Influence of soft tissue balancing and distal femoral resection on flexion contracture in navigated total knee arthroplasty

Kim, Seong Hwan; Lim, Ji Hong; Jung, Hosung; Lee, Han‐Jun

doi:10.1007/s00167-016-4269-9

Cited by 27 publications

(41 citation statements)

References 36 publications

(48 reference statements)

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“…Ligament balancing is essential during TKA and especially difficult to assess and to manage. Experienced surgeons traditionally obtain soft tissue balance using their own subjective "feeling" rather than a scientific perspective [25][26][27][28]. The ligament balancing "feeling" is affected by many factors such as patient obesity, gender, generalized laxity, degree of joint contracture, surgical experience, and even the surgeon's daily condition [29,30].…”

Section: Sensors In Tka 41 General Conceptsmentioning

confidence: 99%

New Technologies in Knee Arthroplasty: Current Concepts

Batailler

Swan

Sappey‐Marinier

et al. 2020

JCM

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Total knee arthroplasty (TKA) is an effective treatment for severe osteoarthritis. Despite good survival rates, up to 20% of TKA patients remain dissatisfied. Recently, promising new technologies have been developed in knee arthroplasty, and could improve the functional outcomes. The aim of this paper was to present some new technologies in TKA, their current concepts, their advantages, and limitations. The patient-specific instrumentations can allow an improvement of implant positioning and limb alignment, but no difference is found for functional outcomes. The customized implants are conceived to reproduce the native knee anatomy and to reproduce its biomechanics. The sensors have to aim to give objective data on ligaments balancing during TKA. Few studies are published on the results at mid-term of these two devices currently. The accelerometers are smart tools developed to improve the TKA alignment. Their benefits remain yet controversial. The robotic-assisted systems allow an accurate and reproducible bone preparation due to a robotic interface, with a 3D surgical planning, based on preoperative 3D imaging or not. This promising system, nevertheless, has some limits. The new technologies in TKA are very attractive and have constantly evolved. Nevertheless, some limitations persist and could be improved by artificial intelligence and predictive modeling.

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Section: Sensors In Tka 41 General Conceptsmentioning

confidence: 99%

New Technologies in Knee Arthroplasty: Current Concepts

Batailler

Swan

Sappey‐Marinier

et al. 2020

JCM

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“…However, adequate soft tissue balancing still remains a challenge for many surgeons, especially younger surgeons who lack surgical experience. Further, experienced surgeons traditionally obtain soft tissue balance using their own subjective “feeling” rather than a scientific perspective [ 6 – 9 ]. The soft tissue balancing “feeling” is affected by factors such as surgical experience, patient’s BMI, gender, generalized laxity, degree of joint contracture and even the surgeon’s daily condition [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Objective quantification of ligament balancing using VERASENSE in measured resection and modified gap balance total knee arthroplasty

Cho

Seon

Jang

et al. 2018

BMC Musculoskelet Disord

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BackgroundSoft tissue balancing which is above all most important factor of total knee arthroplasty, has been performed by subjective methods. Recently objective orthosensor has been developed for compartment pressure measurement. The purpose of this study was: (1) to quantify the compartment pressure of the joint throughout the range of motion during TKA using orthosensor, (2) to determine the usefulness of orthosensor by analyzing correlation between the pressure in both compartment with initial trial and after final implantation, and (3) to evaluate the types and effectiveness of additional ligament balancing procedures to compartment pressure.MethodsEighty-four patients underwent total knee arthroplasty (TKA) using VERASENSE Knee System. TKA was performed by measured resection and modified gap balance technique. Compartment pressure was recorded on full extension, 30°, 60°, 90° and full flexion at initial (INI), after each additional procedure, and after final (FIN) implantation. “Balanced” knees were defined as when the compartment pressure difference was less than 15 pounds.ResultsThirty patients (35.7%) showed balanced knee initially and 79 patients (94.0%) showed balance after final implantation. The proportion of balanced knee after initial bony resection, modified gap balancing TKAs showed significantly higher proportion than measured resection TKAs (P = 0.004) On both compartment, the pressure was generally decreased throughout the range of motion. Linear correlation on both compartment showed statistically significant throughout the range on motion, with higher correlation value on the lateral compartment. Total 66 additional ligament balancing procedures were performed.ConclusionUsing orthosensor, we could obtain 94% quantified balance knee, consequently. And between the techniques, measured resection TKA showed less balanced knee and also required more additional procedures compared to modified gap balancing TKA. Furthermore, with the acquired quantified data during appropriate ligament balancing, the surgeon could eventually reduce the complications associated with soft tissue imbalance in the future.

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“…Hanratty et al hypothesised that capsular stripping could improve flexion and range of motion; however, despite finding an immediate increase in knee flexion, no difference was maintained after 3 months or 1 year [ 12 ]. Reports of treating flexion contracture post-TKA by posterior capsular release or removal of posterior femoral osteophytes have not considered the possible effect on knee AP stability [ 14 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…There is an ongoing debate whether flexion contracture in TKA should be fixed surgically or alternatively treated with continuous physiotherapy postoperatively [ 14 , 22 ]. This study has found that one such surgical treatment, releasing the posterior capsule from its femoral attachment, did not cause a large detrimental increase in AP laxity at time of surgery.…”

Section: Discussionmentioning

confidence: 99%

“…In total knee arthroplasty (TKA), the knee may be found to be too stiff in extension, causing an extension deficit. Being unable to fully extend the knee requires continuous quadriceps contraction during daily routine movements or standing, leading to tiredness and reduced function [ 14 , 19 , 24 ]. One proposed surgical technique to correct this flexion contracture is resecting additional bone from the distal femur, but that may lead to raising the joint line [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

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Posterior capsular release is a biomechanically safe procedure to perform in total knee arthroplasty

Athwal

Milner

Bellier³

et al. 2018

Knee Surg Sports Traumatol Arthrosc

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Purpose Surgeons may attempt to strip the posterior capsule from its femoral attachment to overcome flexion contracture in total knee arthroplasty (TKA); however, it is unclear if this impacts anterior-posterior (AP) laxity of the implanted knee. The aim of the study was to investigate the effect of posterior capsular release on AP laxity in TKA, and compare this to the restraint from the posterior cruciate ligament (PCL). Methods Eight cadaveric knees were mounted in a six degree of freedom testing rig and tested at 0°, 30°, 60° and 90° flexion with ± 150 N AP force, with and without a 710 N axial compressive load. After the native knee was tested, a deep dished cruciate-retaining TKA was implanted and the tests were repeated. The PCL was then cut, followed by releasing the posterior capsule using a curved osteotome. Results With 0 N axial load applied, cutting the PCL as well as releasing the posterior capsule significantly increased posterior laxity compared to the native knee at all flexion angles, and CR TKA states at 30°, 60° and 90° (p < 0.05). However, no significant increase in laxity was found between cutting the PCL and subsequent PostCap release (n.s.). In anterior drawer, there was a significant increase of 1.4 mm between cutting the PCL and PostCap release at 0°, but not at any other flexion angles (p = 0.021). When a 710 N axial load was applied, there was no significant difference in anterior or posterior translation across the different knee states (n.s.). Conclusions Posterior capsular release only caused a small change in AP laxity compared to cutting the PCL and, therefore, may not be considered detrimental to overall AP stability if performed during TKA surgery. Level of evidence Controlled laboratory study.

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Influence of soft tissue balancing and distal femoral resection on flexion contracture in navigated total knee arthroplasty

Abstract: II.

Cited by 27 publications

References 36 publications

New Technologies in Knee Arthroplasty: Current Concepts

New Technologies in Knee Arthroplasty: Current Concepts

Objective quantification of ligament balancing using VERASENSE in measured resection and modified gap balance total knee arthroplasty

Posterior capsular release is a biomechanically safe procedure to perform in total knee arthroplasty

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