Combination of Accelerometer-Based Navigation and Force Sensor for Precise Bone Resection and Appropriate Soft Tissue Balancing in Total Knee Arthroplasty
Background: Precise bone resection and appropriate soft tissue balancing are considered indispensable in total knee arthroplasty (TKA). However, in most TKAs, only the experienced-based subjective physical “feel” of the surgeon, or either a computer-based navigation system or a soft tissue balancing system are applied to improve the results. In the present study, a combination of both an accelerometer-based navigation system and an electronic knee balancing force sensor were applied to attempt to obtain optimal outcomes.
Materials and Methods: An accelerometer-based navigation system and an electronic knee balancing force sensor were applied in combination in 5 TKAs. Thereafter, the incidence of radiographical outliers of the lower-extremity mechanical axis and the alignments of femoral and tibial components, and the incidence of intraoperative lateral retinacular release were evaluated and compared against those of 5 TKAs performed with the force sensor alone as a control.
Results: The posterior slope of the tibia was significantly improved in the TKAs performed with the combination of both devices (P=0.004). No lateral release was performed in any TKAs of either group.
Conclusion: TKAs performed under the combination of an accelerometer-based navigation system and an electronic knee balancing force sensor can obtain greater the accuracy of bone resection and appropriate soft tissue balancing.
Gothesen O, Espehaug B, Havelin L, Petursson G, Lygre S, Ellison P, Hallan G, Furnes O. Survival rates and causes of revision in cemented primary total knee replacement: a report from the Norwegian Arthroplasty Register 1994-2009. Bone Joint J. 2013 May;95-B(5):636-42.
Scott CE, Howie CR, MacDonald D, Biant LC. Predicting dissatisfaction following total knee replacement: a prospective study of 1217 patients. J Bone Joint Surg Br. 2010 Sep;92(9):1253-8.
Lombardi AV Jr, Berend KR, Adams JB. Why knee replacements fail in 2013: patient, surgeon, or implant? Bone Joint J. 2014 Nov;96-B(11 Supple A):101-4.
Sharkey PF, Lichstein PM, Shen C, Tokarski AT, Parvizi J. Why are total knee arthroplasties failing today--has anything changed after 10 years? J Arthroplasty. 2014 Sep;29(9):1774-8.
Clayton AW, Cherian JJ, Banerjee S, Kapadia BH, Jauregui JJ, Harwin SF, Mont MA. Does the use of navigation in total knee arthroplasty affect outcomes? J Knee Surg. 2014 Jun;27(3):171-5.
Moreland JR. Mechanisms of failure in total knee arthroplasty. Clin Orthop Relat Res. 1988 Jan;(226):49-64.
Anderson KC, Buehler KC, Markel DC. Computer assisted navigation in total knee arthroplasty: comparison with conventional methods. J Arthroplasty 2005;20 (7, Suppl 3):132–138
Blakeney WG, Khan RJ, Wall SJ. Computer-assisted techniques versus conventional guides for component alignment in total knee arthroplasty: a randomized controlled trial. J Bone Joint Surg Am. 2011 Aug 3;93(15):1377-84.
Mahaluxmivala J, Bankes MJ, Nicolai P, Aldam CH, Allen PW. The effect of surgeon experience on component positioning in 673 Press Fit Condylar posterior cruciate-sacrificing total knee arthroplasties. J Arthroplasty. 2001 Aug;16(5):635-40.
Krackow KA, Bayers-Thering M, Phillips MJ, Bayers-Thering M, Mihalko WM. A new technique for determining proper mechanical axis alignment during total knee arthroplasty: progress toward computer-assisted TKA. Orthopedics 1999;22(7):698–702
Daines BK, Dennis DA. Gap balancing vs. measured resection technique in total knee arthroplasty. Clin Orthop Surg. 2014 Mar;6(1):1-8.
Fetto JF, Hadley S, Leffers KJ, Leslie CJ, Schwarzkopf R. Electronic measurement of soft-tissue balancing reduces lateral releases in total knee arthroplasty. Bull NYU Hosp Jt Dis. 2011;69(4):285-8.
Joseph J, Simpson PM, Whitehouse SL, English HW, Donnelly WJ. The use of navigation to achieve soft tissue balance in total knee arthroplasty - a randomised clinical study. Knee. 2013 Dec;20(6):401-6.
Nam D, Nawabi DH, Cross MB, Heyse TJ, Mayman DJ. Accelerometer-based computer navigation for performing the distal femoral resection in total knee arthroplasty. J Arthroplasty. 2012 Oct;27(9):1717-22.
Nam D, Cody EA, Nguyen JT, Figgie MP, Mayman DJ. Extramedullary guides versus portable, accelerometer-based navigation for tibial alignment in total knee arthroplasty: a randomized, controlled trial: winner of the 2013 HAP PAUL award. J Arthroplasty. 2014 Feb;29(2):288-94.
Jeffery RS, Morris RW, Denham RA. Coronal alignment after total knee replacement. J Bone Joint Surg Br. 1991 Sep;73(5):709-14.
Ritter MA, Faris PM, Keating EM, Meding JB. Postoperative alignment of total knee replacement. Its effect on survival. Clin Orthop Relat Res. 1994 Feb;(299):153-6.
Wasielewski RC, Galante JO, Leighty RM, Natarajan RN, Rosenberg AG. Wear patterns on retrieved polyethylene tibial inserts and their relationship to technical considerations during total knee arthroplasty. Clin Orthop Relat Res. 1994 Feb;(299):31-43.
Berend ME, Ritter MA, Meding JB, Faris PM, Keating EM, Redelman R, Faris GW, Davis KE. Tibial component failure mechanisms in total knee arthroplasty. Clin Orthop Relat Res. 2004 Nov;(428):26-34.
Rebal BA, Babatunde OM, Lee JH, Geller JA, Patrick DA Jr, Macaulay W. Imageless computer navigation in total knee arthroplasty provides superior short term functional outcomes: a meta-analysis. J Arthroplasty. 2014 May;29(5):938-44.
Ossendorf C, Fuchs B, Koch P. Femoral stress fracture after computer navigated total knee arthroplasty. Knee 2006;13(5): 397–399
Kim YH, Kim JS, Choi Y, Kwon OR. Computer-assisted surgical navigation does not improve the alignment and orientation of the components in total knee arthroplasty. J Bone Joint Surg Am. 2009 Jan;91(1):14-9.
Johnson DR, Dennis DA, Kindsfater KA, Kim RH. Evaluation of total knee arthroplasty performed with and without computer navigation: a bilateral total knee arthroplasty study. J Arthroplasty. 2013 Mar;28(3):455-8.
Bugbee WD, Kermanshahi AY, Munro MM, McCauley JC, Copp SN. Accuracy of a hand-held surgical navigation system for tibial resection in total knee arthroplasty. Knee. 2014 Dec;21(6):1225-8
Saragaglia D, Chaussard C, Rubens-Duval B. Navigation as a predictor of soft tissue release during 90 cases of computer-assisted total knee arthroplasty. Orthopedics. 2006 Oct;29(10 Suppl):S137-8.
Stephens BF, Hakki S, Saleh KJ, Mihalko WM. Clinical alignment variations in total knee arthroplasty with different navigation methods. Knee. 2014 Oct;21(5):971-4.
Camarata DA. Soft tissue balance in total knee arthroplasty with a force sensor. Orthop Clin North Am. 2014 Apr;45(2):175-84.
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