scholarly journals Coronal Knee Laxity Measured During Computer-Assisted Total Knee Arthroplasty

10.29007/mdm5 ◽  
2018 ◽  
Author(s):  
Yifei Dai ◽  
Guillaume Bras ◽  
David Liu
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Knee Laxity ◽  
Computer Assisted ◽  
Clinical Implications ◽  
Valgus Knee ◽  
Soft Tissue Management ◽  
Soft Tissue Laxity ◽  
Total Knee

This observational study on fifty-six patients presents the coronal knee angular laxity measured during computer-assisted total knee arthroplasty. Varus/valgus knee laxity was assessed at extension, mid-flexion, and high flexion, and compared between arthritic knees and knees following trial TKA implantation. The data represented soft tissue laxity under surgical reality and may be used to further understand the clinical implications of intraoperative soft-tissue management. The findings highlight the potential for CAOS to accurately manage soft tissue balance in addition to bony cuts and overall alignment.

scholarly journals Variability in Coronal Knee Laxity Measured During Computer-Assisted Total Knee Arthroplasty

10.29007/w2b4 ◽  
2020 ◽  
Author(s):  
Yifei Dai ◽  
Charlotte Bolch ◽  
Andrew Jensen ◽  
Amaury Jung
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Principal Component ◽  
Knee Laxity ◽  
Computer Assisted ◽  
Second Mode ◽  
Soft Tissue Laxity ◽  
Total Knee ◽  
Post Implantation

Principal component analysis on 376 TKA knees presented the distinctive patterns and variabilities in the coronal knee angular laxity throughout the range of motion, measured post-implantation during computer-assisted total knee arthroplasty. The variability in the laxity curves were dominated by the first mode of variation (varus/valgus offset of the laxity envelope) and the second mode of variation (varus/valgus crossing pattern). Further analysis revealed that surgeon-specific impact was associated with the first mode of variation for the laxity curve, and both first and second mode of variation for the size of the laxity envelope. The results shed a light on the characteristics and variabilities of post-implantation soft-tissue laxity under surgical reality and may be used to further understand the clinical implications of intraoperative soft-tissue management.

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

A Prospective Randomised Control Trial Comparing Functional with Mechanical Axis Alignment in Total Knee Arthroplasty: study protocol for an investigator initiated trial

2021 ◽  
Author(s):  
Richard Steer ◽  
Beth Tippett ◽  
R Nazim Khan ◽  
Dermot Collopy ◽  
Gavin Clark
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Functional Outcomes ◽  
Medical Information ◽  
Randomised Control Trial ◽  
Computer Assisted ◽  
Patient Reported ◽  
Total Knee ◽  
Alternative Alignment

Abstract Background: A drive to improve functional outcomes for patients undergoing total knee arthroplasty (TKA) has led to alternative alignment being used. Functional alignment (FA) uses intraoperative soft tissue tension to determine the optimal position of the prosthesis within the patients soft tissue envelope. Angular limits for bone resections are followed to prevent long term prosthesis failure. This study will use the aid of robotic assistance to plan and implement the final prosthesis position. This method has yet to be compared to the traditional mechanically aligned (MA) knee in a randomised trial. Methods: A blinded randomised control trial with 100 patients will be undertaken via Perth Hip and Knee clinic. Fifty patients will undergo a MA TKA and fifty will undergo a FA TKA. Both alignment techniques will be balanced via computer assisted navigation to assess prosthetic gaps, being achieved via the initial bony resection and further soft tissue releases as required to achieve satisfactory balance. The primary outcome will be the forgotten joint score (FJS) two years after surgery, with secondary outcomes being other patient reported outcome measures, clinical functional assessment, radiographic position and complications. Other data that will be collected will be patient demography (Sex, Age, level of activity) and medical information (grade of knee injury, any other relevant medical information). The linear statistical model will be fitted to the response (FJS), including all the other variables as covariates. Discussion: Many surgeons are utilising alternative alignment techniques with a goal of achieving better functional outcomes for their patients. Currently MA TKA remains the gold standard with good outcomes and excellent longevity. There is no published RCTs comparing FA to MA yet and only two registered studies are planned or currently in progress. This study utilizes a FA technique which differs from the two studies. This study will help determine if FA TKA has superior functional results for patients.Trial registration: This trial has been registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) http://www.anzctr.org.au: U1111-1257-2291, registered 25th Jan 2021. It is also listed on www.clinicaltrials.gov: NCT04748510

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.

Preoperative Templating and Computer-Assisted Total Knee Arthroplasty for Arthritic Valgus Knee

2013 ◽  
Vol 28 (10) ◽  
pp. 1781-1787 ◽  
Author(s):  
Wen-Yi Chou ◽  
Ka-Kit Siu ◽  
Jih-Yang Ko ◽  
Jung-Ming Chen ◽  
Ching-Jen Wang ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Computer Assisted ◽  
Valgus Knee ◽  
Preoperative Templating ◽  
Total Knee

Highly Satisfied Total Knee Arthroplasty Patients Display a Wide Range of Soft Tissue Balance

2019 ◽  
Vol 33 (03) ◽  
pp. 247-254 ◽  
Author(s):  
Michael J. McAuliffe ◽  
Patrick B. O'Connor ◽  
Lisa J. Major ◽  
Gautam Garg ◽  
Sarah L. Whitehouse ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Individual Variability ◽  
Measured Parameter ◽  
Computer Assisted ◽  
Maximum Extension ◽  
Wide Range ◽  
Coronal Laxity ◽  
Total Knee

AbstractSoft tissue balancing while crucial for a successful total knee arthroplasty (TKA) is incompletely defined and the subject of broad recommendations. We analyzed 69 unilateral computer-assisted surgery posterior stabilized (PS) TKA subjects who postoperatively scored ≥36 out of a possible 40 points on the satisfaction section of the American Knee Society score (2011). We examined a range of postoperative coronal plane laxity parameters and the correlation between preoperative and postoperative laxity. Total postoperative coronal laxity arcs at maximum extension and 20 degrees of flexion varied between 2 and 12 and 3 and 13 degrees, respectively. Depending on the position of measurement, medial laxity was between 0.5 and 9.5 degrees and lateral laxity between 1 and 12 degrees. The change in laxity between maximum extension and 90 degrees of flexion demonstrated a range of 7 degrees medially and 12 degrees laterally. The total coronal arc of movement did not affect functional outcomes. A moderate correlation of 0.452 and 0.424 was seen between initial and postoperative total coronal laxity arcs in maximum extension and 20 degrees of flexion, respectively. The individual variability for each measured parameter within our cohort demonstrates TKA satisfaction is not as simple as producing a narrow range of coronal laxity parameters and that as with many body systems considerable variation is still consistent with excellent function. Our findings help to define acceptable balance parameters for PS TKA. It does not appear necessary to closely match postoperative laxity to that present preoperatively.

Which Pre- and Postoperative Coronal Plane Laxity Parameters Influence Patient Satisfaction and Function after Primary Total Knee Arthroplasty?

2020 ◽  
Author(s):  
Michael McAuliffe ◽  
Patrick O'Connor ◽  
Lisa Major ◽  
Gautam Garg ◽  
Sarah L. Whitehouse ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Patient Satisfaction ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Coronal Plane ◽  
Soft Tissue Release ◽  
Computer Assisted ◽  
Soft Tissue Balancing ◽  
Total Knee ◽  
And Function

AbstractSoft tissue balancing, while accepted as crucial to total knee arthroplasty (TKA) outcomes, is incompletely defined as the subject of broad recommendations. We analyzed 120 computer-assisted, posterior stabilized TKA undertaken for osteoarthritis. Coronal plane laxity was measured, in the 91 varus and 29 valgus knees, prior to any bone resection or soft tissue release, and again after implant insertion. Soft tissue laxity parameters were correlated to the American Knee Society Score (2011) at a minimum follow-up of 12 months with a focus on patient function and satisfaction. Thirteen specific laxity parameters showed a significant correlation to satisfaction, one parameter correlated to function, and another to both functional and satisfaction outcomes. Most correlations were weak, the strongest related to postoperative decreases in coronal plane laxity. Greater preoperative varus but not valgus deformity was associated with higher satisfaction scores. Additionally, 30 patients who reported 40 of 40 satisfaction and that their TKA knee felt normal at all times did not have soft tissue balancing parameters distinguishing them from other subjects. Patient satisfaction and function outcomes demonstrated limited correlation to coronal plane soft tissue parameters. It appears that optimizing TKA satisfaction and function is not as simple as producing a narrow range of coronal laxity parameters. The ongoing debate around optimal coronal plane alignment and its subsequent effect on coronal plane soft tissues may not be as independently important as currently argued. Soft tissue balance may need to be considered as a more complex global envelope.

scholarly journals A prospective randomised control trial comparing functional with mechanical axis alignment in total knee arthroplasty: study protocol for an investigator initiated trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Richard Steer ◽  
Beth Tippett ◽  
R. Nazim Khan ◽  
Dermot Collopy ◽  
Gavin Clark
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Functional Outcomes ◽  
Medical Information ◽  
Randomised Control Trial ◽  
Computer Assisted ◽  
Link Type ◽  
Total Knee ◽  
Alternative Alignment

Abstract Background A drive to improve functional outcomes for patients undergoing total knee arthroplasty (TKA) has led to alternative alignment being used. Functional alignment (FA) uses intraoperative soft tissue tension to determine the optimal position of the prosthesis within the patient’s soft tissue envelope. Angular limits for bone resections are followed to prevent long-term prosthesis failure. This study will use the aid of robotic assistance to plan and implement the final prosthesis position. This method has yet to be compared to the traditional mechanically aligned (MA) knee in a randomised trial. Methods A blinded randomised control trial with 100 patients will be undertaken via Perth Hip and Knee Clinic. Fifty patients will undergo a MA TKA and fifty will undergo a FA TKA. Both alignment techniques will be balanced via computer-assisted navigation to assess prosthetic gaps, being achieved via the initial bony resection and further soft tissue releases as required to achieve satisfactory balance. The primary outcome will be the Forgotten Joint Score (FJS) 2 years after surgery, with secondary outcomes being other patient-reported outcome measures, clinical functional assessment, radiographic position and complications. Other data that will be collected will be patient demography (sex, age, level of activity) and medical information (grade of knee injury, any other relevant medical information). The linear statistical model will be fitted to the response (FJS), including all the other variables as covariates. Discussion Many surgeons are utilising alternative alignment techniques with a goal of achieving better functional outcomes for their patients. Currently, MA TKA remains the gold standard with good outcomes and excellent longevity. There is no published RCTs comparing FA to MA yet and only two registered studies are planned or currently in progress. This study utilises a FA technique which differs from the two studies. This study will help determine if FA TKA has superior functional results for patients. Trial registration This trial has been registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) http://www.anzctr.org.au: U1111-1257-2291, registered 25th Jan 2021. It is also listed on www.clinicaltrials.gov: NCT04748510.

Sign in / Sign up

Export Citation Format

Share Document