Outcome of technique of total knee arthroplasty by independent total femoral first followed by tibial cuts as a measured resection based on anatomical landmarks along with scientific soft tissue balancing: A surgicoclinical study (original) (raw)
Related papers
The Journal of Arthroplasty
Background: Total knee arthroplasty requires careful surgical technique to attain the goal of a wellaligned and symmetrically balanced knee. Soft tissue balance and correct femoral component rotation are paramount in achieving these goals. The two competing techniques to select femoral component rotation and soft tissue balance are the gap balance technique and the measured resection technique. Methods: We performed a randomized, prospective study to compare the two techniques in patients undergoing simultaneous bilateral total knee arthroplasty, whereby one technique was performed in each knee. Fifty (50) subjects were enrolled into the study. The inclusion criteria were osteoarthritic varus knee deformities with similar deformities in both knees. Subjects were followed up for a minimum of two years. Results: The knees balanced via the gap balance technique had significantly more posterior medial bone removed from the femur than those knees balanced via the measured resection technique (P < .001). Knees in the gap balance group tended to require more medial knee releases in extension and tended to have smaller sized femoral components as a result of cutting more bone from the femur in flexion. The modular tibial polyethylene bearing tended to be thicker in the gap balance group. Despite these differences, average knee flexion and functional revised Oxford Knee Scores at 2-year follow-up were not statistically different. Conclusion: At 2-year follow-up, there were no differences between the function and scores using the two techniques. Long-term follow-up will be necessary to evaluate any differences in long-term durability.
The Journal of Arthroplasty, 2019
Background: Total knee arthroplasty requires careful surgical technique to attain the goal of a wellaligned and symmetrically balanced knee. Soft tissue balance and correct femoral component rotation are paramount in achieving these goals. The two competing techniques to select femoral component rotation and soft tissue balance are the gap balance technique and the measured resection technique. Methods: We performed a randomized, prospective study to compare the two techniques in patients undergoing simultaneous bilateral total knee arthroplasty, whereby one technique was performed in each knee. Fifty (50) subjects were enrolled into the study. The inclusion criteria were osteoarthritic varus knee deformities with similar deformities in both knees. Subjects were followed up for a minimum of two years. Results: The knees balanced via the gap balance technique had significantly more posterior medial bone removed from the femur than those knees balanced via the measured resection technique (P < .001). Knees in the gap balance group tended to require more medial knee releases in extension and tended to have smaller sized femoral components as a result of cutting more bone from the femur in flexion. The modular tibial polyethylene bearing tended to be thicker in the gap balance group. Despite these differences, average knee flexion and functional revised Oxford Knee Scores at 2-year follow-up were not statistically different. Conclusion: At 2-year follow-up, there were no differences between the function and scores using the two techniques. Long-term follow-up will be necessary to evaluate any differences in long-term durability.
Gap Balancing versus Measured Resection Technique for Total Knee Arthroplasty
Clinical Orthopaedics & Related Research, 2009
Multiple differing surgical techniques are currently utilized to perform total knee arthroplasty (TKA). We compared knee arthroplasties performed using either a measured resection or gap balancing technique to determine if either operative technique provides superior coronal plane stability as measured by assessment of the incidence and magnitude of femoral condylar lift-off. We performed 40 TKA using a measured resection technique (20 PCLretaining and 20 PCL-substituting) and 20 PCL-substituting TKA were implanted using gap balancing. All subjects were analyzed fluoroscopically while performing a deep knee bend. The incidence of coronal instability (femoral condylar lift-off) was then determined using a 3-D model fitting technique. The incidence of lift-off greater than 0.75 mm was 80% (maximum, 2.9 mm) and 70% (maximum, 2.5 mm) for the PCL-retaining and substituting TKA groups performed using measured resection versus 35% (maximum, 0.88 mm) for the gap-balanced group. Lift-off greater than 1 mm occurred in 60% and 45% of the PCL-retaining and-substituting TKA using measured resection versus none in the gap-balanced group. Rotation of the femoral component using a gap balancing technique resulted in better coronal stability which we suggest will improve functional performance and reduce polyethylene wear. An institution of the authors (Center for Musculoskeletal Research) and one author (DAD) have received funding from DePuy, Inc. (Warsaw, IN). Each author certifies that his or her institution has approved the reporting of these cases, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.
Technical Considerations in Total Knee Arthroplasty
Clinical Orthopaedics and Related Research, 1986
Results with total knee arthroplasty as published in this issue show few mechanical failures in knees correctly aligned. If the principles of technique are respected, the narrow Limits for margin of error can be met. To provide optimal results, the following measures are recommended. The tibia should be cut no more than 5 mm from the medial subchondral bone, if the posterior cruciate ligament is sacrificed, and between 5 mm and 8 mm, if the posterior cruciate is saved. Fill a defect as necessary with bone graft. The tibia should be cut 90" to its axis in the medial-lateral plane and with 5" posterior tilt. Maintain the anterior-posterior height of the femur to ensure flexion stability. Use the distal femur as the "adjustment cut" even if the F i t Line is elevated. If the posterior cruciate ligament tension is tight, lengthen the ligament or convert to a sacrificing design. Deformity should be corrected with soft tissue release and not angular bone cuts. The patella cut should be performed so that the result is a symmetrical patella that is not increased from its anatomic height. If these principles are followed, the instrumentation use and order of osteotomy of the distal femur or tibia do not matter. CONTROVERSIES IN TECHNIQUE Several significant variables affecting prosthetic loosening come under the direct control of the surgeon both preoperation and at the
Study of functional and radiological outcome of total knee arthroplasty using the knee society score
International Journal of Orthopaedics Sciences, 2017
The common causes of arthritis of the knee include Osteoarthritis (OA), Rheumatoid Arthritis (RA), Juvenile Rheumatoid Arthritis, Post traumatic Arthritis or secondary Osteoarthritis and other types of inflammatory arthritis. Osteoarthritis is thought to be the most prevalent chronic joint disease. The surgical techniques have varied from soft tissue interposition arthroplasty to resection arthroplasty to surface replacement arthroplasty. In surface replacement arthroplasty different types of prosthesis were developed to address the complex knee kinematics. Total Knee Arthroplasty (TKA) is now a reliable treatment for severe arthritis. Various systems are available with specific features regarding the geometry of the components, the degree of conformity of the articulating surface and the anchoring technique. Aim: To study the clinical, functional and radiological outcome in a consecutive series of Total Knee Arthroplasty using Knee Society Score. Materials and Methods: This study was done to analyse the clinical, functional and radiological outcome of Total Knee Arthroplasty using Knee Society score using a Posterior Cruciate substituting (Indus Knee Prosthesis). A Prospective study consisting of 30 patients who consented and underwent Total Knee Arthroplasty. The follow up period was at 3 months, 6 months and 1 year. Results and Discussion: According to the Knee Society Functional Scoring system, 30 patients were assessed in this study. 16 patients (53%) had Excellent, 11 patients (37%) had Good, 2 patients (7%) had Fair and 1 patient (3%) poor results. The results were found to be comparable with other studies. Conclusion: Total Knee Arthroplasty improves the functional ability of the patient and the ability of the patient to get back to pre-disease state, which is to have a pain free mobile joint, as reflected by the improvement in the post-op Knee Clinical Score and Knee Functional Score.
Background & Objectives: Anterior knee pain is one of the common complication after Total Knee Arthroplasty (TKA). This study is an attempt to reduce or eliminate the problem of post -operative anterior knee pain by proper mechanical balancing of the patello–femoral joint during TKA. Methods: 32 Patients with osteoarthritis or rheumatoid arthritis of knee requiring TKA were enrolled for this prospective study. We have excluded patients of revision knee arthroplasty, charcot joints and patients with life expectancy less than 10 years. Bilateral total knee arthroplasty was performed in 10 patients hence 42 total knee arthroplasties were studied. Along with meticulous attention to all aspects of TKA our study focuses on restoration of patellar height of 10 – 30 mm proximal to the prosthetic joint line, change in joint line of prosthesis as compared to original joint line from tibial tuberosity of less than 8mm and Judicious retinacular release, if needed. Results and Interpretation: Post – operative excellent results were seen in 91 % of cases. Good results were seen in 3 % of cases, fair results were seen in 3 % of cases and poor result in 3 % of cases. No patient complained of anterior knee pain. Achieving proper mechanical balance of the patella-femoral joint is an excellent technique in an attempt to reduce post – operative incidence of anterior knee pain after TKA.
Total knee arthroplasty, different alignment and balance methods-A review
Indian Journal of Orthopaedics Surgery, 2023
The two most frequent techniques used to implant a total knee replacement (TKR) are measured resection and gap balancing. Both methods have been around for a while and are currently in widespread usage, and both have shown to be effective in the real world. Plus, new technologies have evolved in the recent past to help surgeons achieve soft tissue balance and limb alignment. Proper alignment of a knee replacement is crucial to its effective functioning. It has to be in the right axial and rotational planes for this to work. Patellofemoral instability and early wear can be caused by improper alignment, as can loosening of the prosthesis. Altering the prosthesis's orientation might potentially affect the tension of the surrounding soft tissues. We have extensively reviewed 50 studies (Level 1- Level 4) published in many prestigious journals by searching through platforms like PUBMED, MEDLINE and EMBASE databases. In this research, we have attempted to document the relationship between alignment and the equilibrium of soft tissues and to summarize the present state of our understanding of this connection. Keywords: TKA, Alignment, Balancing, Review, Kinematics.
[Robotic Total Knee Arthroplasty]
PubMed, 2021
Total Knee Arthroplasty (TKA) is one of the most common operations performed in the orthopaedic surgery field. TKA is usually performed as a result of primary osteoarthritis which causes pain and a major decrease in the patient's quality of life. TKA is considered a successful operation with a success rate of 80-85%. In recent years, orthopaedic surgeons have started to perform robotic assisted TKA. In Israel, these operations have been performed since 2019. In this article we reviewed this topic and the latest clinical data comparing a conventional TKA and robotic assisted TKA. In the world, there are several robotic systems in use. Four systems are in use in Israel. The robotic system assists in the pre-operative and intra-operative planning, in order to perform precise cuts of the femur and tibia. The precision helps to achieve better soft tissue balance reconstruction of the lower limb axis. While robotic surgery performed in Israel has been rising since the technology came into use in 2019, the clinical data are not showing a significant advantage to either one of the operations. Recent studies have shown evidence of better imaging results in the robotic-assisted operation, however, the clinical benefits are still in doubt, due to the lack of large and long-term studies.
Relationship between surgical balancing and outcome measures in total knees
Arthroplasty Today, 2019
Background: The purpose of the study was to investigate the accuracy of balancing which could be achieved at total knee surgery and its relation to functional outcomes. Methods: During surgery, the forces on the medial and lateral plateaus were measured at 10-15 degrees flexion in 101 patients, using an instrumented tibial trial, with equal forces being targeted. Of the initial 101 cases, 71 cases completed all follow-up visits to 1 year. At each follow-up visit, the function was measured using the Knee Society Scoring System, and varus and valgus laxity angles were measured. Results: The mean medial/(medial þ lateral) compartmental force ratio was 0.52, with a standard deviation of 0.09. The total contact force was 217 Newtons, with a standard deviation of 72 Newtons. No correlations were found between the functional scores and the compartmental force ratio or total contact force. However, the mean varus and valgus laxity angles, 2.8 and 2.3 degrees, respectively, were very close to the angles of normal intact knees. Conclusions: The likely reason for the lack of correlation of function was that the large majority of the balancing ratios were within the range 0.4-0.6 but with a wide spread of functional scores typical of total knee study groups. However, the normal varus and valgus angles achieved at follow-up indicated that equal balancing in early flexion was a reasonable surgical target. Using instrumented tibial trials enabled accurate and consistent balancing values to be achieved, as well as normal varus and valgus laxity angles, which may be important in obtaining optimal outcomes.
Biosciences Biotechnology Research Asia, 2014
This study was designed to evaluate accuracy of lower limb alignment in patients with Total Knee Arthroplasty (TKA) in Fajr Hospital of Tehran in 2008 to 2013. All patients evaluated in the study had undergone TKA surgery during the years 2008 to 2013. A checklist was used to collect data. Evaluations for the angle between the femoral mechanical axis and the tibial mechanical axis and lower limb mechanical axis were calculated from X-rays of alignment taken before and after the surgery.Assessment for effects of the surgery were made according to Knee Society scores (KSS) taken before the operation and 12 months after the procedure. This study evaluated 102 patients within average age of. 65.79± 6.8 years. Fourteen patients were male and 88 were female. The mean for mechanical axis angle in the lower extremity was 1.54±2.94 in various, the mean for range of motion (ROM) was 112.07±18.75, the mean for flexion contracture (FC) was 2.42 ±3. 77 degrees.Results determined no significant difference between these angles in terms of sex, side of the defect and the type of surgery. The mean duration of hospitalization was reported as 8.5±3.46 days. KSS showed better results after TKA. The results showed that TKA, as a routine procedure in the treatment of the last stages of knee disorders as such as osteoarthritis, rheumatoid arthritis and the other defects can be useful and that factors such as sex, type of surgery and side of involvement made no difference in the results of TKA.