scholarly journals Short- to mid-term outcomes of computer navigation assisted total knee arthroplasty using adjusted mechanical alignment compared to mechanical alignment

2021 ◽  
Author(s):  
Kai Zheng ◽  
Houyi Sun ◽  
Weicheng Zhang ◽  
Feng Zhu ◽  
Jun Zhou ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Computer Navigation ◽  
Mechanical Alignment ◽  
Lateral Flexion ◽  
Femoral Prosthesis ◽  
Flexion Gap ◽  
Functional Scores ◽  
Total Knee

Abstract Purpose To evaluate efficacy of navigation-assisted total knee arthroplasty (TKA) achieved using adjusted mechanical alignment (aMA) and mechanical alignment (MA) technique. Methods The authors performed a retrospective study enrolled a single-center series of patients who underwent navigation-assisted TKA with aMA (n = 77) and with MA (n = 61) technique. The demographic data was recorded. Functional scores including Hospital for Special Surgery score, Western Ontario and McMaster Universities Osteoarthritis Index score and Forgotten Joint Score-12 were evaluated. In addition, the parameter of resection and soft tissue balance as well as radiographic evaluation was measured and compared between groups. Results The HSS score at 1-month and 6-months postoperatively were significant higher using aMA compared to MA. The postoperative coronal alignment was made with a mean of 1.11° more varus/valgus in the aMA group compared to MA. The femoral prosthesis was positioned in a mean of 2.29° more varus/valgus using aMA compared to MA. The medial extension gap was significantly tighter in the MA group. In addition, the femoral prosthesis in the aMA group was positioned in a mean of 0.77° more external rotation than the MA group. The lateral flexion gap was wider in the aMA group with a mean of 0.71 mm more laxity. Conclusions Both aMA and MA technique in TKA obtained good clinical outcomes. Notably, aMA-TKA grant superior functional scores at 1-month and 6-months follow-up, might due to the preservation of mild constitutional frontal deformity with less release of soft tissue and a biomimetic wider lateral flexion gap was remained.

scholarly journals Accuracy of total knee arthroplasty using the modified gap technique based on the bone gap: an evaluation of the bone gap with a distal femoral trial component

Arthroplasty ◽  
2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Goki Kamei ◽  
Shigeki Ishibashi ◽  
Koki Yoshioka ◽  
Satoru Sakurai ◽  
Hiroyuki Inoue ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Distal Femur ◽  
Gap Size ◽  
Flexion Gap ◽  
Gap Technique ◽  
Joint Gap ◽  
Total Knee ◽  
The Mean

Abstract Background In total knee arthroplasty (TKA) using the modified gap technique, the soft-tissue balance is measured after osteotomy of the distal femur and proximal tibia (conventional bone gap). However, after osteotomy, the flexion gap size during 90° knee flexion may be larger than that observed after implantation. The tension of the lateral compartment during 90° flexion may also be reduced after osteotomy of the distal femur. We manufactured a distal femoral trial component to reproduce the condition after implantation and prior to posterior condyle osteotomy. This study aimed to evaluate the effect of the trial component on the flexion gap. Methods This prospective study included 21 consecutive patients aged 78 years with medial osteoarthritis who underwent cruciate-retaining TKA between February 2017 and March 2018. The postoperative flexion gap size and inclination during 90° flexion were compared between cases with and without the trial component. Results The mean joint gap size with the trial component (13.4 ± 0.80 mm) was significantly smaller than that without the trial component (14.7 ± 0.84 mm). The mean gap inclination angle with the trial component (3.7° ± 0.62°) was significantly smaller than that without the trial component (5.5° ± 0.78°). Conclusions In the present study, the joint gap size and medial tension were significantly reduced after the trial component had been set. Accurate measurement of the soft-tissue balance is an important factor in the modified gap technique, and this method using a distal femoral trial component can offer better outcomes than those achieved with conventional methods.

The Impact of Intraoperative Gap Difference Between Extension and Flexion on Perception of Joint Function After Total Knee Arthroplasty: a Comparative Retrospective Study

2021 ◽  
Author(s):  
Tomohiro Okayoshi ◽  
Yoshinori Okamoto ◽  
Hitoshi Wakama ◽  
Shuhei Otsuki ◽  
Masashi Neo
Keyword(s):  
Total Knee Arthroplasty ◽  
Retrospective Study ◽  
Soft Tissue ◽  
Knee Joint ◽  
Predictive Factors ◽  
Knee Arthroplasty ◽  
Difference Threshold ◽  
Joint Function ◽  
Flexion Gap ◽  
Total Knee

Abstract Background: The argument presupposes that intra-operative soft tissue balance is associated with patient-reported outcome measures after total knee arthroplasty (TKA). Our aim was to assess the association between the extension-to-flexion gap and patients’ reported perception of knee joint function.Methods: This was a retrospective study of 60 cases of primary cruciate-retaining TKAs performed for the treatment of medial-compartment knee osteoarthritis, at a mean follow-up of 2.6 (range, 2.0–5.2) years. Knee perception was evaluated by asking patients whether they considered their knee joint as “natural” (grade I) or “artificial”, with or without restrictions (grades II–V). The following factors were compared between the two groups: age, sex, and the extension-to-flexion gap difference. A multiple logistic regression analysis was used to identify predictive factors of an artificial knee joint perception. A receiver operating characteristic curve analysis was used to identify cut-off values of predictive factors. Result: Compared to a natural knee joint perception (26 knees, 43%), an artificial perception (34 knees, 57%) was associated with a smaller gap difference at the distraction force of 20 lbf (p < .001), 30 lbf (p = .022), and 40 lbf (p = .038), a lower EuroQol 5-Dimension score (p = .029), and self-reported joint health (Knee injury and Osteoarthritis Outcome Score-Joint Replacement [KOOS-JR], p = .032). A gap difference <1.0 mm was a predictive of an artificial perception (odds ratio, 1.63; 95% confidence interval, 1.33–4.54; p < .001). A cut-off gap difference of 0.99 mm at 20 lbf predicted an artificial perception with a sensitivity of 81.5% and a specificity of 87.9%. Post-operative satisfaction (p < .001), KOOS-JR (p < .001), patient’s joint perception (p = .006), pain (p = .015), and EuroQol 5-Dimension (p = .032) differed between the two groups when the gap difference threshold was set to 1.0 mm.Conclusion: Careful balancing of soft tissue during TKA to achieve an extension-to-flexion gap ≥ 1.0 mm can improve patients’ perception of knee joint function and quality of life.

scholarly journals Does Patella Position Influence Soft Tissue Balance and Clinical Outcome in Minimally Invasive Total Knee Arthroplasty?

2020 ◽  
Author(s):  
Kaiyuan Liu ◽  
Dong Yang ◽  
Tianyang Xu ◽  
Wenwei Jiang ◽  
Lin Fan ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Minimally Invasive ◽  
Knee Arthroplasty ◽  
Soft Tissue Balance ◽  
Femoral Prosthesis ◽  
Group A ◽  
Total Knee ◽  
Group B ◽  
Varus Angle

Abstract Purpose: We hypothesized that patellar positioning during minimally invasive total knee arthroplasty (MIS-TKA) would affect soft tissue balance and postoperative outcome.Methods: From December 2018 to February 2019, 55 patients receiving primary MIS-TKA were enrolled. The gap-balance technique was used, with patients randomly assigned to undergo osteotomy and balance of soft tissue with the patella reduced (group A; n = 27) or with the patella subluxated (group B; n = 28). The soft tissue balance achieved with the patella reduced and subluxated were compared. Femoral prosthesis rotation, mechanical femoral axis–to–tibial axis angle, Knee Society Score (KSS), pain score, and range of flexion were compared between the groups. Follow-up was for 6 months.Results: The flexion gap and the varus angle were significantly greater after patella reduction than before reduction, but the extension joint gap and varus angle were comparable before and after patella reduction. The femoral prosthesis tended to be internally rotated in group B. Range of flexion was better in the group A than in group B at 1 month after surgery, but the differences were not significant at 3 and 6 months. KSS and pain score were comparable between the groups after surgery.Conclusion: During MIS-TKA, as far as possible, soft tissue balance should be achieved with the patella reduced; otherwise, the femoral prosthesis may be installed more internally and, after patella reduction, the flexion gap and varus would increase.

scholarly journals Changes of mediolateral soft tissue gaps in total knee arthroplasty after suturing medial extensor in navigation

2018 ◽  
Vol 26 (3) ◽  
pp. 230949901880251
Author(s):  
Seung Bum Chae ◽  
Myung Rae Cho ◽  
Jae Bum Kwon ◽  
Jae Hyuk Lee ◽  
Won Kee Choi
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Knee Flexion ◽  
Computer Navigation ◽  
Varus Knee ◽  
Total Knee ◽  
The Difference ◽  
Lateral Gaps

Purpose: Aim is to investigate the changes of mediolateral soft tissue gaps in total knee arthroplasty (TKA) after suturing medial extensor. Methods and materials: We compared the differences of medial and lateral gap values that were shown by the computer navigation at 0°, 45°, 90°, and 120° knee flexion during patella in situ and during patella repaired by a towel clip on two constant sites. Fifty consecutive knees (43 patients) scheduled for TKA due to varus knee osteoarthritis, from February 2017 to May 2017, were enrolled in this prospective study. Results: The medial gaps with patella repaired were significantly lower ( p < 0.05) than the medial gaps with patella in situ at 45°, 90°, and 120° knee flexion. Differences in the medial gap were largest at 90, with the difference of 0.87 mm. Twenty-four of 50 cases (48%) showed medial gap differences of 1 mm or over, and 13 of 50 cases (26%) showed medial gap differences of 2 mm or over. The variation in the medial gap at 90° following patellar repair showed significant association (correlation coefficient = 0.78, p = 0.001) with the difference between medial and lateral gaps (medial gap − lateral gap) at 90° of patella in situ. At 90° knee flexion, when the medial and lateral gap difference in patella in situ was 1 mm or less, 73.5% (25/34) of the cases showed variation in the medial gap of less than 1 mm after patellar repair. Conclusion: During TKA, while measuring the medial gap with patella in situ, overestimation might occur, especially in the position of knee flexion. Thus, reevaluation using towel clips should be considered when the medial and lateral gap difference is 1 mm or larger when patella in situ during evaluation of the medial and lateral gaps at 90° knee flexion.

Does the Robotic Arm and Preoperative CT Planning Help with 3D Intraoperative Total Knee Arthroplasty Planning?

2018 ◽  
Vol 32 (08) ◽  
pp. 742-749 ◽  
Author(s):  
Robert C. Marchand ◽  
Nipun Sodhi ◽  
Manoshi Bhowmik-Stoker ◽  
Laura Scholl ◽  
Caitlin Condrey ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Length Of Stay ◽  
Knee Arthroplasty ◽  
Robotic Arm ◽  
Lateral Flexion ◽  
Flexion Gap ◽  
Implant Size ◽  
Total Knee ◽  
Extension Gap ◽  
Robotic Software

Although several studies highlight the advantages of robotic arm-assisted total knee arthroplasty (RA-TKA), few investigate its intraoperative outcome. Therefore, the purpose of this study was to analyze the RA-TKA's ability to assist with intraoperative correction of: (1) flexion and (2) extension gaps, as well as its ability to (3) accurately predict implant sizes. Additionally, in this RA-TKA cohort, length of stay, complications, and readmissions were assessed. A total of 335 patients who underwent RA-TKA were included. The robotic software virtually measured the intraoperative prebone cut extension and flexion gaps. Differences in medial versus lateral prebone cut extension and flexion gaps were calculated. A total of 155 patients (46%) had an extension gap difference of between –2 and 2 mm (mean, –0.3 mm), while 119 patients (36%) had a flexion gap difference of between –2 and 2 mm (mean, –0.6 mm). Postbone cut differences in medial versus lateral flexion and extension gaps were measured. Balanced knees were considered to have a medial and lateral flexion gap difference within 2 mm. The robot-predicted implant size was also compared with the final implant size. Additionally, lengths of stay, complications, and readmissions were assessed. All patients achieved a postbone cut extension gap difference between –1 and 1 mm (mean, –0.1 mm). A total of 332 patients (99%) achieved a postbone cut flexion gap difference of between –2 and 2 mm (mean, 0 mm). For 98% of prostheses, the robotic software predicted within 1 implant size the actual tibial or femoral implant size used.The mean length of stay was found to be 2 days. No patients suffered from superficial skin infection, pin site infections or fractures, soft tissue damage, and no robotic cases were converted to manual TKA due to intraoperative complications. A total of 8 patients (2.2%) were readmitted; however, none were directly related to robotic use. The robotic software and use of a preoperative computed tomography (CT) substantially helped with intraoperative planning and accurate prediction of implant sizes. Therefore, based on the results of this study, the RA-TKA device does, in fact, provide considerable intraoperative assistance.

Medial and lateral gap laxity differential in computer-assisted kinematic total knee arthroplasty

2019 ◽  
Vol 101-B (3) ◽  
pp. 331-339 ◽  
Author(s):  
P. McEwen ◽  
G. Balendra ◽  
K. Doma
Keyword(s):  
Total Knee Arthroplasty ◽  
Outcome Measures ◽  
Knee Arthroplasty ◽  
Computer Assisted ◽  
Lateral Flexion ◽  
Lateral Extension ◽  
Flexion Gap ◽  
Patient Reported ◽  
Total Knee ◽  
Extension Gap

AimsThe results of kinematic total knee arthroplasty (KTKA) have been reported in terms of limb and component alignment parameters but not in terms of gap laxities and differentials. In kinematic alignment (KA), balance should reflect the asymmetrical balance of the normal knee, not the classic rectangular flexion and extension gaps sought with gap-balanced mechanical axis total knee arthroplasty (MATKA). This paper aims to address the following questions: 1) what factors determine coronal joint congruence as measured on standing radiographs?; 2) is flexion gap asymmetry produced with KA?; 3) does lateral flexion gap laxity affect outcomes?; 4) is lateral flexion gap laxity associated with lateral extension gap laxity?; and 5) can consistent ligament balance be produced without releases?Patients and MethodsA total of 192 KTKAs completed by a single surgeon using a computer-assisted technique were followed for a mean of 3.5 years (2 to 5). There were 116 male patients (60%) and 76 female patients (40%) with a mean age of 65 years (48 to 88). Outcome measures included intraoperative gap laxity measurements and component positions, as well as joint angles from postoperative three-foot standing radiographs. Patient-reported outcome measures (PROMs) were analyzed in terms of alignment and balance: EuroQol (EQ)-5D visual analogue scale (VAS), Knee Injury and Osteoarthritis Outcome Score (KOOS), KOOS Joint Replacement (JR), and Oxford Knee Score (OKS).ResultsPostoperative limb alignment did not affect outcomes. The standing hip-knee-ankle (HKA) angle was the sole positive predictor of the joint line convergence angle (JLCA) (p < 0.001). Increasing lateral flexion gap laxity was consistently associated with better outcomes. Lateral flexion gap laxity did not correlate with HKA angle, the JLCA, or lateral extension gap laxity. Minor releases were required in one third of cases.ConclusionThe standing HKA angle is the primary determinant of the JLCA in KTKA. A rectangular flexion gap is produced in only 11% of cases. Lateral flexion gap laxity is consistently associated with better outcomes and does not affect balance in extension. Minor releases are sometimes required as well, particularly in limbs with larger preoperative deformities. Cite this article: Bone Joint J 2019;101-B:331–339.

scholarly journals Difference between Mechanical Alignment in Navigation and Scanogram during Total Knee Arthroplasty

2019 ◽  
Vol 2019 ◽  
pp. 1-5 ◽  
Author(s):  
Rohan Bhimani ◽  
Fardeen Bhimani ◽  
Preeti Singh
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Mechanical Axis ◽  
Computer Navigation ◽  
Primary Total Knee Arthroplasty ◽  
P Value ◽  
Mechanical Alignment ◽  
Significant Difference ◽  
Total Knee ◽  
The Mean

Introduction. Malpositioning of the implant results in polyethylene wear and loosing of implant after total knee arthroplasty. Scanogram is often used for measurement of limb alignment. Computer navigation provides real time measurements and thus, the aim is to see any association pre- and postoperatively between coronal alignments measured on scanogram to computer navigation during total knee arthroplasty. Material and Methods. We prospectively gathered data of 200 patients with advanced degenerative symptomatic arthritis, who were consecutively selected for primary total knee arthroplasty with computer navigation. Every patient’s pre- and postoperative scanogram were compared to the intraoperative computer navigation findings. Results. The results show that the preoperative mean mechanical axis on navigation was 10.65° (SD ± 6.95) and on scanogram it was 10.38° (SD ± 6.89). On the other hand, the mean postoperative mechanical axis on navigation was 0.69° (SD ± 0.87) and on scanogram it was 2.73° (SD ± 2.10). Preoperatively, there was no significant difference (p value = 0.46) between the two. However, the postoperative outcomes suggest that there was a noteworthy difference, with no correlation between the mean Hip-Knee Ankle Axis (HKA) and intraoperative mechanical axis (p value <0.0001). Conclusion. Postoperative mechanical alignment values after total knee arthroplasty are lower on navigation than measured on standing full length hip to ankle scanogram.

scholarly journals Clinical outcomes of kinematic alignment versus mechanical alignment in total knee arthroplasty: a systematic review

2020 ◽  
Vol 5 (8) ◽  
pp. 486-497
Author(s):  
Mark Anthony Roussot ◽  
Georges Frederic Vles ◽  
Sam Oussedik
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Clinical Outcomes ◽  
Knee Arthroplasty ◽  
Soft Tissue Balance ◽  
Kinematic Alignment ◽  
Mechanical Alignment ◽  
Patient Reported ◽  
Total Knee ◽  
Alignment Strategy

Although mechanical alignment (MA) has traditionally been considered the gold standard, the optimal alignment strategy for total knee arthroplasty (TKA) is still debated. Kinematic alignment (KA) aims to restore native alignment by respecting the three axes of rotation of the knee and thereby producing knee motion more akin to the native knee. Designer surgeon case series and case control studies have demonstrated excellent subjective and objective clinical outcomes as well as survivorship for KA TKA with up to 10 years follow up, but these results have not been reproduced in high-quality randomized clinical trials. Gait analyses have demonstrated differences in parameters such as knee adduction, extension and external rotation moments, the relevance of which needs further evaluation. Objective improvements in soft tissue balance using KA have not been shown to result in improvements in patient-reported outcomes measures. Technologies that permit accurate reproduction of implant positioning and objective measurement of soft tissue balance, such as robotic-assisted TKA and compartmental pressure sensors, may play an important role in improving our understanding of the optimum alignment strategy and implant position. Cite this article: EFORT Open Rev 2020;5:486-497. DOI: 10.1302/2058-5241.5.190093

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