Soft-Tissue Balancing Technology for Total Knee Arthroplasty

Abstract

» Improperly balanced total knee arthroplasties are at increased risk for complications including residual pain and/or instability, which are often corrected by a revision surgical procedure.» Because of the morbidity and financial burden associated with revision total knee arthroplasty, different technological applications, such as tibial insert sensors and computer-assisted gap balancing, are being used to assist with soft-tissue balancing during primary total knee arthroplasty.» Computer-assisted gap balancing increases the accuracy of mechanical alignment and improves the precision of balancing flexion and extension gaps during total knee arthroplasty. It is unclear whether this translates to improved short-term or long-term outcome measures. Considerations of this technology include increased cost, increased operative time, and a steep learning curve.» Intraoperative sensors increase the accuracy of balancing by quantifying the mediolateral intercompartmental load distribution through the range of motion, which may lead to improved outcome scores, patient satisfaction, higher activity levels, and decreased pain. The advantages of this technology compared with computer assistance include decreased cost and no disruption of operative time or workflow. Limited availability with constrained implants, limited implant choices, and a lack of long-term follow-up data have reduced utilization of intraoperative sensors.» Computer-assisted gap balancing and intraoperative sensors are not yet universally accepted, and the cost-benefit ratio associated with their use remains a consideration in today’s cost-conscious health-care environment. Future research should focus on longer-term follow-up to evaluate implant survivorship, cost-effectiveness, and clinical outcomes.

A clinical review of robotic navigation in total knee arthroplasty: historical systems to modern design

“…6 ). 71 The robotic lamina spreader measures soft tissue tension throughout the range of motion after the tibial cut and prior to any femoral cuts. 71 The robot consists of two autonomous motorized actuators with integrated force sensors.…”

“… 71 The robotic lamina spreader measures soft tissue tension throughout the range of motion after the tibial cut and prior to any femoral cuts. 71 The robot consists of two autonomous motorized actuators with integrated force sensors. 71 , 72 The soft tissue tension data help plan femoral component rotation and position that optimizes symmetric flexion and extension gaps with minimal soft tissue releases.…”

“… 71 The robot consists of two autonomous motorized actuators with integrated force sensors. 71 , 72 The soft tissue tension data help plan femoral component rotation and position that optimizes symmetric flexion and extension gaps with minimal soft tissue releases. The main robotic-assisted systems currently used are summarized in Table 2 .…”

Spacer-based gap balancing is useful in total knee arthroplasty: a 3-year follow-up of a retrospective study

“…Total knee arthroplasty (TKA) has been established as a safe and effective surgical treatment for patients with severe knee osteoarthritis. Despite its successful clinical benefits, 19% of patients still suffer from poor joint balance [ 1 ] and instability [ 2 ] that cause postoperative pain, decreased patient satisfaction and might require revision surgery [ 3 , 4 ]. The precise positioning and alignment of the prosthesis in the coronal and sagittal planes and the balance of the soft tissues are critical to the recovery of function after TKA [ 5 , 6 ].…”

Development and Proof-of-Concept Study of a Novel Intraoperative Surgical Planning Tool for Robotic Arm-Assisted Total Knee Arthroplasty

“…In other words, the influence of active soft tissue forces, and, even, of gravity are not considered, which is likely to adversely affect the patient's functional stability after the arthroplasty [21]. Current technologies that aim to improve soft-tissue tensioning and balancing have shortcomings: with computer-assisted gap balancing systems and intraoperative use of tibial insert sensors [22], there is no kinetic feedback because they are used while the patient is in a non-weight-bearing state under anesthesia; and, with a robotic-assisted active soft-tissue balancing system, there is, as yet, only very limited evaluation (one report of a cadaver study [23] and one report of early clinical results) [13]).…”