Impact of intra-operative predictive ligament balance on post-operative balance and patient outcome in TKA: a prospective multicenter study

Keggi, John M.; Wakelin, Edgar A.; Koenig, Jan; Lawrence, Jeffrey M.; Randall, Amber; Ponder, Corey; DeClaire, Jeffrey H.; Shalhoub, Sami; Lyman, Stephen; Plaskos, Christopher

doi:10.1007/s00402-021-04043-3

Cited by 23 publications

(22 citation statements)

References 32 publications

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“…Currently, robotics is starting to be increasingly used in TKA. Most of these robotic systems allow the measurement of knee dynamics ( Keggi et al, 2021 ). These measures of soft-tissue balance throughout the range of motion could be included as features.…”

Section: Discussionmentioning

confidence: 99%

Artificial Intelligence Based Patient-Specific Preoperative Planning Algorithm for Total Knee Arthroplasty

et al. 2022

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Previous studies have shown that the manufacturer’s default preoperative plans for total knee arthroplasty with patient-specific guides require frequent, time-consuming changes by the surgeon. Currently, no research has been done on predicting preoperative plans for orthopedic surgery using machine learning. Therefore, this study aims to evaluate whether artificial intelligence (AI) driven planning tools can create surgeon and patient-specific preoperative plans that require fewer changes by the surgeon. A dataset of 5409 preoperative plans, including the manufacturer’s default and the plans corrected by 39 surgeons, was collected. Features were extracted from the preoperative plans that describe the implant sizes, position, and orientation in a surgeon- and patient-specific manner. Based on these features, non-linear regression models were employed to predict the surgeon’s corrected preoperative plan. The average number of corrections a surgeon has to make to the preoperative plan generated using AI was reduced by 39.7% compared to the manufacturer’s default plan. The femoral and tibial implant size in the manufacturer’s plan was correct in 68.4% and 73.1% of the cases, respectively, while the AI-based plan was correct in 82.2% and 85.0% of the cases, respectively, compared to the surgeon approved plan. Our method successfully demonstrated the use of machine learning to create preoperative plans in a surgeon- and patient-specific manner for total knee arthroplasty.

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Section: Discussionmentioning

confidence: 99%

Artificial Intelligence Based Patient-Specific Preoperative Planning Algorithm for Total Knee Arthroplasty

et al. 2022

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“…Omnibot). The OMNIBot (Corin Ltd, Rayham, MA) has been shown to be a reliable tool for delivering different alignment philosophies as well as planning and achieving tibio-femoral coronal balancing [ 43 , 44 ]. The utility of the system is increased when the robot is used in conjunction with a soft-tissue tensioning device—the BalanceBot.…”

Section: Discussionmentioning

confidence: 99%

Sensor-guided gap balance versus manual gap balance in primary total knee arthroplasty: a meta-analysis

Sun

Zhao

Lee³

et al. 2022

J Orthop Surg Res

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Background Despite Vast improvements in technology and surgical technique in total knee arthroplasty (TKA), approximately 15–25% TKAs, have suboptimal subjective clinical outcomes. Our study sought to evaluate if sensor-guided balancing improves postoperative clinical outcomes compared to a conventional gap balancing technique. Methods We searched Web of Science, Embase, PubMed, Cochrane Controlled Trials Register, Cochrane Library, Highwire, CBM, CNKI, VIP, and Wanfang database in March 2022 to identify studies involving sensor-guided balancing versus conventional gap balancing technique in TKA. Finally, we identified 2147 knees assessed in nine studies. Results Compared with manual gap balancing, Sensor-guided gap balancing resulted in less rate of Manipulation under anesthesia (MUA) (P = 0.02), however more rate of intraoperative additional procedures (P = 0.0003). There were no significant differences in terms of KSS (P = 0.21), KSS Function score (P = 0.36), OKS (P = 0.61), KOOS (P = 0.78), operative time (P = 0.17), Mechanical axis (P = 0.69) and rate of reoperation between two groups. Conclusion Compared with conventional manual gap balancing techniques, sensors have more balancing procedures being performed. However, it did result in a reduction in the rate of MUA. More extensive, high-quality RCTs are required to verify our findings further.

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“…The major difference of the FA to previous philosophies is the modification of alignment based on a combination of constitutional bony anatomy and soft-tissue laxity assessment. It is established that instability after knee arthroplasty is a cause for failure [ 10 , 43 ] (particularly in younger patients) [ 44 ], and there is emerging evidence demonstrating that patient pain, and satisfaction scores are related to achieving a target range of tibiofemoral gaps intra-operatively [ 12 , 45 – 47 ]. Wakelin et al used a robotic platform to demonstrate when gap thresholds of an equally balanced compartment or mediolateral imbalance of less than 1.5 mm were achieved with a PS implant, it was associated with significantly improved KOOS pain scores at one-year follow-up [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Functional Alignment Philosophy in Total Knee Arthroplasty – Rationale and technique for the varus morphotype using a CT based robotic platform and individualized planning

Shatrov

Battelier

Sappey‐Marinier

et al. 2022

SICOT-J

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Introduction: Alignment techniques in total knee arthroplasty (TKA) continue to evolve. Functional alignment (FA) is a novel technique that utilizes robotic tools to deliver TKA with the aim of respecting individual anatomical variations. The purpose of this paper is to describe the rationale and technique of FA in the varus morphotype with the use of a robotic platform. Rationale: FA reproduces constitutional knee anatomy within quantifiable target ranges. The principles are founded on a comprehensive assessment and understanding of individual anatomical variations with the aim of delivering personalized TKA. The principles are functional pre-operative planning, reconstitution of native coronal alignment, restoration of dynamic sagittal alignment within 5° of neutral, maintenance of joint-line-obliquity and height, implant sizing to match anatomy and a joint that is balanced in flexion and extension through manipulation of implant positioning rather than soft tissue releases. Technique: An individualized plan is created from pre-operative imaging. Next, a reproducible and quantifiable method of soft tissue laxity assessment is performed in extension and flexion that accounts for individual variation in soft tissue laxity. A dynamic virtual 3D model of the joint and implant position that can be manipulated in all three planes is modified to achieve target gap measurements while maintaining the joint line phenotype and a final limb position within a defined coronal and sagittal range. Conclusion: Functional alignment is a novel knee arthroplasty technique that aims to restore constitutional bony alignment and balance the laxity of the soft tissues by placing and sizing implants in a manner that it respects the variations in individual anatomy. This paper presents the approach for the varus morphotype.

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Impact of intra-operative predictive ligament balance on post-operative balance and patient outcome in TKA: a prospective multicenter study

Cited by 23 publications

References 32 publications

Artificial Intelligence Based Patient-Specific Preoperative Planning Algorithm for Total Knee Arthroplasty

Artificial Intelligence Based Patient-Specific Preoperative Planning Algorithm for Total Knee Arthroplasty

Sensor-guided gap balance versus manual gap balance in primary total knee arthroplasty: a meta-analysis

Functional Alignment Philosophy in Total Knee Arthroplasty – Rationale and technique for the varus morphotype using a CT based robotic platform and individualized planning

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