies have subsequently failed to demonstrate any significant difference in overall satisfaction, knee-specific outcomes, and general health-related quality of life measures at 6 and 12 months [ 42 , 51 , 56 •, 59 ••, 62 , 64 , 66 ]. These findings could suggest that the current ‘target’ balance utilised by most authors is either incorrect or at the very least too narrow to identify a difference.…”

Section: Intra-operative Technique and Supporting Evidencementioning

confidence: 99%

Total Knee Arthroplasty and Intra-Articular Pressure Sensors: Can They Assist Surgeons with Intra-Operative Decisions?

Yapp

Robinson

Clement

et al. 2021

Curr Rev Musculoskelet Med

View full text Add to dashboard Cite

Purpose of Review Soft tissue imbalance, presenting as instability or stiffness, is an important cause of revision total knee arthroplasty (TKA). Traditional methods of determining soft tissue balance of the knee lack precision and are not reliable between operators. Use of intra-operative pressure sensors offers the potential to identify and avoid soft tissue imbalance following TKA. This review aims to summarise the literature supporting the clinical indication for the use of intra-articular pressure sensors during TKA. Recent Findings Analytical validation studies suggest that intra-operative pressure sensors demonstrate ‘moderate’ to ‘good’ intra-observer reliability and ‘good’ to ‘excellent’ interobserver reliability throughout the flexion arc. However, there are important errors associated with measurements when devices are used out-with the stated guidelines and clinicians should be aware of the limitations of these devices in isolation. Current evidence regarding patient benefit is conflicting. Despite positive early results, several prospective studies have subsequently failed to demonstrate significant differences in overall survival, satisfaction, and patient-reported outcome measures within 1 year of surgery. Summary Surgeon-defined soft tissue stability appears to be significantly different from the absolute pressures measured by the intra-operative sensor. Whilst it could be argued that this confirms the need for intra-articular sensor guidance in TKA; the optimal ‘target’ balance remains unclear and the relationship with outcome in patients is not determined. Future research should (1) identify a suitable reference standard for comparison; (2) improve the accuracy of the sensor outputs; and (3) demonstrate that sensor-assisted TKA leads to patient benefit in patient-reported outcome measures and/or enhanced implant survival.

show abstract

Does the Use of Intraoperative Pressure Sensors for Knee Balancing in Total Knee Arthroplasty Improve Clinical Outcomes? A Comparative Study With a Minimum Two-Year Follow-Up

Cited by 15 publications

References 21 publications

Impact of a Digital Balancing Tool on Femur and Tibial First Total Knee Arthroplasty: A Prospective Nonrandomized Controlled Trial

Impact of a Digital Balancing Tool on Femur and Tibial First Total Knee Arthroplasty: A Prospective Nonrandomized Controlled Trial

Can mobile-bearing unicompartmental knee arthroplasty achieve natural gap-balancing? An observational study with a novel pressure sensor

Total Knee Arthroplasty and Intra-Articular Pressure Sensors: Can They Assist Surgeons with Intra-Operative Decisions?

Contact Info

Product

Resources

About