Proven accuracy for a new dynamic gap measurement in navigated TKA

Mehliß, Volkmar; Leira, Marco Strauch; Olaizola, Agustín Serrano; Scior, Wolfgang; Graichen, Heiko

doi:10.1007/s00167-018-4989-0

Cited by 17 publications

(24 citation statements)

References 19 publications

(18 reference statements)

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“…A key advantage of this technical approach was that it allows immediate observation of the outcome of the different surgical gestures performed, modification of their amplitude, and correction of errors or anomalous situations [7].…”

Section: Introductionmentioning

confidence: 99%

Can the need for soft tissue release in total knee replacement be predicted pre-operatively? A study based on surgical navigation

Hernández-Vaquero

Noriega-Fernandez

Roncero-Gonzalez

et al. 2021

International Orthopaedics (SICOT)

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Introduction In complex and deformed knees, soft tissue release (STR) is required to obtain symmetry in the femorotibial gap. The objective of this study was to attempt to predict the need for soft tissue release using surgical navigation in total knee replacement (TKR). Methods Prospective and non-randomized study. One hundred thirty knees. At the start of navigation, an attempt was made to correct the femorotibial mechanical axis by applying force to the medial or lateral side of the knee (varus-valgus stress angle test). A gap balanced technique with computer-assisted surgery (CAS) was performed in all cases. The ligaments were tensioned, and using CAS visualization and control, progressive STR was performed in the medial or lateral side until a symmetry of the femorotibial gap was achieved. Results Eighty-two patients had a varus axis ≥ 3° and 38 had a valgus axis (P < 0.001). STR was performed under navigation control in 38.5% of cases, lateral release (LR) in 12 cases, and medial release (MR) in 38 cases. After performing the varus-valgus stress angle test (VVSAT), the axis of 0° could be restored at some point during the manoeuvre in 28 cases. STR was required in 44.6% of varus cases and 27% of valgus cases (P = 0.05). A significant relationship was found between the previous deformity and the need for MR (P < 0.001) or LR (P = 0.001). STR was more common in male patients (P = 0.002) and as obesity increased. Conclusion This study shows that pre-operative factors favouring the need to perform STR in a TKR implant can be defined.

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Section: Introductionmentioning

confidence: 99%

Can the need for soft tissue release in total knee replacement be predicted pre-operatively? A study based on surgical navigation

Hernández-Vaquero

Noriega-Fernandez

Roncero-Gonzalez

et al. 2021

International Orthopaedics (SICOT)

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“…Quantitative dynamic gap measurements under valgus and varus stress before and after tibia and femur cuts throughout the ROM can be performed to measure maximum gap sizes. Both the reproducibility and reliability of dynamic testing using this CAS system have previously been reported to be high [5]. Intraoperative soft tissue balance is reported to influence the postoperative clinical outcomes [6] and use of a predictive joint tensioning tool improved the final balance and clinical outcomes [7].…”

Section: Introductionmentioning

confidence: 91%

“…TF-TKAs were performed by using the same implant and approach as used for the MR technique. First, anatomical landmarks and the individual biomechanical knee data were obtained; the ROM, varus-valgus angles of the leg axis, and gap sizes throughout the entire ROM were obtained at the beginning of surgery for registration of the navigation system [5]. A tibial osteotomy was first performed to ensure that the tibial bony resection was perpendicular to the anatomical tibial axis.…”

Section: Surgical Procedures Of the Tf Technique Using A Casmentioning

confidence: 99%

Can tibia-first total knee arthroplasty using computer-assisted system improve anterior and posterior knee stability?

Takahashi¹,

Sugimoto²,

et al. 2022

THC

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BACKGROUND: Total knee arthroplasty (TKA) is a widely performed procedure to alleviate pain and restore function of patients with end-stage knee osteoarthritis. OBJECTIVE: The study aim was to determine if tibia-first (TF) total knee arthroplasty (TKA) using a novel computer-assisted surgery (CAS) system can yield better anterior and posterior (AP) knee stability. METHODS: Patients with knee osteoarthritis with obvious varus knee who met the indication for and underwent TKA from May 2019 to November 2020 were included. Forty-one measured resection (MR)-TKAs and 32 TF-TKAs were compared. The varus-valgus ligament balance and joint tension at a joint center-gap setting equal to the tibial-baseplate thickness were measured, and appropriate polyethylene inserts with 0∘, 30∘, 45∘, 60∘, 90∘, and 120∘ of knee flexion were placed. A Kneelax 3 arthrometer was used to measure knee AP laxity in the postoperative anesthetized patients with 30∘ and 90∘ of knee flexion. RESULTS: The horizontal gap balance was significantly closer in the TF-TKA group than the MR-TKA group for 0∘, 30∘, 45∘, and 60∘ of knee flexion. In contrast, no significant differences were observed for 90∘ and 120∘ of knee flexion. No significant differences in joint-gap tensions among all knee-flexion angles were observed. Translation was significantly smaller in the TF-TKA group than the MR-TKA group for AP laxity with 30∘ of knee flexion (8.8 ± 2.9 mm vs. 10.7 ± 3.1 mm, P= 0.0079). In contrast, no significant AP laxity was observed with 90∘ of knee flexion (7.2 ± 2.8 mm vs. 7.2 ± 3.5 mm). CONCLUSION: TF-TKA using a novel CAS system provided better AP knee stability with close to horizontal gap balances.

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“…7 By introducing more modern navigation software, it became possible to perform an advanced soft tissue balancing in real time. 8,9 For the first time, it became possible to perform quantitative TKA surgery, meaning that all cutting steps and their effects on soft tissue balance can be visualized, planned and controlled. However, also this modern navigation technology still has to prove whether it really will help to improve patient outcome.…”

Section: Navigation/robotics/aimentioning

confidence: 99%

“…Navigation has shown to reduce the number of outliers regarding alignment and gap balancing compared to conventional techniques. 1,2,9 On a planning screen the relationship between the different cuts and the gap widths (medial/lateral and extension/flexion) is quantitatively visualized (Fig. 1).…”

Section: Navigation/robotics/aimentioning

confidence: 99%

How will digitalisation affect patient treatment in arthroplasty? Part I: Intraoperative aspects

Graichen

Lekkreusuwan

Scior

2020

Journal of Orthopaedics

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We cannot deny that technology has become an important part of our daily life, not only in automobiles, houses or cellphones but also in hospitals. In the OR, in particular for knee arthroplasty, image free navigation has proven to reduce the number of outliers and by that the revision rate in younger patients. Over the last years robotics has again been introduced into the operation theatres. However, in their present version they add time and costs, but only minimal benefits to the procedure. Therefore, future robots should be faster and instrumentation free. Beside those more economical aspects, the goal of this digital technology must be an improvement in clinical outcome. To achieve that, additional steps for analyzing the pre-, and intra-OP quantitative data is key. With the use of artificial intelligence and/or machine learning a data based algorithm will probably be developed, which helps the surgeon to integrate all parameters into his individual cutting and releasing plan for each patient. Digital data therefore, might become the key to enable the surgeon to treat patients more individual and by that hopefully deliver better outcome.

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Proven accuracy for a new dynamic gap measurement in navigated TKA

Cited by 17 publications

References 19 publications

Can the need for soft tissue release in total knee replacement be predicted pre-operatively? A study based on surgical navigation

Can the need for soft tissue release in total knee replacement be predicted pre-operatively? A study based on surgical navigation

Can tibia-first total knee arthroplasty using computer-assisted system improve anterior and posterior knee stability?

How will digitalisation affect patient treatment in arthroplasty? Part I: Intraoperative aspects

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