Small Improvements in Postoperative Outcome with Gap Balancing Technique Compared with Measured Resection in Total Knee Arthroplasty

Hommel, Hagen; Kunze, Daniel; Hommel, Peggy; Fennema, Peter

doi:10.2174/1874325001711011236

Cited by 13 publications

(14 citation statements)

References 33 publications

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“…The no difference or improved outcomes shown here may be the result of accepting a wider variation in femoral component placement to achieve a balanced knee without soft tissue release. This data, combined with recent literature, showing similar or improved outcomes using alternate alignment strategies that target joint balance with variable component placement [7,8], indicate balance may have a stronger link to patient outcome than alignment.…”

Section: Discussionsupporting

confidence: 60%

Femoral Component Alignment Boundaries for Tibia First Gap Balancing using Digital Tensioning Tool

Wakelin¹,

Shalhoub²,

Lawrence³

et al.

EPiC Series in Health Sciences

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Achieving a balanced knee is a critical aspect of Total Knee Arthroplasty (TKA). Coronal and axial boundaries for femoral component placement to achieve balance however, are not well defined. Our aim is to investigate the effect of femoral component and long leg coronal and axial alignment on patient outcomes when using a tibia-first gap balancing technique.All surgeries were performed using the OMNIBotics robot-assisted TKA platform and BalanceBot device. A total of 197 patients were prospectively enrolled into this study and received TKA surgery using the OMNIBotics platform and completed 1-year KOOS outcome scores. Femoral component and tibiofemoral alignment were categorized as inliers or outliers in the coronal and axial planes. Knee Injury and Osteoarthritis Outcome Score (KOOS), and University of California at Los Angeles Activity Scale (UCLA) was collected at 1-year post-op.No significant differences were found between the KOOS subscores or UCLA outcome and femoral coronal or tibiofemoral coronal and axial alignment. Significant differences were found between the KOOS pain and sports sub-scores and femoral axial alignment (∆ = 5.4, p = 0.007, ∆ = 8.3, p = 0.03 respectively), in which outlier femoral rotation reported higher scores.Component alignment limits for improved survival and patient outcomes are a source of ongoing debate. The data presented here indicates that when utilizing a tibia-first gap balancing technique, small deviations outside of traditional ±3°alignment boundaries did not negatively affect KOOS or UCLA outcomes, indicating balance may have a stronger link to patient outcome than alignment.

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Section: Discussionsupporting

confidence: 60%

Femoral Component Alignment Boundaries for Tibia First Gap Balancing using Digital Tensioning Tool

Wakelin¹,

Shalhoub²,

Lawrence³

et al.

EPiC Series in Health Sciences

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“…Total knee arthroplasty has become one of the most reliable and durable procedures for restoring patient function. Excellent long-term results have been reported in the literature with survival rates ranging from 90 to 100 percent after 5–15 years, based upon failure definition [25–29]. The technique used with this system of gap balancing reliably provides a well-functioning TKA with results comparable to those previously reported in the literature [29].…”

Section: Discussionmentioning

confidence: 60%

“…Excellent long-term results have been reported in the literature with survival rates ranging from 90 to 100 percent after 5–15 years, based upon failure definition [25–29]. The technique used with this system of gap balancing reliably provides a well-functioning TKA with results comparable to those previously reported in the literature [29]. Through a series of initial bone cuts, followed by soft tissue balancing, and then equalization of the flexion/extension gaps with final bone cuts, our cumulative incidence of failure was limited to 1%.…”

Section: Discussionmentioning

confidence: 99%

Cumulative Incidence of Revision for a Balanced Knee System at a Mean 8-Year Follow-Up: A Retrospective Review of 500 Consecutive Total Knee Arthroplasties

Bourne

Miller

Mariani

2019

Advances in Orthopedics

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Purpose. The primary purpose of this study was to evaluate mid-term survival of a Balanced Knee System in the first 500 total knee arthroplasty (TKA) cases using a fully cemented, posterior stabilized TKA at a high-volume private practice. Patients and Methods. In this IRB approved retrospective cohort study, data were extracted from a surgical registry at a high-volume orthopaedic practice for the first 500 total knee arthroplasty (TKA) cases performed using the Balanced Knee® System (BKS, Ortho Development®, Draper, Utah, USA). Procedures were performed between June 2000 and September 2003 by one of two orthopaedic surgeons. Follow-up was performed at 6 weeks, 6 months, 1 year, 5 years, and 10 years. 48 patients (9.6%) were considered lost to follow-up. A competing risk analysis was performed to evaluate the cumulative incidence of revision while accounting for the competing risk of death. In the model, failure was defined as revision of any BKS component. Those who failed prior to two years remained in the analysis. Results. The mean age of the population was 69 years (range: 40–94) and 73% were female. The cumulative incidence of revision of any component was approximately 1% at a mean 8-year follow-up (range: 0.11–14.1 years) when accounting for the competing risk of death. When considering all those lost to follow-up as failures, the cumulative incidence of failure at 8 years was approximately 10%. Conclusion. Based on the results of the current study, a posterior stabilized primary TKA, implanted using a flexion and extension gap balancing technique, had excellent survivorship and outcomes at a mean 8-year follow-up.

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“…Line of force correction is a key step during TKA, which can increase patient satisfaction and prolong the use of the prosthesis. With the aging population and the prevalence of obesity, the number of patients receiving TKA has increased rapidly in the past two decades, and TKA has now become one of the most common and costly medical procedures in the United States and Canada [4][5]. Although the studies reports that the survivorship and surgeon-based measures rates after TKA is as high as 80% [6], these measures do not account for limb alignment following TKA such that chronic pain for poor limb alignment remains a major health burden for many patients.…”

Section: Introductionmentioning

confidence: 99%

A New Measurement Technique for Location Before Osteotomy of The Distal Femur in Patients Undergoing Total Knee Arthroplasty

Zhao

Yao

et al. 2021

Preprint

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Background Many traditional methods are available to prevent unbalance of extension and flexion gap during total knee arthroplasty (TKA), but there are no reports on the use of measurement and positioning method before tibial osteotomy with self-made tools.We designed a self-made tool measuring the location before tibial osteotomy and determined the clinical effect. Methods The retrospective study included patients who received TKA at our hospital, between January 1, 2012 and December 31, 2015. A new method, named as the measurement and localization before osteotomy with self-made tools (MOST), was developed to measure the osteotomy position of the posterior femoral condyle during TKA. They were divided into two groups, one that received the new method (GroupⅠ), and the other that received the traditional method as a control (GroupⅡ). HSS score, Oxford score, VAS score and knee joint activity were evaluated in two groups. Results One hundred and eighty-seven of 210 eligible patients were included. The function of knee joint in all patients was improved and the pain was obviously relieved. Significant differences were found in the HSS score, Oxford score, VAS score, knee joint activity between two groups at 5-year follow-up (p < 0.05). Conclusions The use of MOST may contribute to improve the balance between flexion and extension gaps as well as the balance between internal and external gaps during TKA, and overcome knee flexion instability.

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Small Improvements in Postoperative Outcome with Gap Balancing Technique Compared with Measured Resection in Total Knee Arthroplasty

Cited by 13 publications

References 33 publications

Femoral Component Alignment Boundaries for Tibia First Gap Balancing using Digital Tensioning Tool

Femoral Component Alignment Boundaries for Tibia First Gap Balancing using Digital Tensioning Tool

Cumulative Incidence of Revision for a Balanced Knee System at a Mean 8-Year Follow-Up: A Retrospective Review of 500 Consecutive Total Knee Arthroplasties

A New Measurement Technique for Location Before Osteotomy of The Distal Femur in Patients Undergoing Total Knee Arthroplasty

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