scholarly journals Patient-specific instrumentation combined with a new tool for gap balancing is useful in total knee replacement: a 3-year follow-up of a retrospective study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Ting Deng ◽  
Tangyou Liu ◽  
Qing Lei ◽  
Lihong Cai ◽  
Song Chen
Keyword(s):  
Mechanical Axis ◽  
Knee Function ◽  
Patient Specific ◽  
Gap Balancing ◽  
Resection Group ◽  
Patient Specific Instrumentation ◽  
Measured Resection ◽  
Total Knee ◽  
The Mean

Abstract Objective The purpose of this study was to determine whether the gap-balancing technique with patient-specific instrumentation (PSI) and a new balancing device in total knee arthroplasty (TKA) can improve knee function to a greater extent than can the measured resection technique. Materials and methods Data from 150 patients who underwent TKA from August 2014 to June 2016 were studied retrospectively. The gap-balancing technique assisted by PSI and the new balancing device was used in 80 patients (82 knees), and the measured resection technique was used in 70 patients (70 knees). The surgical, imaging, and knee function data were compared. Results The gap-balancing technique assisted by PSI and the new balancing device was found to be feasible in all operated knees and reliable. In total, 150 patients (152 knees) of ages ranging from 52 to 78 years (mean 67 years) underwent TKA during the study period. The follow-up period ranged from 35 to 52 months (mean 45 months). Only one patient, who was included in the gap-balancing group, underwent a revision surgery at 2 years postoperatively due to infection. There were no differences in the incidence of anterior knee pain between the two groups. The mean flexion angle, KSS scores, and VAS scores did not significantly differ between the measured resection group and gap-balancing group at 12 weeks or 36 weeks postoperatively. The average joint line displacement was 1.3 ± 1.1 mm (range 0–3) proximally in the GB (gap-balancing) group and 1.2 ± 1.4 mm in the MR (measured-resection) group. No outliers >5 mm in either group were recorded. The mean leg axis deviation from the neutral mechanical axis was 1.8°±1.5° varus (range 0°–3°varus) versus the neutral mechanical axis in the GB group and 1.4°±1.2°(range 0°–3°)in the MR group. No outliers with >3° deviation in either group were recorded. Conclusions The gap-balancing technique performed with the new balancing device and PSI can yield accurate femoral component alignment as well as outcomes similar to those of measured resection at 3 years. The new balancing device can be taken into consideration by surgeons who prefer performing the gap-balancing technique with PSI.

scholarly journals Patient-Specific Instrumentation Combined With A New Tool for Gap Balancing Is Useful in Total Knee Replacement: 3-Year Follow-Up of A Retrospective Study

2020 ◽  
Author(s):  
Ting Deng ◽  
Tangyou Liu ◽  
Qing Lei ◽  
Lihong Cai ◽  
Song Chen
Keyword(s):  
Knee Function ◽  
Patient Specific ◽  
Gap Balancing ◽  
Leg Axis ◽  
Patient Specific Instrumentation ◽  
Measured Resection ◽  
Vas Scores ◽  
Total Knee ◽  
The Mean

Abstract Objective：The purpose of this study was to prove that knee function is well recovered using gap balancing technique with patient-specific instrumentation（PSI）combined a new balancer device in total knee arthroplasty (TKA) compared with the measured resection technique.Materials and methods：Data of 152 patients received TKA from August 2014 to June 2016 were studied retrospectively. Gap balancing technique assisted by PSI combined a new balance device was used in 80 patients (82 knees) and the measured resection technique was used in the surgery in 70 patients (70 knees). The data of surgery, imaging and knee function were compared. Results：The gap balancing technique assisted by PSI and a new balancer device was feasible in all operated knees and found to be reliable. In total, 152 patients (150 knees) with ages ranging from 52 to 78 years (mean 67 years) underwent TKA during the study period. The follow-up ranged from 35 to 52 months (mean 45 months). Only one patient underwent revision surgery in gap balance group at 2 years postoperatively due to infection. There was no difference in the incidence of anterior knee pain between the two groups. 2 patients received or required revisions. Until the latest follow-up, the mean flexion degree、KSS scores、VAS scores were not significantly different between the measured resection group and gap-balancing group at 12 weeks and 36 weeks. The average joint line displacement in GB group was 1.3 ± 1.1 mm (range 0-3) proximal and 1.2±1.4 mm in MR group. No outliers＞5 mm in each group were recorded. The mean leg axis was 1.8°±1.5°varus (range 0°-3°varus) versus the neutral mechanical axis in GB group and 1.4°±1.2°(range 0°-3°)in MR group. No outliers with＞ 3° deviation in each group were recorded.Conclusions：The gap balancing technique assisted by the new balancer device and PSI can be used to achieve accurate femoral component alignment as well as measured resection in 3 years outcomes. The new balancer device can be taken into account by surgeons who prefer the gap-balancing technique together with the PSI.

Gap-Balancing versus Measured Resection Technique in Total Knee Arthroplasty: A Comparison Study

2017 ◽  
Vol 31 (01) ◽  
pp. 013-016 ◽  
Author(s):  
Jessica Churchill ◽  
Anton Khlopas ◽  
Assem Sultan ◽  
Steven Harwin ◽  
Michael Mont
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Component Alignment ◽  
Gap Balancing ◽  
Pain Scores ◽  
Measured Resection ◽  
Total Knee ◽  
The Mean ◽  
Ks Function

AbstractProper femoral component alignment in the axial plane during total knee arthroplasty (TKA) depends on accurate bone cuts and soft tissue balancing. Two methods that are used to achieve this are “measured resection” and “gap balancing.” However, a controversy exists as to which method is more accurate and leads to better outcomes. Therefore, the purpose of this study was to evaluate: (1) implant survivorship, (2) patient outcomes, (3) complications, and (4) radiographic analysis comparing patients who underwent TKA with either gap-balancing or measured resection techniques. A total of 214 consecutive patients (221 knees) underwent primary TKA by a single surgeon between 2011 and 2012. Component alignment was achieved by using measured resection in 116 knees and gap balancing was used in 105 knees. The patients had a mean age of 66 years (range, 44–86 years) and a mean body mass index of 32 kg/m2 (range, 22–52 kg/m2). Patient range-of-motion (ROM) and Knee Society (KS) function and pain scores, and radiographic assessment, were assessed preoperatively and postoperatively at ∼6 weeks, 3 months, 1 year, and then annually. The mean follow-up time was 3 years. A Kaplan–Meier's analysis was performed to calculate the survivorship. The aseptic survivorship was 98% in both the measured resection and gap-balancing groups. The mean ROM was not significantly different between the measured resection and gap-balancing groups (123 vs. 123 degrees, p = 0.990). There were no significant differences between the two groups in terms of the KS function scores (86 vs. 85 points, p = 0.829) or the KS pain scores (93 vs. 92 points, p = 0.425). Otherwise, the radiographic evaluation at latest follow-up did not demonstrate any evidence of progressive radiolucencies or loosening, of any prosthesis. The results of this study found that at a mean follow-up of 3 years, both the measured resection and gap-balancing techniques achieved excellent survivorship and postoperative outcomes. This demonstrates that both methods can be used to achieve accurate femoral component alignment with similar short-term outcomes.

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

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Yanhui Hu ◽  
Da Song ◽  
Yi Liu ◽  
Yong Zhao ◽  
Wenpu Ma ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
External Rotation ◽  
Medial Condyle ◽  
Gap Balancing ◽  
Measured Resection ◽  
Significant Difference ◽  
Total Knee ◽  
The Mean

Abstract Background Which technique, gap balancing or measured resection, can obtain better femoral component alignment and soft tissue balance in total knee arthroplasty (TKA) is still controversial. This study aimed to determine whether the gap balancing technique using a modified spacer block in TKA can result in better postoperative clinical outcomes than the measured resection technique. Methods A total of 124 patients who underwent consecutive primary TKA between May 2016 and August 2018 were retrospectively reviewed. The gap balancing technique assisted by a modified spacer block was used in 61 patients, and the measured resection technique was used in 63 patients. The surgical, imaging and knee function outcomes of the two groups were compared. Results The thickness of the posterior medial condyle bone resection using the modified spacer block tool in gap balancing was significantly larger than that of the MR technique (P = 0.001). Compared with the measured resection group, the gap balancing group had a greater external rotation resection angle of the femur (4.06 ± 1.10° vs. 3.19 ± 0.59°, P < 0.001°). Despite these differences, the mean ROM, KSS scores, and WOMAC scores at the 6-week, 1-year, and 2-year follow-ups were not significantly different. Postoperatively, there was no significant difference between the two groups in mechanical axis measurements (P = 0.275), the number of HKA outliers (P = 0.795) or the joint line displacement (P = 0.270). Conclusion The functional outcomes of the gap balancing technique based on the modified spacer are similar to those of measured resection at 3 years. Compared with the MR technique, the GB technique resulted in a greater external rotation resection angle and thicker posterior medial condylar cuts in TKA with knee varus.

Kniegelenksendoprothetik bei hämophiler Arthropathie

2010 ◽  
Vol 30 (S 01) ◽  
pp. S104-S106
Author(s):  
W. Miesbach ◽  
L. M. Sahner ◽  
A. Kurth ◽  
B. Habermann
Keyword(s):  
Quality Of Life ◽  
Total Knee Replacement ◽  
Knee Replacement ◽  
Knee Society Score ◽  
Normal Population ◽  
Knee Function ◽  
Total Knee ◽  
The Mean

Summary Purpose Purpose of this retrospective study was to evaluate our own results after total knee replacement in patients with haemophilia. Patients, material, method: 30 patients with haemophilia who underwent total knee replacement between 1987 and 2005 were included. We used the clinical and radiological Knee Society Score. Furthermore, the Petterson and the Arnold and Hilgartner score were applied. Results: The mean age at the time of surgery was 43.2 (27–66). At the time of follow- up examination the mean age was 51.6 (30–82) years. The mean follow-up was 7.1 (2–20) years. Preoperative, he mean Arnold and Hilgartner score was 4.17 (± 0.59) and the mean Petterson-Score was 9 ± 2.29. Compared to the preoperative deficiency in knee function (KSS-Score 88.17 ± 33.58) an improvement with 166.67 (± 22.73) points was seen. 1 patient showed an aseptic loosening after 11 years. Discussion: Total knee replacement in patients with haemophilia improves knee function and quality of life. The results of our study represent results in earlier published studies. Compared to a non-haemo-philic normal population the rate of perioper-ative complications was not increased.

CLINICAL AND RADIOLOGICAL RESULTS OF TOTAL KNEE REPLACEMENT USING PATIENT-SPECIFIC POSITIONING GUIDES WITH AT LEAST 5 YEARS OF FOLLOW-UP

2020 ◽  
pp. 2050020
Author(s):  
Xabier Foruria ◽  
Jesús Moreta ◽  
Carlos Jaramillo ◽  
Ane Anton ◽  
Isidoro Calvo ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Patient Specific ◽  
Knee Score ◽  
Conventional Instrumentation ◽  
Total Knee ◽  
The Mean ◽  
Clinical And Radiological Results ◽  
Coronal Malalignment

Objective: Patient-specific positioning guides have been designed to improve precision in total knee arthroplasty. The aim of this study is to evaluate the medium-term clinical and radiological outcomes with magnetic resonance imaging-based patient-specific positioning guides. Material and methods: We retrospectively reviewed patients from two centers treated with total knee arthroplasty performed with patient-specific positioning guides. We enrolled patients operated on between January 2011 and December 2013, with a minimum follow-up of 5 years. Preoperative and postoperative hip knee angle (HKA) and position of each component in the coronal plane were assessed. Overall malalignment was defined as an outlier of more than [Formula: see text] from the neutral mechanical axis and specific malalignment as when any component showed more than [Formula: see text] of deviation. Clinical outcomes were evaluated using the Hospital for Special Surgery (HSS) knee Score. Results: This study included 68 patients with a mean age of 72 years. The mean postoperative alignment (HKA) was [Formula: see text] and 26.5% of patients showed coronal malalignment [Formula: see text]. Regarding femoral components, 19.1% showed specific malalignment [Formula: see text], while 11.7% of tibial components were classified as outliers. The mean HSS Knee Score at final follow up was 89.2. Patients whose implants were mechanically aligned did not obtain better functional outcomes ([Formula: see text]). Conclusion: In our series, the use of patient-specific positioning guides resulted in a range of mechanical malalignment, similar to conventional instrumentation results reported in the literature.

scholarly journals Early experience and patient-reported outcomes of 503 INFINITY total ankle arthroplasties

2021 ◽  
Vol 103-B (7) ◽  
pp. 1270-1276
Author(s):  
David N. Townshend ◽  
Andrew J. F. Bing ◽  
Timothy M. Clough ◽  
Ian T. Sharpe ◽  
Andy Goldberg ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Early Experience ◽  
Outcome Data ◽  
Patient Specific ◽  
Patient Specific Instrumentation ◽  
Significant Difference ◽  
Patient Reported ◽  
The Mean ◽  
One Year

Aims This is a multicentre, non-inventor, prospective observational study of 503 INFINITY fixed bearing total ankle arthroplasties (TAAs). We report our early experience, complications, and radiological and functional outcomes. Methods Patients were recruited from 11 specialist centres between June 2016 and November 2019. Demographic, radiological, and functional outcome data (Ankle Osteoarthritis Scale, Manchester Oxford Questionnaire, and EuroQol five-dimension five-level score) were collected preoperatively, at six months, one year, and two years. The Canadian Orthopaedic Foot and Ankle Society (COFAS) grading system was used to stratify deformity. Early and late complications and reoperations were recorded as adverse events. Radiographs were assessed for lucencies, cysts, and/or subsidence. Results In all, 500 patients reached six-month follow-up, 420 reached one-year follow-up, and 188 reached two-year follow-up. The mean age was 67.8 years (23.9 to 88.5). A total of 38 patients (7.5%) presented with inflammatory arthritis. A total of 101 (20.0%) of implantations used patient-specific instrumentation; 167 patients (33.1%) underwent an additional procedure at the time of surgery. A total of seven patients died of unrelated causes, two withdrew, and one was lost to follow-up. The mean follow-up was 16.2 months (6 to 36). There was a significant improvement from baseline across all functional outcome scores at six months, one, and two years. There was no significant difference in outcomes with the use of patient-specific instrumentation, type of arthritis, or COFAS type. Five (1.0%) implants were revised. The overall complication rate was 8.8%. The non-revision reoperation rate was 1.4%. The 30-day readmission rate was 1.2% and the one-year mortality 0.74%. Conclusion The early experience and complications reported in this study support the current use of the INFINITY TAA as a safe and effective implant in the treatment of end-stage ankle arthritis. Cite this article: Bone Joint J 2021;103-B(7):1270–1276.

scholarly journals Accuracy of Coronal Plane Mechanical Alignment in a Customized, Individually Made Total Knee Replacement with Patient-Specific Instrumentation

2017 ◽  
Vol 31 (08) ◽  
pp. 792-796 ◽  
Author(s):  
Gary Levengood ◽  
Jack Dupee
Keyword(s):  
Mechanical Axis ◽  
Computer Assisted Surgery ◽  
Coronal Plane ◽  
Patient Specific ◽  
Computer Assisted ◽  
Consecutive Series ◽  
Mechanical Alignment ◽  
Patient Specific Instrumentation ◽  
Patient Specific Instruments ◽  
Total Knee

AbstractThe objective of this study was to evaluate the accuracy of a customized individually made total knee implant used in conjunction with patient-specific cutting guides in restoring coronal plane mechanical axis alignment using computer-assisted surgery (CAS). A consecutive series of 63 total knee arthroplasty (TKA) patients were prospectively measured with intraoperative CAS. The patient-specific instruments and implants were created utilizing a preoperative CT scan. CAS system was used for all patients, to determine mechanical alignment. Bone cuts were made using the patient-specific instruments. Both bone cuts and final coronal mechanical alignment were recorded utilizing the navigation system for the assessment.The patient-specific instruments and implants provided perfect neutral coronal mechanical alignment (0°) in 53 patients. The remaining 10 patients had a postoperative alignment within ± 2° of neutral. The average preoperative deformity was 5.57° versus 0.18° postoperatively (p < 0.0001). The mean correction angle was 5.68°. No patients had postoperative extension deficits as measured with CAS (7.50° pre-op for 40/63 patients). Customized, individually made total knee implant with patient-specific cutting jigs showed results that are comparable to those of CAS systems in this study. This technology restores the neutral coronal mechanical axis very accurately, while offering unique benefits such as improved implant fit and restoration of the patient's J-curves, which require further investigation.

scholarly journals Patient-specific instrumentation improved three-dimensional accuracy in total knee arthroplasty: a comparative radiographic analysis of 1257 total knee arthroplasties

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Leo Pauzenberger ◽  
Martin Munz ◽  
Georg Brandl ◽  
Julia K. Frank ◽  
Philipp R. Heuberer ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Mechanical Axis ◽  
Three Dimensional ◽  
Mobile Bearing ◽  
Patient Specific ◽  
Limb Alignment ◽  
Patient Specific Instrumentation ◽  
Conventional Instrumentation ◽  
Total Knee

Abstract Background The purpose of this study was to compare restoration of mechanical limb alignment and three-dimensional component-positioning between conventional and patient-specific instrumentation in total knee arthroplasty. Methods Radiographic data of patients undergoing mobile-bearing total knee arthroplasty (n = 1257), using either conventional (n = 442) or patient-specific instrumentation (n = 812), were analyzed. To evaluate accuracy of axis restoration and 3D-component-positioning between conventional and patient-specific instrumentation, absolute deviations from the targeted neutral mechanical limb alignment and planned implant positions were determined. Measurements were performed on standardized coronal long-leg and sagittal knee radiographs. CT-scans were evaluated for accuracy of axial femoral implant rotation. Outliers were defined as deviations from the targeted neutral mechanical axis of > ± 3° or from the intraoperative component-positioning goals of > ± 2°. Deviations greater than ± 5° from set targets were considered to be severe outliers. Results Deviations from a neutral mechanical axis (conventional instrumentation: 2.3°± 1.7° vs. patient-specific instrumentation: 1.7°± 1.2°; p < 0.001) and numbers of outliers (conventional instrumentation: 25.8% vs. patient-specific instrumentation: 10.1%; p < 0.001) were significantly lower in the patient-specific instrumentation group. Significantly lower mean deviations and less outliers were detected regarding 3D-component-positioning in the patient-specific instrumentation compared to the conventional instrumentation group (all p < 0.05). Conclusions Patient-specific instrumentation prevented from severe limb malalignment and component-positioning outliers (> ± 5° deviation). Use of patient-specific instrumentation proved to be superior to conventional instrumentation in achieving more accurate limb alignment and 3D-component positioning, particularly regarding femoral component rotation. Furthermore, the use of patient-specific instrumentation successfully prevented severe (> 5° deviation) outliers.

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