How to Quantitatively Balance a Total Knee? A Surgical Algorithm to Assure Balance and Control Alignment

Abstract

To achieve a balanced total knee, various surgical corrections can be performed, while intra-operative sensors and surgical navigation provide quantitative, patient-specific feedback. To understand the impact of these corrections, this paper evaluates the quantitative impact of both soft tissue releases and bone recuts on knee balance and overall limb alignment. This was achieved by statistically analyzing the alignment and load readings before and after each surgical correction performed on 479 consecutive primary total knees. An average of three surgical corrections were required following the initial bone cuts to achieve a well aligned, balanced total knee. Various surgical corrections, such as an arcuate release or increasing the tibial polyethylene insert thickness, significantly affected the maximum terminal extension. The coronal alignment was significantly impacted by pie-crusting the MCL, adding varus to the tibia, or releasing the arcuate ligament or popliteus tendon. Each surgical correction also had a specific impact on the intra-articular loads in flexion and/or extension. A surgical algorithm is presented that helps achieve a well-balanced knee while maintaining the sagittal and coronal alignment within the desired boundaries. This analysis additionally indicated the significant effect that soft tissue adjustments can have on the limb alignment in both anatomical planes.

Robotic-assisted revision total knee arthroplasty: a novel surgical technique

“…8 feedback in the system can provide real-time information thus helping surgeons achieve a well-balanced knee throughout the range of movement. Recent studies of robotic-assisted primary TKA showed that surgeons were able to achieve quantitatively balanced knee by using the robotic platform with real-time feedback from intraoperative load sensors [19,20]. A study by Held et al reported that robotic-assisted TKA resulted in improved intraoperative compartment balancing when compared with conventional TKA [21].…”

Popliteus Avulsion Fracture After Unicompartmental Arthroplasty

“…To the best of our knowledge, no description of this injury pattern and method of treatment have been detailed in the arthroplasty patient. The popliteus is occasionally viewed as structure that may be released to improve gap balancing 5,6 on occasion during knee arthroplasty. However, dysfunction of the popliteus tendon (i.e., subluxation) may represent a source of discomfort after arthroplasty, while routine sectioning of this tendon during knee balancing may adversely affect postoperative functional scores.…”

Assistive technologies in knee arthroplasty: fashion or evolution? Rate of publications and national registries prove the Scott Parabola wrong

“…Modern robotic platforms are integrating all these parameters and will probably continue to evolve integrating augmented reality to be able to visualize 3D and to use intra-operatively a 3D planning without having to look at a screen while operating. AI tools will also probably become a part of the platforms as most of these systems are giving direct feedbacks on a significant number of intricated surgical parameters such as component position, bone resections, femoral rotation [21], ligament balancing [22], and global alignment [23].…”