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Lookup NU author(s): Dr Alasdair Blain, Lee Longstaff, Professor David Deehan
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
Purpose - A balanced knee arthroplasty should optimise survivorship and performance. Equilibration of medial and lateral femorotibial load requires guided judicious pericapsular ligament release. The null hypothesis was that there would be no difference between use of a tensiometer device and a remote load sensor final load transfer across the joint through functional arc of motion.Methods - A cadaveric study, using eight knees, was performed to define the impact of an established gap distraction device against load sensor-aimed soft tissue release in a TKA setting. Using validated measures of laxity in six degrees of freedom and true real-time load sensing four states were examined: native knee, TKA using spacer blocks (TKA), TKA with soft tissue release aided by a monogram tensiometer (TKA-T) and finally where load across the tibiofemoral articulation remains unbalanced final soft tissue release using a sensor device (TKA-OS).Results - The laxity pattern was equivalent for TKA-T and TKA-OS. However, in only four of these seven knees despite the tensiometer confirming equivalence of rectangular flexion–extension gap dimensions and centralisation of collateral ligament distraction, there remained a?>?15lb medial to lateral load difference for at least one point of the flexion arc. This was corrected by further final soft tissue release guided by the OS sensor device in the final three knees.Conclusion - Tensiometer-guided soft tissue release at two points of flexion failed to achieve balance for three out of seven knee arthroplasty procedures. Sensor technology guided final soft tissue balancing to equilibrate load across the joint through full arc of motion. This work argues for the role of continuous sensor readings to guide the soft tissue balancing during total knee arthroplasty.
Author(s): Manning WA, Blain A, Longstaff L, Deehan DJ
Publication type: Article
Publication status: Published
Journal: Knee Surgery, Sports Traumatology, Arthroscopy
Year: 2019
Volume: 27
Issue: 7
Pages: 2238-2250
Print publication date: 01/07/2019
Online publication date: 04/10/2018
Acceptance date: 25/09/2018
Date deposited: 05/10/2018
ISSN (print): 0942-2056
ISSN (electronic): 1433-7347
Publisher: Springer Berlin Heidelberg
URL: https://doi.org/10.1007/s00167-018-5164-3
DOI: 10.1007/s00167-018-5164-3
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