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

Koenig, Jan; Wakelin, Edgar A.; Passano, Brandon; Shalhoub, Sami; Plaskos, Christopher

doi:10.1016/j.artd.2022.06.020

Cited by 3 publications

(2 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The remaining cases ( n = 258) were performed using a tibia‐first GB approach by all surgeons. A detailed MA and GB surgical workflow is described by Koenig et al [16] and Shalhoub et al [27], respectively. In both workflows, a neutral coronal tibial resection was targeted; however, the GB group then modified the femoral component to achieve the desired balance, and the MA group executed a neutral coronal femoral resection and 3° external rotation from the posterior condylar axis followed by soft‐tissue release to achieve balance [24].…”

Section: Methodsmentioning

confidence: 99%

Intra‐operative laxity and balance impact 2‐year pain outcomes in TKA: a prospective cohort study

Wakelin,

Ponder,

Randall

et al. 2023

Knee surg. sports traumatol. arthrosc.

Self Cite

View full text Add to dashboard Cite

Purpose The objective of this study was to determine if intra-operatively measured joint gaps are associated with 2-year pain outcomes in total knee arthroplasty (TKA) and whether balance and laxity windows could be defined throughout flexion to optimize 2-year pain outcomes. Our hypothesis is that intra-operative joint gaps are associated with 2 year post-operative pain outcome. Methods A prospective study investigating 310 robotically assisted TKAs was performed. Final intra-operative joint gap data were recorded using a digital tensioner and component alignment data were recorded by the robotics system. Patient demographics and Knee Injury and Osteoarthritis Outcome Score (KOOS) were recorded pre-operatively and KOOS and Hospital for Special Surgery (HSS) satisfaction were recorded at 2 years post-op. A random search Simulated Annealing (SANN) optimisation algorithm was used to determine global optimum laxity and balance windows at different flexion angles which maximized the 2-year KOOS pain scores. The windows were combined to determine the impact of achieving optimal laxity and balance throughout flexion. To improve clinical utility, boundaries identified by the SANN algorithm were rounded to the nearest 0.5 mm before statistical analysis. Results Laxity and balance windows were defined in extension (Med lax: -2.0 to 2.5 mm, Lat lax: -0.5 to 2.5 mm, Balance: -3.0 to 0.0 mm), mid-flexion (Med lax: -1.0 to 2.5 mm, Lat lax: -0.5 to 3.0 mm, Balance: -2.0 to 2.0 mm), and flexion (Med lax: -2.0 to 3.5 mm, Lat lax: -2.0 to 1.5 mm, Balance: -3.0 to 3.0 mm). When all windows were satisfied, the greatest difference in KOOS pain score was observed (100.0 vs 94.4, p < 0.0001). The highest percentage of knees satisfying the Patient Acceptable Symptom State (PASS) for KOOS pain was also observed in knees which satisfied all windows compared to knees which did not (93% vs 71%, p = 0.0009). The proportion of knees which satisfy the PASS threshold decreased in knees which only satisfied 1-3 (29%) or 4-6 (69%) windows (p ≤ 0.0018). No optimal windows were found between component alignment and KOOS pain outcome (p ≥ 0.1180). High satisfaction was found across all groups (≥ 95%). Conclusion Intra-operatively measured joint gaps are associated with all KOOS sub-score outcomes at 2 years after TKA. Optimal windows for a clinically relevant improvement in post-operative KOOS pain were defined for laxity and balance but not for alignment indicating balance may have a greater impact on outcome than alignment. Level of evidence II.

show abstract

Section: Methodsmentioning

confidence: 99%

Intra‐operative laxity and balance impact 2‐year pain outcomes in TKA: a prospective cohort study

Wakelin,

Ponder,

Randall

et al. 2023

Knee surg. sports traumatol. arthrosc.

Self Cite

View full text Add to dashboard Cite

show abstract

“…In all cases, a medial parapatellar posterior cruciate ligament (PCL) sacrificing technique was performed using the OMNIBotics robotic-assisted platform with the BalanceBot® digital balancing tool (Figure 2a). After the knee was opened, landmarking was performed to digitise the knee joint, hip centre and ankle centre as described previously [10,11]. Coronal deformity was recorded by supporting the heel and placing the knee in full extension without applying an external force.…”

Section: Surgical Workflowmentioning

confidence: 99%

Widening of tibial resection boundaries increases the rate of femoral component valgus and internal rotation in functionally aligned TKA

Ollivier,

Wakelin,

Plaskos

et al. 2024

Knee surg. sports traumatol. arthrosc.

Self Cite

View full text Add to dashboard Cite

PurposeThe purpose of this study was to investigate the influence of increasing the tibial boundaries in functional alignment on femoral component orientation in total knee arthroplasty (TKA).MethodsA retrospective review of a database of robotic‐assisted TKAs using a digital joint tensioning device was performed (BalanceBot®; Corin). A total of 692 TKAs with correctable deformity were included. Functional alignment with a tibia‐first balancing technique was simulated by performing an anatomic tibial resection to recreate the native medial proximal tibial angle within certain boundaries (A, 87–90°; B, 86–90°; C, 84–92°), while accounting for wear. After balancing the knee, the resulting amount of femoral component outliers in the coronal and axial plane was calculated for each group and correlated to the coronal plane alignment of the knee (CPAK) classification.ResultsThe proportion of knees with high femoral component varus (>96°) or valgus (<87°) alignment increased from 24.5% (n = 170) in group A to 26.5% (n = 183) in group B and 34.2% (n = 237) in group C (p < 0.05). Similarly, more knees with high femoral component external rotation (>6°) or internal rotation (>3°) were identified in group C (33.4%, n = 231) than in group B (23.7%, n = 164) and A (18.4%, n = 127) (p < 0.05). There was a statistically significant (p < 0.01) overall increase in knees with both femoral component valgus <87° and internal rotation >3° from group A (4.0%, n = 28) to B (7.7%, n = 53) and C (15.8%, n = 109), with CPAK type I and II showing a 12.9‐ and 2.9‐fold increase, respectively.ConclusionExtending the tibial boundaries when using functional alignment with a tibia‐first balancing technique in TKA leads to a statistically significant higher percentage of knees with a valgus lateral distal femoral angle < 87° and >3° internal rotation of the femoral component, especially in CPAK type I and II.Level of EvidenceLevel IV.

show abstract

Variation in knee balance as a function of hip-knee-ankle angle and joint line obliquity in robotic assisted total knee arthroplasty

Kim

Wakelin²,

Plaskos³

et al. 2022

International Orthopaedics (SICOT)

View full text Add to dashboard Cite

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

Cited by 3 publications

References 17 publications

Intra‐operative laxity and balance impact 2‐year pain outcomes in TKA: a prospective cohort study

Intra‐operative laxity and balance impact 2‐year pain outcomes in TKA: a prospective cohort study

Widening of tibial resection boundaries increases the rate of femoral component valgus and internal rotation in functionally aligned TKA

Variation in knee balance as a function of hip-knee-ankle angle and joint line obliquity in robotic assisted total knee arthroplasty

Contact Info

Product

Resources

About