Improved kinematics of total knee replacement following partially navigated modified gap-balancing technique

Baier, Christel; Fitz, Wolfgang; Craiovan, Benjamin; Keshmiri, Armin; Winkler, Sebastian; Springorum, R.; Grifka, Joachim; Beckmann, Johannes

doi:10.1007/s00264-013-2140-x

Cited by 21 publications

(19 citation statements)

References 34 publications

(46 reference statements)

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“…However, such a great influence of sagittal component alignment on patellar kinematics was not conceivable. While some recent investigations have described the influence of sagittal component alignment on tibiofemoral kinematics ( Fitz et al 2012 , Baier et al 2014 , Gromov et al 2014 ), we could not find any study on its influence on patellar kinematics in the current literature. The impact of sagittal component alignment could be explained by changed parapatellar soft tissue tension and tibiofemoral contact points.…”

Section: Discussioncontrasting

confidence: 58%

The influence of component alignment on patellar kinematics in total knee arthroplasty

Keshmiri¹,

Maderbacher²,

Baier³

et al. 2015

Acta Orthopaedica

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Background and purpose Postoperative anterior knee pain is one of the most frequent complications after total knee arthroplasty (TKA). Changes in patellar kinematics after TKA relative to the preoperative arthritic knee are not well understood. We compared the patellar kinematics preoperatively with the kinematics after ligament-balanced navigated TKA.Patients and methods We measured patellar tracking before and after ligament-balanced TKA in 40 consecutive patients using computer navigation. Furthermore, the influences of different femoral and tibial component alignment on patellar kinematics were analyzed using generalized linear models.Results After TKA, the patellae shifted statistically significantly more laterally between 30° and 60°. The lateral tilt increased at 90° of flexion whereas the epicondylar distance decreased between 45° and 75° of flexion. Sagittal component alignment, but not rotational component alignment, had a significant influence on patellar kinematics.Interpretation There are major differences in patellar kinematics between the preoperative arthritic knee and the knee after TKA. Combined sagittal component alignment in particular appears to have a major effect on patellar kinematics. Surgeons should be especially aware of altering preoperative sagittal alignment until the possible clinical relevance has been investigated.

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Section: Discussioncontrasting

confidence: 58%

The influence of component alignment on patellar kinematics in total knee arthroplasty

Keshmiri¹,

Maderbacher²,

Baier³

et al. 2015

Acta Orthopaedica

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“…This behavior has also been observed in studies analyzing the effect of native laxities in various knee flexion angles 48 and their relationship with alignment, especially when following, as we did, a gapbalancing technique. 19,21 After surgery, we could not find any statistically significant differences among the different PDPs. It is remarkable to mention that, despite the PDP, it is more difficult to achieve a postoperative "within-range" dynamic alignment as the knee bends.…”

Section: Discussionmentioning

confidence: 71%

“…[17][18][19][20] It is a powerful instrument for intraoperatively supporting and guiding the surgeon in the adequate postoperative soft tissue balance of the knee. 17,[21][22][23][24] Through this technology, the authors have published that there is well-defined preoperative dynamic alignment in osteoarthritic knees. 16 The purpose of this study was to determine the dynamic coronal HKA angle after MA in total knee replacement using computer navigation.…”

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confidence: 99%

Mechanical Alignment in Knee Replacement Homogenizes Postoperative Coronal Hip–Knee–Ankle Angle in Varus Knees: A Navigation-Based Study

et al. 2021

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After knee replacement, postoperative lower limb alignment is influenced by the geometry of the prosthesis position and surrounding soft tissue that contributes to the hip–knee–ankle (HKA) angle. The purpose of this study is to determine the dynamic coronal HKA angle after mechanical alignment in total knee replacement using computer navigation. We conducted a pre–post design study of 71 patients with varus osteoarthritic knees on which total knee arthroplasty was performed. The HKA was measured before and at the end of the surgical procedure with the patient in the supine position using a navigation system at 30, 60, and 90 degrees of knee flexion. Postoperative implant position and flexion and extension gaps were assessed. HKA was clustered in three preoperative dynamic patterns (PDPs; Varus-Neutral, Varus-Valgus, and Varus-Varus). There were statistically significant differences in the dynamic coronal HKA between the preoperative and postoperative statuses after mechanically aligned knee replacement (with p < 0.0001) Before the surgical procedure, statistically significant differences were found between patterns at any angle of flexion confirming a well-differentiated preoperative dynamic behavior between the three groups. Postoperatively, 98.6% (71 out of 72) of the knees were within ± 3 degrees of the HKA at full extension. Fifty-eight knees (80.6%) were assessed to a “within-range” postoperative dynamic alignment at any grade of flexion considered. There are differences between the preoperative and postoperative status of the dynamic coronal HKA angle after mechanically aligned knee replacement. We proposed that an excellent dynamic HKA alignment is achieved not only at full extension within the range of 0 ± 3 degrees but also when this alignment is maintained at 30, 60, and 90 degrees.

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“…Four comparative studies reported outcomes of KSS and FKSS scores [9,[11][12][13]. One RCT reported outcomes of sixmonth KSS, and one RCT reported outcomes of six-month FKSS.…”

Section: Patient-reported Outcomesmentioning

confidence: 99%

Is gap balancing superior to measured resection technique in total knee arthroplasty? A meta-analysis

Sun

et al. 2020

Arthroplasty

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Background: Measured resection and gap balancing are two distinct methods for proper femoral component alignment in total knee arthroplasty. Decision-making between the two techniques is controversial. The aim of this systematic review and meta-analysis was to compare measured resection and gap balancing with regard to the radiological and clinical benefits, and to examine whether this change the conclusions from previous trails. Methods: A systematic literature search of the medical literature from January 1990 to February 2015 was performed. We selected six randomized controlled trials and five prospective cohort studies comparing gap balancing and measured resection in patients undergoing primary total knee arthroplasty. Data from included studies were pooled with use of fixed-effects and random-effects models with standard mean differences and risk ratios for continuous and dichotomous variables, respectively. Heterogeneity across studies was assessed with calculation of the I 2 statistic. Results: A total of 857 knees from 11 trials were included. Four hundred and forty-one knees were treated with gap balancing and 416 were treated with measured resection. In contrast to previous studies, we found that gap balancing demonstrated better patient-reported outcomes with regard to Knee Society score for pain (WMD 2.75, p = 0.004) and Knee Society score for function (WMD 5.47, p < 0.0001) at two-year follow-up. Gap balancing showed more precise limb alignment in terms of post-operative value of mechanical axis (WMD 0.40°, p = 0.01) and risk of mechanical alignment outliers (RR 0.350, p < 0.0001). However, gap balancing was associated with more joint line elevation (WMD 1.27 mm, p < 0.0001) and longer operative time (WMD 16.18 min, p < 0.0001). No significant difference was observed in rotation of the femoral component (p = 0.07). Conclusions:The meta-analysis demonstrated that gap balancing was able to achieve more precise coronal alignment with better short-term patient-reported outcomes compared with measured resection. Measured resection was more desirable than gap balancing with regard to restoration of the joint line and operative time. Comparable femoral rotational alignment was observed.

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Improved kinematics of total knee replacement following partially navigated modified gap-balancing technique

Cited by 21 publications

References 34 publications

The influence of component alignment on patellar kinematics in total knee arthroplasty

The influence of component alignment on patellar kinematics in total knee arthroplasty

Mechanical Alignment in Knee Replacement Homogenizes Postoperative Coronal Hip–Knee–Ankle Angle in Varus Knees: A Navigation-Based Study

Is gap balancing superior to measured resection technique in total knee arthroplasty? A meta-analysis

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