scholarly journals Accuracy of Soft Tissue Balancing in Robotic-Assisted Measured-Resection TKA Using a Robotic Distraction Tool

10.29007/h8kn ◽  
2019 ◽  
Author(s):  
Jan Koenig ◽  
Sami Shalhoub ◽  
Eric Chen ◽  
Christopher Plaskos
Keyword(s):  
Soft Tissue ◽  
Range Of Motion ◽  
Measurement Data ◽  
Soft Tissue Balance ◽  
Maximum Difference ◽  
Robotic Assisted ◽  
Soft Tissue Balancing ◽  
Gap Measurement ◽  
Measured Resection ◽  
Patient Reported

Achieving proper soft tissue balance during total knee arthroplasty (TKA) can reduce post- operative instability and stiffness as well as improve patient reported outcomes. The objective of this study was to compare final intra-operative coronal balance throughout the knee range of motion in navigated robotic-assisted TKA when performed with quantifiable feedback from a robotic ligament tensioning tool versus with standard trials and navigation measurements alone.The study included a prospective cohort of 52 patients undergoing robotic-assisted TKA using a measured resection technique. The cohort was divided into two sequential groups: a non-sensor-assisted group (n=25) and a subsequent sensor-assisted group (n=27). Once bony cuts and soft tissue balancing was performed in the non-sensor cohort, the final tibiofemoral gaps were measured throughout the knee range of motion using a robotic-assisted tensioner with the surgeon blinded to the measurements. For the sensor cohort, the surgeon preformed soft-tissue releases or re-cuts in order to balance the knee using the gap measurement data from the robotic tensioner. The robotic-assisted tensioner was then used to measure the final medial and lateral gap measurements.The average mediolateral gap difference throughout the range of flexion was 1.9 ± 0.7 mm with maximum difference of 7.8 mm for the non-sensor cohort. The sensor cohort had an average mediolateral difference of 1.5 ± 0.6 mm and a maximum difference of 3.8 mm. The difference between the two groups was statistically significant from 60 to 90 degrees of flexion. 38-41% of knees were balanced to within 1 mm mediolaterally in the non-sensor group compared to 48-70% for the sensor group when measured at various flexion angles. 65-76% of knees were balanced to within 2 mm for the non-sensor group compared to 78-86% for the sensor-assisted group. The number of knees requiring subsequent soft tissue releases was similar in each group. Soft tissue balancing with the aid of a robotic tensioning tool resulted in significantly more accurate soft tissue balance than when using navigation measurements and standard trials alone in this single surgeon study.

scholarly journals Combining sensor and robotic technologies to achieve a well balanced total knee arthroplasty while avoiding any soft tissue releases

10.29007/vwhp ◽  
2020 ◽  
Author(s):  
Julien Bardou-Jacquet
Keyword(s):  
Soft Tissue ◽  
Range Of Motion ◽  
Patient Reported Outcomes ◽  
Soft Tissue Release ◽  
Measured Resection ◽  
Patient Reported ◽  
Initial Load ◽  
Total Knee ◽  
Polyethylene Thickness ◽  
Load Numbers

Achieving a balanced total knee throughout the entire range of motion leads to improved patient reported outcomes and satisfaction. Sensor-assisted technology allows the surgeon to quantitatively assess and address imbalance through either soft tissue releases or bone recuts. However, balancing through soft tissue releases leads to unpredictable gap increments and frequent early over-releases.METHODS: During a consecutive and prospective series of 29 robotic total knee surgeries, intra-operative load sensors were used following the initial bone resections to quantitatively assess the knee’s state of balance through the range of motion with trial components in place. Load measurements were taken at 10 and 90 degrees of knee flexion. Based on previous literature, a balanced knee is defined as having a mediolateral load difference below 15 pounds (lbf) through the range of motion, with an absolute load magnitude per compartment above 5lbf and not exceeding 45lbf. The initial load numbers were recorded as well as the number and type of subsequent corrections needed to achieve quantitative balance.RESULTS Of the 29 robotics cases, only 12 (41%) were well-balanced after the initial bone cuts (mechanical alignment by measured resection). Another two cases were too loose and required an increase in the polyethylene thickness size of two millimeters to achieve a well-balanced knee without further bone resection. In 14 cases, a bone recut was required to balance the knee. More specifically, four cases required a recut of the femur, ten cases required a recut of the tibia. Eventually, one case was left unbalanced in flexion with a mediolateral load differential of 20 lbf. It should be noted explicitly that no soft tissue releases were done for any of the 29 cases. At the end, all 29 knees were considered well balanced in extension and all but six (79%) at 90° of flexion. For these six cases with balance issue at 90° of flexion, absolute load magnitude in both compartments was below 45 lbf and above 5lbf, though the mediolateral load differential was between 15lbf and 30lbf.DISCUSSION Based on a preliminary series, this work demonstrates the opportunity of combining multiple technologies to achieve a quantitatively balanced knee through the range of motion without any soft tissue release.

scholarly journals Frequency of soft-tissue releases and their effect on patient reported outcomes in robotic-assisted TKA.

10.29007/grf3 ◽  
2020 ◽  
Author(s):  
Christopher Plaskos ◽  
Edgar Wakelin ◽  
Sami Shalhoub ◽  
Jeffrey Lawrence ◽  
John Keggi ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissues ◽  
Soft Tissue Release ◽  
Bone Resection ◽  
Gap Balancing ◽  
Robotic Assisted ◽  
Measured Resection ◽  
Patient Reported ◽  
Total Knee ◽  
A Prospective Study

Soft tissue releases are often required to correct deformity and achieve balance in total knee arthroplasty (TKA). However, releasing soft tissues can be subjective, highly variable and is perceived as an ‘art’ in TKA. The objective of this study was to compare the rate of soft tissue release required to achieve a balanced knee in tibial-first gap- balancing versus conventional, measured resection TKA, and its effect on outcomes.Soft tissue releases were documented and reviewed in 1256 robotic-assisted gap- balancing and 85 robotic-assisted measured-resection TKAs. Knees were stratified by coronal deformity (varus: >2° varus; valgus: >2° valgus). Rates of releases were compared between the two groups and literature. A subset of these patients were also enrolled in a prospective study. KOOS outcomes were captured pre-operatively and at 6M post TKA.The frequency of soft tissue release was significantly lower in the robotic gap- balancing group, with 21% of knees requiring release versus 40% (p=0.001) in the robotic measured resection group and 67% (p<0.001) for conventional measured resection. Pre-operative KOOS scores were similar between groups, however 6M scores showed a significant improvement in QOL, Sports and Symptoms scores in knees not released.Robotic assisted TKA with predictive gap balancing was found to reduce the number of releases across all coronal angles compared to conventional instruments. Furthermore, performing a soft tissue release rather than bone resection to achieve balance, correlated with worse outcomes. Further research is required to understand when imbalance should be corrected with bone resection adjustment versus soft tissue release.

scholarly journals Soft Tissue Imbalance Resulting from a Simulated Measured Resection Model as Predicted by the Use of Robotic-Assisted Total Knee Arthroplasty Technology

10.29007/mrbg ◽  
2020 ◽  
Author(s):  
Bertrand Kaper
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Surgical Technique ◽  
Knee Arthroplasty ◽  
Soft Tissue Balance ◽  
Robotic Assisted ◽  
Accuracy And Precision ◽  
Measured Resection ◽  
Soft Tissue Laxity ◽  
Total Knee

In this study, patients undergoing RA-TKA were critically assessed to understand the accuracy and precision of a simulated MR model used historically in manually instrumented TKA surgery. Using a 3mm threshold of soft-tissue laxity, knees were identified that would have been expected to require the application of a “reactive” CI-TKA surgical technique to achieve adequate soft-tissue balance.

scholarly journals Can Knee Stability at 0 and 90 Degrees Accurately Predict Mid-Flexion Stability in TKA

10.29007/q4d5 ◽  
2020 ◽  
Author(s):  
Bertrand Kaper
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Balance ◽  
Knee Stability ◽  
Robotic Assisted

The goal of this study was to utilize the NAVIO robotic-assisted (RA)-TKA technique to assess whether a knee that is well-balanced at 0 and 90 is also well balanced in mid-flexion. Using a 3mm threshold to define soft-tissue balance, results demonstrated that 11.5% of knees studied could be expected to be unstable in the mid-flexion arc (15-75) despite being well-balanced at the static poses at 0 and 90.

Accuracy of soft tissue balancing in TKA: comparison between navigation-assisted gap balancing and conventional measured resection

2009 ◽  
Vol 18 (3) ◽  
pp. 381-387 ◽  
Author(s):  
Dae-Hee Lee ◽  
Jong-Hoon Park ◽  
Dong-Ik Song ◽  
Debabrata Padhy ◽  
Woong-Kyo Jeong ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Gap Balancing ◽  
Soft Tissue Balancing ◽  
Measured Resection

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

scholarly journals Post-operative Virtual Range of Motion in Robotic-assisted THA Patients to determine Pre-operative Simulation Needs

10.29007/ld57 ◽  
2020 ◽  
Author(s):  
Matthew Thompson ◽  
Roopa Guttal ◽  
Shon Darcy ◽  
Akshay Alaghatta ◽  
Andrea Marcovigi ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Pelvic Tilt ◽  
Robotic Assisted ◽  
Total Hip ◽  
Bony Impingement ◽  
Hip Range Of Motion ◽  
Patient Reported ◽  
Pelvic Position ◽  
Hip Arthroplasties ◽  
Stem Version

For preoperative simulations of hip range of motion to be useful in predicting complications after total hip arthroplasty (THA), the factors that could affect post-operative function must be considered including, but not limited to, bony impingement, pelvic position, and implanted vs. planned differences. This study retrospectively simulates ranges of motion to prosthetic and bony impingement of THA patients with known planned and implanted component positions and pelvic tilt to determine the factors and needs to accurately simulate range of motion preoperatively.Twenty-two (22) anterolateral, cementless total hip arthroplasties were performed using robotic-arm assisted technology which allowed capture of the implanted stem version and position in addition to robotic-assisted cup placement to plan. With the known implanted positions and preoperative 3-dimentional (3D) bone models, six (6) hip maneuvers were virtually simulated in custom software. Correlations were evaluated between planned and implanted component positions, pelvic tilt, ranges of motion, and patient-reported outcomes.Average ranges of motion to impingement were similar to those of previous simulation and navigation studies. Supine tilt varied from -10 ̊ (posterior) to 15 ̊ (anterior) with an average of 3.4±6.6 ̊. Very little correlation was seen between native or planned stem version and implanted stem version. Correlations were seen between some maneuvers such as internal rotation (IR) at 90 degrees flexion (F) (IR@90F) and combined component version and pelvic tilt. Bony impingement occurred during IR@90F in 9 of the 22cases. Pelvic tilt assessment, bony impingement detection, better prediction of implanted component position or the ability to execute a plan, such as robotically, would all provide a more accurate pre-operative simulation of the post-operative patient’s function.

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