Soft-tissue penetration of the oscillating saw during tibial resection in total knee arthroplasty

2020 ◽  
Vol 102-B (10) ◽  
pp. 1324-1330
Author(s):  
Stijn Herregodts ◽  
Mathijs Verhaeghe ◽  
Rico Paridaens ◽  
Jan Herregodts ◽  
Hannes Vermue ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Tissue Damage ◽  
Soft Tissue Damage ◽  
Iliotibial Band ◽  
Collateral Ligament ◽  
Tibial Resection ◽  
Total Knee ◽  
Oscillating Saw

Aims Inadvertent soft tissue damage caused by the oscillating saw during total knee arthroplasty (TKA) occurs when the sawblade passes beyond the bony boundaries into the soft tissue. The primary objective of this study is to assess the risk of inadvertent soft tissue damage during jig-based TKA by evaluating the excursion of the oscillating saw past the bony boundaries. The second objective is the investigation of the relation between this excursion and the surgeon’s experience level. Methods A conventional jig-based TKA procedure with medial parapatellar approach was performed on 12 cadaveric knees by three experienced surgeons and three residents. During the proximal tibial resection, the motion of the oscillating saw with respect to the tibia was recorded. The distance of the outer point of this cutting portion to the edge of the bone was defined as the excursion of the oscillating saw. The excursion of the sawblade was evaluated in six zones containing the following structures: medial collateral ligament (MCL), posteromedial corner (PMC), iliotibial band (ITB), lateral collateral ligament (LCL), popliteus tendon (PopT), and neurovascular bundle (NVB). Results The mean 75th percentile value of the excursion of all cases was mean 2.8 mm (SD 2.9) for the MCL zone, mean 4.8 mm (SD 5.9) for the PMC zone, mean 3.4 mm (SD 2.0) for the ITB zone, mean 6.3 mm (SD 4.8) for the LCL zone, mean 4.9 mm (SD 5.7) for the PopT zone, and mean 6.1 mm (SD 3.9) for the NVB zone. Experienced surgeons had a significantly lower excursion than residents. Conclusion This study showed that the oscillating saw significantly passes the edge of the bone during the tibial resection in TKA, even in experienced hands. While reported neurovascular complications in TKA are rare, direct injury to the capsule and stabilizing structures around the knee is a consequence of the use of a hand-held oscillating saw when making the tibial cut. Cite this article: Bone Joint J 2020;102-B(10):1324–1330.

scholarly journals Less iatrogenic soft-tissue damage utilizing robotic-assisted total knee arthroplasty when compared with a manual approach

2019 ◽  
Vol 8 (10) ◽  
pp. 495-501 ◽  
Author(s):  
Emily L. Hampp ◽  
Nipun Sodhi ◽  
Laura Scholl ◽  
Matthew E. Deren ◽  
Zachary Yenna ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Tissue Damage ◽  
Soft Tissues ◽  
Soft Tissue Damage ◽  
Anatomical Structures ◽  
Cruciate Retaining ◽  
Robotic Assisted ◽  
Total Knee

Objectives The use of the haptically bounded saw blades in robotic-assisted total knee arthroplasty (RTKA) can potentially help to limit surrounding soft-tissue injuries. However, there are limited data characterizing these injuries for cruciate-retaining (CR) TKA with the use of this technique. The objective of this cadaver study was to compare the extent of soft-tissue damage sustained through a robotic-assisted, haptically guided TKA (RATKA) versus a manual TKA (MTKA) approach. Methods A total of 12 fresh-frozen pelvis-to-toe cadaver specimens were included. Four surgeons each prepared three RATKA and three MTKA specimens for cruciate-retaining TKAs. A RATKA was performed on one knee and a MTKA on the other. Postoperatively, two additional surgeons assessed and graded damage to 14 key anatomical structures in a blinded manner. Kruskal–Wallis hypothesis tests were performed to assess statistical differences in soft-tissue damage between RATKA and MTKA cases. Results Significantly less damage occurred to the PCLs in the RATKA versus the MTKA specimens (p < 0.001). RATKA specimens had non-significantly less damage to the deep medial collateral ligaments (p = 0.149), iliotibial bands (p = 0.580), poplitei (p = 0.248), and patellar ligaments (p = 0.317). The remaining anatomical structures had minimal soft-tissue damage in all MTKA and RATKA specimens. Conclusion The results of this study indicate that less soft-tissue damage may occur when utilizing RATKA compared with MTKA. These findings are likely due to the enhanced preoperative planning with the robotic software, the real-time intraoperative feedback, and the haptically bounded saw blade, all of which may help protect the surrounding soft tissues and ligaments. Cite this article: Bone Joint Res 2019;8:495–501. DOI: 10.1302/2046-3758.810.BJR-2019-0129.R1.

Effects of Tourniquet Use on Blood Loss and Soft-Tissue Damage in Total Knee Arthroplasty

2012 ◽  
Vol 94 (24) ◽  
pp. 2209-2215 ◽  
Author(s):  
Ta-Wei Tai ◽  
Chih-Wei Chang ◽  
Kuo-An Lai ◽  
Chii-Jeng Lin ◽  
Chyun-Yu Yang
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Blood Loss ◽  
Knee Arthroplasty ◽  
Tissue Damage ◽  
Soft Tissue Damage ◽  
Total Knee

scholarly journals Soft-tissue damage during total knee arthroplasty

2017 ◽  
Vol 14 (3) ◽  
pp. 347-353 ◽  
Author(s):  
Constantin Mayer ◽  
Alexander Franz ◽  
Jan-Frieder Harmsen ◽  
Fina Queitsch ◽  
Michael Behringer ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Tissue Damage ◽  
Soft Tissue Damage ◽  
Total Knee

scholarly journals Less Iatrogenic Soft Tissue Damage Utilizing Robotic Assisted Total Knee Arthroplasty when Compared with a Manual Approach: A Blinded Assessment

10.29007/v7g9 ◽  
2019 ◽  
Author(s):  
Emily Hampp ◽  
Nipun Sodhi ◽  
Laura Scholl ◽  
Matthew Deren ◽  
Zachary Yenna ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Tissue Damage ◽  
Soft Tissues ◽  
Hypothesis Test ◽  
Patellar Ligament ◽  
Robotic Arm ◽  
Soft Tissue Damage ◽  
Total Knee

While manual total knee arthroplasty (MTKA) has demonstrated excellent clinical results, occasionally intraoperative damage to soft tissues can occur. Robotic-arm assisted technology is designed to constrain a sawblade in a haptic zone to help ensure that only the desired bone cuts are made. The objective of this cadaver study was to quantify the extent of soft tissue damage sustained during TKA through a robotic-arm assisted (RATKA) haptically guided approach and conventional MTKA approach. Four surgeons each prepared 3 RATKA and 3 MTKA specimens for cruciate retaining TKAs. RATKA was performed on one knee, with MTKA on the other. Postoperatively, 2 additional blinded surgeons, assessed and graded damage to 14 key anatomic structures. A Kruskal-Wallis hypothesis test was performed to assess for statistical differences of soft tissue damages between RATKA and MTKA cases. A p-value &lt;0.05 was used as the threshold for statistical significance, and p-values were adjusted for ties. Significantly less damage occurred to the PCL in the RATKA than the MTKA specimens (p&lt;0.0001). RATKA specimens had less damage to the dMCL (p=.149), ITB (p=0.580), popliteus (p=0.248), and patellar ligament (p=0.317). The results of this study indicate that RATKA may result in less soft-tissue damage than MTKA, especially to the PCL.

scholarly journals The Effect of the PCL on Kinematics as it Relates to Soft-Tissue Preservation from Robotic-Arm Assisted Surgery

10.29007/vbqh ◽  
2019 ◽  
Author(s):  
Raga Rajaravivarma ◽  
Sally Liarno ◽  
Tatyana Kaverina ◽  
Sonia Donde ◽  
Emily Sneddon
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Tissue Damage ◽  
Robotic Arm ◽  
Soft Tissue Damage ◽  
Tissue Preservation ◽  
Soft Tissue Preservation ◽  
Total Knee ◽  
Tibial Translation

The use of haptic-based robotic-arm assisted total knee arthroplasty (hRATKA) has demonstrated a decrease in soft tissue damage. Hampp et al. [4] compared the soft tissue damage in a cadaveric study between manual total knee arthroplasty (MTKA) and hRATKA and found that the hRATKA specimens had significantly less damage to the PCL than the MTKA specimens [4]. The purpose of this study is to look at the effect of the posterior cruciate ligament (PCL) on kinematics, as defined by anterior-posterior (AP) tibial translation, during stair climb. Using a 6 degree-of-freedom (6-DOF) joint motion simulator, the stair climb profile was run on four cadaveric knee specimens with the PCL intact and the PCL cut. In the PCL deficient condition, there was more posterior tibial motion than when the PCL was intact, and this was more noticeable during the high flexion portion of the profile. These findings speak to the importance of soft tissue preservation, and the development of haptic-based robotic-arm assisted TKA can help prevent soft tissue damage to the PCL.

Can isolated removal of osteophytes achieve correction of varus deformity and gap-balance in computer-assisted total knee arthroplasty?

2020 ◽  
Vol 102-B (6_Supple_A) ◽  
pp. 49-58
Author(s):  
Arun Mullaji
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Medial Collateral Ligament ◽  
Knee Flexion ◽  
Deformity Correction ◽  
Computer Assisted ◽  
Cruciate Ligaments ◽  
Collateral Ligament ◽  
Total Knee

Aims The aims of this study were to determine the effect of osteophyte excision on deformity correction and soft tissue gap balance in varus knees undergoing computer-assisted total knee arthroplasty (TKA). Methods A total of 492 consecutive, cemented, cruciate-substituting TKAs performed for varus osteoarthritis were studied. After exposure and excision of both cruciates and menisci, it was noted from operative records the corrective interventions performed in each case. Knees in which no releases after the initial exposure, those which had only osteophyte excision, and those in which further interventions were performed were identified. From recorded navigation data, coronal and sagittal limb alignment, knee flexion range, and medial and lateral gap distances in maximum knee extension and 90° knee flexion with maximal varus and valgus stresses, were established, initially after exposure and excision of both cruciate ligaments, and then also at trialling. Knees were defined as ‘aligned’ if the hip-knee-ankle axis was between 177° and 180°, (0° to 3° varus) and ‘balanced’ if medial and lateral gaps in extension and at 90° flexion were within 2 mm of each other. Results Of 50 knees (10%) with no soft tissue releases (other than cruciate ligaments), 90% were aligned, 81% were balanced, and 73% were aligned and balanced. In 288 knees (59%) only osteophyte excision was performed by subperiosteally releasing the deep medial collateral ligament. Of these, 98% were aligned, 80% were balanced, and 79% were aligned and balanced. In 154 knees (31%), additional procedures were performed (reduction osteotomy, posterior capsular release, and semimembranosus release). Of these, 89% were aligned, 68% were balanced, and 66% were aligned and balanced. The superficial medial collateral ligament was not released in any case. Conclusion Two-thirds of all knees could be aligned and balanced with release of the cruciate ligaments alone and excision of osteophytes. Excision of osteophytes can be a useful step towards achieving deformity correction and gap balance without having to resort to soft tissue release in varus knees while maintaining classical coronal and sagittal alignment of components. Cite this article: Bone Joint J 2020;102-B(6 Supple A):49–58.

scholarly journals Robotic-Arm Assisted Total Knee Arthroplasty Demonstrated Soft Tissue Protection

10.29007/8bxp ◽  
2018 ◽  
Author(s):  
Emily Hampp ◽  
Manoshi Bhowmik-Stoker ◽  
Laura Scholl ◽  
Jason Otto ◽  
David Jacofsky ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Cadaver Study ◽  
Patellar Ligament ◽  
Robotic Arm ◽  
Collateral Ligament ◽  
Tissue Protection ◽  
Total Knee ◽  
Patellar Eversion

Total knee arthroplasty (TKA) typically addresses end-stage osteoarthritis. While TKA procedures have demonstrated clinical success, occasionally intraoperative complications can occur. This cadaver study examined the potential benefits of soft tissue protection in robotic-arm assisted TKA (RATKA). Six cadaver knees were prepared using RATKA by a single surgeon from a high-volume TKA joint center with no former clinical robotic experience, and compared to seven manually performed cases as a control. The presence of soft tissue disruption was assessed by having the surgeon perform visual evaluation and palpation of the medial collateral ligament (MCL), lateral collateral ligament (LCL), posterior cruciate ligament (PCL), and the patellar ligament after the procedures. The amount of tibial subluxation and patellar eversion was recorded for each case.For all RATKA cases, there was no visible evidence of disruption of any of the ligaments. All RATKA cases were successfully left with a bone island on the tibial plateau, which protected the PCL. Tibial subluxation and patellar eversion were not required for visualization. In two of the seven MTKA cases, there was slight disruption noted of the PCL, although this did not lead to any apparent change in the functional integrity of the ligament. All MTKA cases required tibial subluxation and patellar eversion to achieve optimal visualization.Aspects of soft tissue protection were noted in this cadaver study for RATKA. Standard retraction techniques during cutting are recommended. This is the first study to have soft tissue injury parameters assessed for RATKA, and may serve as a platform for future studies.

Is Soft Tissue Laxity Associated with Tissue Metal Concentrations after Total Knee Arthroplasty?

2018 ◽  
Vol 28 (2) ◽  
pp. 79-85
Author(s):  
Meredith Perkins ◽  
Julie Lowell ◽  
Christina Arnholt ◽  
Daniel MacDonald ◽  
Anita L. Kerkhof ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Metal Concentrations ◽  
Soft Tissue Laxity ◽  
Total Knee

scholarly journals Postoperative laxity of the lateral soft tissue is largely negligible in total knee arthroplasty for varus osteoarthritis

2021 ◽  
Vol 29 (1) ◽  
pp. 230949902110020
Author(s):  
Seikai Toyooka ◽  
Hironari Masuda ◽  
Nobuhiro Nishihara ◽  
Takashi Kobayashi ◽  
Wataru Miyamoto ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Mechanical Axis ◽  
Varus Deformity ◽  
Varus Knee ◽  
Before And After ◽  
Knee Deformity ◽  
Varus Stress ◽  
Total Knee

Purpose: To evaluate the integrity of lateral soft tissue in varus osteoarthritis knee by comparing the mechanical axis under varus stress during navigation-assisted total knee arthroplasty before and after compensating for a bone defect with the implant. Methods: Sixty-six knees that underwent total knee arthroplasty were investigated. The mechanical axis of the operated knee was evaluated under manual varus stress immediately after knee exposure and after navigation-assisted implantation. The correlation between each value of the mechanical axis and degree of preoperative varus deformity was compared by regression analysis. Results: The maximum mechanical axis under varus stress immediately after knee exposure increased in proportion to the degree of preoperative varus deformity. Moreover, the maximum mechanical axis under varus stress after implantation increased in proportion to the degree of preoperative varus deformity. Therefore, the severity of varus knee deformity leads to a progressive laxity of the lateral soft tissue. However, regression coefficients after implantation were much smaller than those measured immediately after knee exposure (0.99 vs 0.20). Based on the results of the regression formula, the postoperative laxity of the lateral soft tissue was negligible, provided that an appropriate thickness of the implant was compensated for the bone and cartilage defect in the medial compartment without changing the joint line. Conclusion: The severity of varus knee deformity leads to a progressive laxity of the lateral soft tissue. However, even if the degree of preoperative varus deformity is severe, most cases may not require additional procedures to address the residual lateral laxity.

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