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The Effect of Minor Adjustments to Tibial and Femoral Component Position on Soft Tissue Balance in Robotic Total Knee Arthroplasty

Simon W. Young, MD, FRACS
NEW ZEALAND

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The Effect of Minor Adjustments to Tibial and Femoral Component Position on Soft Tissue Balance in Robotic Total Knee Arthroplasty

Simon W. Young, MD, FRACS, NEW ZEALAND Matthew Carter, NEW ZEALAND Gavin William Clark, MBBS, FRACS, AUSTRALIA Christina Esposito, PhD, AUSTRALIA Matthew Walker, MBChB, FRACS, NEW ZEALAND

University of Auckland, Auckland, NEW ZEALAND

2023 Congress ePoster Presentation 2023 Congress Not yet rated

Anatomic Location

Knee

Anatomic Structure

Cartilage Ligaments

Diagnosis / Condition

Arthritis

Treatment / Technique

Arthroplasty

Summary: A high percentage of TKAs can be balanced without soft tissue release using minor adjustments to component position, from both MA and KA start points.

Introduction

Ideal goals for alignment and balance in total knee arthroplasty (TKA) remain controversial. Some authors propose balance and alignment targets that more closely approximate the native knee. We aimed to compare initial alignment and gap balance using mechanical alignment (MA) and kinematic alignment (KA) techniques, and to analyze the percentage of knees that could achieve balance using limited adjustments to component position.

Methods

Prospective data on 388 primary robotic TKAs (154 MA and 234 KA) was analysed. Medial extension, lateral extension, medial flexion and lateral flexion virtual gaps were recorded. A computer algorithm calculated potential solutions to achieve soft tissue balance, utilizing virtual angular and translational adjustments of the tibial and femoral components (±1°, ±2°, or ±3° from initial). The percentage of knees that could achieve balance without soft tissue release was compared. We also analyzed the effect of balance targets with greater lateral gap tolerances (1-3mm).

Results

Less than 5% of TKAs were initially balanced in both KA and MA cohorts. Limited adjustments to component position increased the percentage of TKAs that could be balanced in a graduated manner, with no difference between MA and KA start points: adjustments of ±1° (10% vs 6% p=0.39), of ±2° (48% vs 38% p=0.23) or of ±3° (64% vs 51% p=0.39). A higher percentage of TKAs could be balanced when a greater tolerance for lateral gap laxity (up to 3mm) was allowed, in both KA and MA cohorts (KA 51% vs 88%, P< 0.01; MA 64% vs 89% p< 0.01).

Conclusion

A high percentage of TKAs can be balanced without soft tissue release using minor adjustments to component position, from both MA and KA start points. KA positioning alone did not lead to a more balanced knee. Surgeons should consider the relationship between alignment and balance goals when optimizing component positioning in TKA.

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Novel Technique For Surgeon-Placed Nerve Block And Continuous Nerve Block In Total Knee Arthroplasty. A Cadaveric Study ePoster Presentation Daniel E Matthews, MD, FAAOS, UNITED STATES
A Prospective Randomised Study to Compare the Clinical and Radiological Outcomes of Functionally Aligned versus Mechanically Aligned Total Knee Arthroplasty with Robotic Arm Assistance ePoster Presentation Jai Thilak, MS, MCh, FRCS, INDIA Amal Antony Paul, MBBS, INDIA
Long-Term Results of Per-Operative Knee Arthroscopy in Confirming Suitability for Unicompartmental Arthroplasty ePoster Presentation James Gill, MB BChir, BSc, FRCS, UNITED KINGDOM McMeniman J Peter, AUSTRALIA Timothy John Mcmeniman, MBBS(Med)/MBBS, FRACS FA(Orth)A, AUSTRALIA Daniel Johnson Brimm, BSc, MD, AUSTRALIA Peter T. Myers, MBBS, FRACS, FAOrthA, AUSTRALIA
The Statistical Fragility of Tourniquet Use In Total Knee Arthroplasty: A Systematic Review ePoster Presentation Kyle William Lawrence, BS, UNITED STATES John K Cordero, MD, UNITED STATES Ashley Brown, BS, UNITED STATES Xinning Li, MD, UNITED STATES Brett Hayden, MD, UNITED STATES Robert L Parisien, MD, UNITED STATES
Comparison of Outcomes between Fungal and Non-fungal Periprosthetic Joint Infections in Total Knee Arthroplasty: A Propensity Score-Matched Analysis ePoster Presentation Hong Yeol Yang, MD, PhD, KOREA, REPUBLIC OF Jong-Keun Seon, MD, PhD, Prof, KOREA, REPUBLIC OF
Factors Associated With Failure and Survivorship Following Unicompartmental Knee Arthroplasty: A Single-Center Experience ePoster Presentation Anirudh K Gowd, MD, UNITED STATES Johannes F. Plate, MD, PhD, UNITED STATES Asher Lichtig, MD, UNITED STATES Orhan Yanmis, MD, UNITED STATES Gary G. Poehling, MD, UNITED STATES
Anatomical distribution of radiological OA Influences the Outcome of TKA ePoster Presentation Johanna Elliott, MB, BS, B.Med Sci, Master Science, GERMANY
In-Vivo Kinematic Analysis of Evolution® Medial-Pivot Total Knee Arthroplasty during Weight-Bearing Activity ePoster Presentation Eiichi Nakamura, MD, PhD, JAPAN Nobukazu Okamoto, MD, PhD, JAPAN Hitoshi Ito, MD, PhD, JAPAN Tetsurou Masuda, MD, PhD, JAPAN Satoshi Hisanaga, MD, PhD, JAPAN Yasunari Oniki, MD, PhD, JAPAN
Clinical Comparison and Survival Rate Between Unicompartmental Knee Arthroplasty and High Tibial Osteotomy With An External Fixator For Varus Knee In Patients Younger Than 60 Years at Mid-Term Follow-Up ePoster Presentation Amit Kumar Yadav, M.S (Orth),DNB(Orth),MNAMS, INDIA Riccardo D'Ambrosi, MD, ITALY Mangal Parihar, MS Ortho, INDIA
Bicruciate Substituting Total Knee Arthroplasty Improved Anteroposterior Displacement in Mid-Flexion Range ePoster Presentation Keinosuke Ryu, MD, PhD, JAPAN Takanori Iriuchisima, MD, JAPAN
Intra- And Inter-Operator Reliability Assessment Of A Novel Extramedullary Accelerometer-Based Smart Cutting-Guide For Total Knee Arthroplasty: An In-Vivo Study ePoster Presentation Stefano Zaffagnini, MD, Prof., ITALY Domenico Alesi, MD, ITALY Arcangelo Russo, MD, ITALY Mirco Lo Presti, MD, ITALY Iacopo Sassoli, MD, ITALY Matteo La Verde, MD, ITALY Giulio Maria Marcheggiani Muccioli, MD, PhD, Associate Professor, ITALY
Preoperative Bone Marrow Edema Negatively Impacts Intermediate to Long-Term Outcomes after Unicompartmental Knee Arthroplasty ePoster Presentation Hong Yeol Yang, MD, PhD, KOREA, REPUBLIC OF Jong-Keun Seon, MD, PhD, Prof, KOREA, REPUBLIC OF
Implant Size and Outcome Differences of Knees in Same Patient for Simultaneous vs Staged Bilateral TKA ePoster Presentation Alexander P. Sah, MD, UNITED STATES

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The Effect of Minor Adjustments to Tibial and Femoral Component Position on Soft Tissue Balance in Robotic Total Knee Arthroplasty

The Effect of Minor Adjustments to Tibial and Femoral Component Position on Soft Tissue Balance in Robotic Total Knee Arthroplasty

Introduction

Methods

Results

Conclusion

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The Effect of Minor Adjustments to Tibial and Femoral Component Position on Soft Tissue Balance in Robotic Total Knee Arthroplasty

The Effect of Minor Adjustments to Tibial and Femoral Component Position on Soft Tissue Balance in Robotic Total Knee Arthroplasty

Introduction

Methods

Results

Conclusion

More 2023 ISAKOS Congress Content