Large osteophyte removal from the posterior femoral condyle significantly improves extension at the time of surgery in a total knee arthroplasty

Leie, Murilo Anderson; Klasan, Antonio; Oshima, Takeshi; Putnis, Sven; Yeo, Wai Weng; Luk, Lincoln; Coolican, Myles

doi:10.1016/j.jor.2019.10.021

Cited by 13 publications

(14 citation statements)

References 27 publications

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“…In cases without preoperative flexion contractures and large osteophytes, the function can correctly evaluate the extension gap after bone resection. In cases with preoperative flexion contracture, the precise extension gap is barely predicted before bone resection, and the cases with large posterior osteophytes could change the extension gap after its removal 21 ; therefore, the present preoperative evaluations for the extension gap seem not to control thicker insert usage. Another merit of using robotic TKA might be its ease of use compared with navigated TKA because the reset of the cutting guide is unnecessary and the recut is robotic arm-assisted.…”

Section: Discussionmentioning

confidence: 86%

Robotic arm‐assisted posterior‐stabilised total knee arthroplasty reduces the amount of tibial bone resection thickness without increasing the rate of postoperative flexion contracture in varus knees in the short term: Comparison with image‐free navigated total knee arthroplasty

Ishida

Shibanuma

Hayashi

et al. 2022

Robotics Computer Surgery

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Background: This study aimed to compare the bone resection thickness, rate of minimal thickness insert usage, and postoperative range of motion (ROM) between robotic and navigated total knee arthroplasty (TKA).Methods: Fifty consecutive posterior-stabilised (PS) robotic TKA and 50 casecontrolled PS navigated TKA were enroled. Bone resection thickness, rate of minimal thickness insert usage, and postoperative flexion contracture over 5°were statistically compared. Results:The tibial bone resection thickness was significantly thinner in robotic TKA.The insert thickness was significantly lower, and the rate of minimal thickness insert usage was significantly higher in robotic TKA. The ROM at 3 months postoperatively and the rate of postoperative flexion contracture were comparable between the two groups. Conclusion:Robotic TKA can reduce the tibial bone resection thickness and increase the rate of minimal thickness insert usage without increasing postoperative flexion contracture as compared with navigated TKA.

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Section: Discussionmentioning

confidence: 86%

Robotic arm‐assisted posterior‐stabilised total knee arthroplasty reduces the amount of tibial bone resection thickness without increasing the rate of postoperative flexion contracture in varus knees in the short term: Comparison with image‐free navigated total knee arthroplasty

Ishida

Shibanuma

Hayashi

et al. 2022

Robotics Computer Surgery

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“…Some studies have assessed the impact of osteophyte removal on ROM and knee exposure. 27 , 28 No study has assessed the impact of osteophytes on operating time. Our predictive model was based on accurate quantification of osteophyte volume and their localization, which is only attainable if derived from 3D images.…”

Section: Discussionmentioning

confidence: 99%

Predicting robotic-assisted total knee arthroplasty operating time

et al. 2022

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Aims No predictive model has been published to forecast operating time for total knee arthroplasty (TKA). The aims of this study were to design and validate a predictive model to estimate operating time for robotic-assisted TKA based on demographic data, and evaluate the added predictive power of CT scan-based predictors and their impact on the accuracy of the predictive model. Methods A retrospective study was conducted on 1,061 TKAs performed from January 2016 to December 2019 with an image-based robotic-assisted system. Demographic data included age, sex, height, and weight. The femoral and tibial mechanical axis and the osteophyte volume were calculated from CT scans. These inputs were used to develop a predictive model aimed to predict operating time based on demographic data only, and demographic and 3D patient anatomy data. Results The key factors for predicting operating time were the surgeon and patient weight, followed by 12 anatomical parameters derived from CT scans. The predictive model based only on demographic data showed that 90% of predictions were within 15 minutes of actual operating time, with 73% within ten minutes. The predictive model including demographic data and CT scans showed that 94% of predictions were within 15 minutes of actual operating time and 88% within ten minutes. Conclusion The primary factors for predicting robotic-assisted TKA operating time were surgeon, patient weight, and osteophyte volume. This study demonstrates that incorporating 3D patient-specific data can improve operating time predictions models, which may lead to improved operating room planning and efficiency. Cite this article: Bone Jt Open 2022;3(5):383–389.

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“…The threshold at which the size of posterior osteophytes’ effect on soft-tissue balance becomes clinically relevant has not been defined. Recent clinical work elsewhere has demonstrated that smaller osteophytes have less of an observable effect than larger osteophytes, particularly in lower degrees of flexion [ 22 ]. Our study suggested that 10-mm and 15-mm osteophytes had no discernible difference in terms of the magnitude of their effect on balance.…”

Section: Discussionmentioning

confidence: 99%

“…First, this is, to our knowledge, an investigation with few, if any, of its kind. We are aware of very limited number of studies that attempt to demonstrate what effect posterior femoral osteophytes and their removal have on soft-tissue balance in TKA [ 22 ]. This is in spite of this being a commonly encountered entity in knees with hypertrophic arthritis, supporting the relevance of the investigation.…”

Section: Discussionmentioning

confidence: 99%

What is the Effect of Posterior Osteophytes on Flexion and Extension Gaps in Total Knee Arthroplasty? A Cadaveric Study

et al. 2021

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Background: Posterior compartment knee osteophytes may pose a challenge in achieving soft-tissue balance during total knee arthroplasty (TKA). Obtaining symmetry of flexion and extension gaps involves balance of both bony and soft-tissue structures. We hypothesize that space-occupying posteromedial femoral osteophytes affect soft-tissue balance. Methods: Five cadaveric limbs were acquired. Computed tomography scans were obtained to define the osseous contours. Three-dimensionally printed, specimen-specific synthetic posterior femoral osteophytes were fabricated in 10-mm and 15-mm sizes. TKAs were implanted. Medial and lateral compartment contact forces were measured during passive knee motion using pressure-sensing technology. For each specimen, trials were completed without osteophytes and with 10-mm and 15-mm osteophytes affixed to the posteromedial femoral condyle. Contact forces were obtained at full extension, 10 , 30 , 45 , 60 , and 90 of flexion. These were recorded across each specimen in each condition for three trials. Tukey post hoc tests were used with a repeated measures ANOVA for statistical data analysis. Results: The presence of posteromedial osteophytes increased asymmetric loading from full extension to 45 of flexion, with statistically significant differences observed at full extension and 30 . A reduction in lateral compartment forces was noted. The 25%-75% bounds of variability in the contact force was less than 3.5 lbs. Conclusions: Posteromedial femoral osteophytes caused an asymmetric increase in medial contact forces from full extension continuing into mid-flexion. The soft-tissue imbalance created from these osteophytes supports their removal before performing ligament releases to obtain desired soft-tissue balancing during TKA.

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Large osteophyte removal from the posterior femoral condyle significantly improves extension at the time of surgery in a total knee arthroplasty

Cited by 13 publications

References 27 publications

Robotic arm‐assisted posterior‐stabilised total knee arthroplasty reduces the amount of tibial bone resection thickness without increasing the rate of postoperative flexion contracture in varus knees in the short term: Comparison with image‐free navigated total knee arthroplasty

Robotic arm‐assisted posterior‐stabilised total knee arthroplasty reduces the amount of tibial bone resection thickness without increasing the rate of postoperative flexion contracture in varus knees in the short term: Comparison with image‐free navigated total knee arthroplasty

Predicting robotic-assisted total knee arthroplasty operating time

What is the Effect of Posterior Osteophytes on Flexion and Extension Gaps in Total Knee Arthroplasty? A Cadaveric Study

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