Surgeon Assessment of Gapping versus Kinetic Loading using Intraoperative Sensors during TKA

Authors

  • Patrick A Meere New York University Hospital for Joint Diseases, New York, NY
  • Justin G LaMont New York University Hospital for Joint Diseases, New York, NY
  • Jorge Baez The Central Orthopedic Group, Plainview, NY
  • Michael N Kang New York University Hospital for Joint Diseases, New York, NY
  • Vijay J Rasquinha North Shore – Long Island Jewish Health System, Great Neck, NY
  • Christopher R Anderson Department of Clinical & Bioengineering Research, OrthoSensor, Inc.
  • Cale A Jacobs Lexington Clinic, Lexington, KY

DOI:

https://doi.org/10.15438/rr.5.3.112

Keywords:

total knee replacement, ligament balancing, laxity, instability, kinetic sensors

Abstract

Purpose: The purpose of this study was to determine if using a sensor-equipped tibial insert would reduce medial (MED) and lateral (LAT) gapping and create more equivalent compressive forces in the MED and LAT compartments.

Methods: 7 orthopedic surgeons each performed bilateral TKA on complete lower extremity cadaveric specimens. Left TKA was performed first without the use of the instrumented tibial insert. With trial components placed, the patella was reduced and joint capsule closed with towel clips. Surgeons performed varus and valgus stress tests on each knee and the mm of MED and LAT gapping were recorded. Compressive forces in the MED and LAT compartment were measured at 10°, 45°, and 90° of flexion. Sensor-assisted TKA was then performed on the right knee and compressive forces and gapping were again recorded. MED, LAT, and total mediolateral (ML) gapping and MED and LAT compressive forces were compared between conventional TKA and sensor-assisted TKA with paired t-tests.

Results: Sensor-assisted TKA resulted in significantly reduced MED (1.2 vs. 1.9 mm, p<.001), LAT (0.8 vs. 1.4 mm, p = 0.003), and total ML gapping (2.0 vs. 3.4 mm, p<.001). There were no differences in the MED and LAT compressive forces between conventional and sensor-assisted TKA. However, sensor-assisted TKAs demonstrated greater MED compartment forces as the knee was flexed whereas conventional TKAs had greater LAT forces.

Conclusions: Sensor-assisted TKA significantly reduced MED and LAT gapping with the knee in 20° of flexion. Future clinical studies are needed to determine the most appropriate compressive forces in the MED and LAT compartments.

Author Biographies

Patrick A Meere, New York University Hospital for Joint Diseases, New York, NY

MD

Justin G LaMont, New York University Hospital for Joint Diseases, New York, NY

MD

Jorge Baez, The Central Orthopedic Group, Plainview, NY

MD

Michael N Kang, New York University Hospital for Joint Diseases, New York, NY

MD

Vijay J Rasquinha, North Shore – Long Island Jewish Health System, Great Neck, NY

MD

Christopher R Anderson, Department of Clinical & Bioengineering Research, OrthoSensor, Inc.

MS, MBA

Cale A Jacobs, Lexington Clinic, Lexington, KY

PhD

References

Christensen CP, Stewart AH, Jacobs CA (2013) Soft tissue releases affect the femoral component rotation necessary to create a balanced flexion gap during total knee arthroplasty. J Arthroplasty 28 (9):1528-1532

Clarke JV, Wilson WT, Wearing SC, Picard F, Riches PE, Deakin AH (2012) Standardising the clinical assessment of coronal knee laxity. Proc Inst Mech Eng H 226 (9):699-708

Edwards E, Miller J, Chan K-H (1988) The effect of postoperative collateral ligament laxity in total knee arthroplasty. Clin Orthop Related Res 236:44-51

Fehring TK, Valadie AL (1994) Knee instability after total knee arthroplasty. Clin Orthop Relat Res 299:157-162

Fujimoto E, Sasashige Y, Masuda Y, Takashi H, Eguchi A, Masuda T, Sawa M, Nagata Y (2013) Significant effect of the posterior tibial slope and medial/lateral ligament balance on knee flexion in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc DOI 10.1007/s00167-012-2059-6

Healy WL, Della Valle CJ, Iorio R, Berend KR, Cushner FD, Dalury DF, Lonner JH (2013) Complications of total knee arthroplasty. Standardized list and definitions of The Knee Society. Clin Orthop Related Res 471:215-220

Jacobs CA, Christensen CP (2015) Intraoperative lateral gapping associated with improved subjective pain and function scores 2-5 years after TKA. Paper presented at the Orthopaedic Research Society 2015 Annual Meeting, Las Vegas, NV, March 28-31, 2015

Kobayashi T, Suzuki M, Sasho T, Nakagawa K, Tsuneizumi Y, Takahashi K (2012) Lateral laxity in flexin increases the postoperative flexion angle in cruciate-retaining total knee arthroplasty. J Arthroplasty 27 (2)

Koh IJ, Kwak D-S, Kim TK, Park IJ, In Y (2014) How effective is multiple needle puncturing for medial soft tissue balancing during total knee arthroplasty? A cadaveric study. J Arthroplasty 29 (12):2478-2483

Krackow KA (1995) Surgical principles in total knee arthroplasty: alignment, deformity, approaches, and bone cuts. In: Callaghan JJ, Dennis DA, Paprosky WG, Rosenberg AG (eds) Orthopaedic Knowledge Update: Hip and Knee Reconstruction. American Academy of Orthopaedic Surgeons, Chicago, IL, pp 269-276

Kuster MS, Bitschnau B, Votruba T (2004) Influence of collateral ligament laxity on patient satisfaction after total knee arthroplasty: a comparative bilateral study. Acta Orthop Trauma Surg 124:415-417

LaPrade RF, Heikes C, Bakker AJ, Jakobsen RB (2008) The reproducibility and repeatability of varus stress radiographs in the assessment of isolated fibular collateral ligament and grade-III posterolateral knee injuries. An in vitro biomechanical study. J Bone Joint Surg (Am) 90-A:69-76

Liebs TR, Kloos S-A, Herzberg W, Ruther W, Hassenpflug J (2013) The significance of an asymmetric extension gap on routine radiographs after total knee replacement. A new sign and its clinical significance. Bone Joint J 95-B (4):472-477

Matsuda Y, Ishii Y, Noguchi H, Ishii R (2005) Varus-valgus balance and range of motion after total knee arthroplasty. J Bone Joint Surg (Br) 87-B:804-808

Matsumoto T, Kubo S, Muratsu H, Matsushita T, Ishida K, Kawakami Y, Oka S, Matsuzaki T, Kuroda Y, Nishida K, Akisue T, Kuroda R, Kurosaka M (2013) Different pattern in gap balancing between the cruciate-retaining and posterior-stabilized total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 21:2338-2345

Matsuzaki T, Matsumoto T, Kubo S, Muratsu H, Matsushita T, Kawakami Y, Ishida K, Oka S, Kuroda R, Kurosaka M (2013) Tibial internal rotation is affected by lateral laxity in cruciate-retaining total knee arthroplasty: an intraoperative kinematic study using a navitation system and offset-type tensor. Knee Surg Sports Traumatol Arthrosc DOI 10.1007/s00167-013-2627-4

Meneghini RM, Daluga AT, Sturgis LA, Lieberman JR (2013) Is the pie-crusting technique safe for MCL release in varus deformity correction in total knee arthroplasty? J Arthroplasty 28 (8):1306-1309

Oka S, Matsumoto T, Muratsu H, Kubo S, Matsushita T, Ishida K, Kuroda R, Kurosaka M (2013) The influence of the tibial slope on intra-operative soft tissue balance in cruciate-retaining and posterior-stabilized total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc DOI 10.1007/s00167-013-2535-7

Okamoto S, Okazaki K, Mitsuyasu H, Matsuda S, Iwamoto Y (2013) Lateral soft tissue laxity increases but medial laxity does not contract with varus deformity in total knee arthroplasty. Clin Orthop Related Res 471:1334-1342

Okazaki K, Miura H, Matsuda S, al e (2006) Asymmetry of mediolateral laxity of the normal knee. J Orthop Sci 11:264-266

Scuderi GR, Bourne RB, Noble PC, Benjamin JB, Lonner JH (2012) The new Knee Society Knee Scoring System. Clin Orthop Related Res 470:3-19

Wasielewski RC, Galante JO, Leighty RM, Natarajan RN, Rosenberg AG (1994) Wear patterns on retrieved polyethylene tibial inserts and their relationship to technical considerations during total knee arthroplasty. Clin Orthop Relat Res 299:31-43

Wasielewski RC, Galat DD, Komistek RD (2005) Correlation of compartment pressure data from an intraoperative sensing device with postoperative fluoroscopic kinematic results in TKA patients. J Biomech 38 333-339

Published

2015-10-31

How to Cite

Meere, P. A., LaMont, J. G., Baez, J., Kang, M. N., Rasquinha, V. J., Anderson, C. R., & Jacobs, C. A. (2015). Surgeon Assessment of Gapping versus Kinetic Loading using Intraoperative Sensors during TKA. Reconstructive Review, 5(3). https://doi.org/10.15438/rr.5.3.112

Issue

Section

Original Article

Most read articles by the same author(s)