Measured Resection Versus Gap Balancing for Total Knee Arthroplasty

Abdel, Matthew P.

doi:10.1007/s11999-014-3524-y

Cited by 48 publications

(30 citation statements)

References 12 publications

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“…Creating appropriate soft-tissue balance during total knee replacement surgery is mainly subjective and highly dependent on the surgeon's expertise [1,2]. Pre-operative planning incorporating predictive tools to evaluate functional outcome may support the surgeon by comparing different surgical treatments.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of predicted knee function for component malrotation in total knee arthroplasty

Vanheule

Delport

Andersen

et al. 2017

Medical Engineering & Physics

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Soft-tissue balancing for total knee arthroplasty (TKA) remains subjective and highly dependent on surgical expertise. Pre-operative planning may support the clinician in taking decisions by integrating subject-specific computer models that predict functional outcome. However, validation of these models is essential before they can be applied in clinical practice. The aim of this study was to evaluate a knee modelling workflow by comparing experimental cadaveric measures to model-based kinematics and ligament length changes. Subject-specific models for three cadaveric knees were constructed from medical images. The implanted knees were mounted onto a mechanical rig to perform squatting, measuring kinematics and ligament length changes with optical markers and extensometers. Coronal malrotation was introduced using tibial inserts with a built-in slope. The model output agreed well with the experiment in all alignment conditions. Kinematic behaviour showed an average RMSE of less than 2.7mm and 2.3° for translations and rotations. The average RMSE was below 2.5% for all ligaments. These results show that the presented model can quantitatively predict subject-specific knee behaviour following TKA, allowing evaluation of implant alignment in terms of kinematics and ligament length changes. In future work, the model will be used to evaluate subject-specific implant position based on ligament behaviour.

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Section: Introductionmentioning

confidence: 99%

Evaluation of predicted knee function for component malrotation in total knee arthroplasty

Vanheule

Delport

Andersen

et al. 2017

Medical Engineering & Physics

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“…Pain, instability, and limitation of the range of motion are the most commonly reported symptoms among unsatisfied patients [1,2]. Inadequate alignment and gap balancing have been implicated as major potential causes of these limitations [2,3]. During the last decade, the philosophy of restoring a neutral mechanical axis to the surgical limb, associated with performing extensive soft tissue releases, has been questioned [4e6].…”

mentioning

confidence: 99%

Accuracy of a New Robotically Assisted Technique for Total Knee Arthroplasty: A Cadaveric Study

Parratte

Price

Jeys

et al. 2019

The Journal of Arthroplasty

106

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Background: Although the utility of robotic surgery has already been proven in cadaveric studies, it is our hypothesis that this newly designed robotically assisted system will achieve a high level of accuracy for bone resection. Therefore, we aimed to analyze in a cadaveric study the accuracy to achieve targeted angles and resection thickness. Methods: For this study, 15 frozen cadaveric specimens (30 knees) were used. In this study, Zimmer Biomet (Warsaw, IN) knees, navigation system, and robot (ROSA Knee System; Zimmer Biomet) were used. Eight trained, board-certified orthopedic surgeons performed robotically assisted total knee arthroplasty implantation using the same robotic protocol with 3 different implant designs. The target angles obtained from the intraoperative planning were then compared to the angles of the bone cuts performed using the robotic system and measured with the computer-assisted system considered to be the gold standard. For each bone cut the resection thickness was measured 3 times by 2 different observers and compared to the values for the planned resections. Results: All angle mean differences were below 1 and standard deviations below 1. For all 6 angles, the mean differences between the target angle and the measured values were not significantly different from 0 except for the femoral flexion angle which had a mean difference of 0.95. The mean hip-knee-ankle axis difference was À0.03 ± 0.87. All resection mean differences were below 0.7 mm and standard deviations below 1.1mm. Conclusion: Despite the fact that this study was funded by Zimmer Biomet and only used Zimmer Biomet implants, robot, and navigation tools, the results of our in vitro study demonstrated that surgeons using this new surgical robot in total knee arthroplasty can perform highly accurate bone cuts to achieve the planned angles and resection thickness as measured using conventional navigation. Funding: This study is funded Zimmer Biomet.

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“…The current TKA techniques for soft tissue balancing is limited by the lack of understanding of the anatomy of each individual, and poor balancing is thought to contribute to patient dissatisfaction 5 . We introduced a new geometric proportion, the MCL ratio, that may help personalize the bone resection in measured resection TKA based on features of the distal femoral anatomy.…”

Section: Discussionmentioning

confidence: 99%

“…In total knee arthroplasty (TKA), balancing the soft tissues that surround the knee joint is critical to achieving full range of motion, reducing pain levels, and restoring knee stability, all important factors that contribute to patient satisfaction 1‐4 . Measured resection is a common surgical technique that arthroplasty surgeons utilize to achieve correct prosthesis alignment and soft tissue tensioning 5,6 . In this technique, surgeons rely on bony anatomical landmarks to resect measured amounts of bone from the femur and the tibia that correspond to the thickness of the implant 5,7 .…”

Section: Introductionmentioning

confidence: 99%

“…Measured resection is a common surgical technique that arthroplasty surgeons utilize to achieve correct prosthesis alignment and soft tissue tensioning 5,6 . In this technique, surgeons rely on bony anatomical landmarks to resect measured amounts of bone from the femur and the tibia that correspond to the thickness of the implant 5,7 . A known limitation of this method, however, is that the bone resections are guided by anatomical landmarks independent of the restraint provided by the surrounding soft tissues 8,9 .…”

Section: Introductionmentioning

confidence: 99%

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A geometric ratio to predict the flexion gap in total knee arthroplasty

Elmasry

Sculco

Kia

et al. 2020

Journal Orthopaedic Research

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Measured resection is a common technique for obtaining symmetric flexion and extension gaps in posterior‐stabilized (PS) total knee arthroplasty (TKA). A known limitation of measured resection, however, is its reliance on osseous landmarks to guide bone resection and component alignment while ignoring the geometry of the surrounding soft tissues such as the medial collateral ligament (MCL), a possible reason for knee instability. To address this clinical concern, we introduce a new geometric proportion, the MCL ratio, which incorporates features of condylar geometry and MCL anterior fibers. The goal of this study was to determine whether the MCL ratio can predict the flexion gaps and to determine whether a range of MCL ratio corresponds to balanced gaps. Six computational knee models each implanted with PS TKA were utilized. Medial and lateral gaps were measured in response to varus and valgus loads at extension and flexion. The MCL ratio was related to the measured gaps for each knee. We found that the MCL ratio was associated with the flexion gaps and had a stronger association with the medial gap (β = −7.2 ± 3.05, P < .001) than with the lateral gap (β = 3.9 ± 7.26, P = .04). In addition, an MCL ratio ranging between 1.1 and 1.25 corresponded to balanced flexion gaps in the six knee models. Future studies will focus on defining MCL ratio targets after accounting for variations in ligament properties in TKA patients. Our results suggest that the MCL ratio could help guide femoral bone resections in measured resection TKA, but further clinical validation is required.

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Measured Resection Versus Gap Balancing for Total Knee Arthroplasty

Cited by 48 publications

References 12 publications

Evaluation of predicted knee function for component malrotation in total knee arthroplasty

Evaluation of predicted knee function for component malrotation in total knee arthroplasty

Accuracy of a New Robotically Assisted Technique for Total Knee Arthroplasty: A Cadaveric Study

A geometric ratio to predict the flexion gap in total knee arthroplasty

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