scholarly journals Frequency of soft-tissue releases and their effect on patient reported outcomes in robotic-assisted TKA.

10.29007/grf3 ◽  
2020 ◽  
Author(s):  
Christopher Plaskos ◽  
Edgar Wakelin ◽  
Sami Shalhoub ◽  
Jeffrey Lawrence ◽  
John Keggi ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissues ◽  
Soft Tissue Release ◽  
Bone Resection ◽  
Gap Balancing ◽  
Robotic Assisted ◽  
Measured Resection ◽  
Patient Reported ◽  
Total Knee ◽  
A Prospective Study

Soft tissue releases are often required to correct deformity and achieve balance in total knee arthroplasty (TKA). However, releasing soft tissues can be subjective, highly variable and is perceived as an ‘art’ in TKA. The objective of this study was to compare the rate of soft tissue release required to achieve a balanced knee in tibial-first gap- balancing versus conventional, measured resection TKA, and its effect on outcomes.Soft tissue releases were documented and reviewed in 1256 robotic-assisted gap- balancing and 85 robotic-assisted measured-resection TKAs. Knees were stratified by coronal deformity (varus: >2° varus; valgus: >2° valgus). Rates of releases were compared between the two groups and literature. A subset of these patients were also enrolled in a prospective study. KOOS outcomes were captured pre-operatively and at 6M post TKA.The frequency of soft tissue release was significantly lower in the robotic gap- balancing group, with 21% of knees requiring release versus 40% (p=0.001) in the robotic measured resection group and 67% (p<0.001) for conventional measured resection. Pre-operative KOOS scores were similar between groups, however 6M scores showed a significant improvement in QOL, Sports and Symptoms scores in knees not released.Robotic assisted TKA with predictive gap balancing was found to reduce the number of releases across all coronal angles compared to conventional instruments. Furthermore, performing a soft tissue release rather than bone resection to achieve balance, correlated with worse outcomes. Further research is required to understand when imbalance should be corrected with bone resection adjustment versus soft tissue release.

scholarly journals Combining sensor and robotic technologies to achieve a well balanced total knee arthroplasty while avoiding any soft tissue releases

10.29007/vwhp ◽  
2020 ◽  
Author(s):  
Julien Bardou-Jacquet
Keyword(s):  
Soft Tissue ◽  
Range Of Motion ◽  
Patient Reported Outcomes ◽  
Soft Tissue Release ◽  
Measured Resection ◽  
Patient Reported ◽  
Initial Load ◽  
Total Knee ◽  
Polyethylene Thickness ◽  
Load Numbers

Achieving a balanced total knee throughout the entire range of motion leads to improved patient reported outcomes and satisfaction. Sensor-assisted technology allows the surgeon to quantitatively assess and address imbalance through either soft tissue releases or bone recuts. However, balancing through soft tissue releases leads to unpredictable gap increments and frequent early over-releases.METHODS: During a consecutive and prospective series of 29 robotic total knee surgeries, intra-operative load sensors were used following the initial bone resections to quantitatively assess the knee’s state of balance through the range of motion with trial components in place. Load measurements were taken at 10 and 90 degrees of knee flexion. Based on previous literature, a balanced knee is defined as having a mediolateral load difference below 15 pounds (lbf) through the range of motion, with an absolute load magnitude per compartment above 5lbf and not exceeding 45lbf. The initial load numbers were recorded as well as the number and type of subsequent corrections needed to achieve quantitative balance.RESULTS Of the 29 robotics cases, only 12 (41%) were well-balanced after the initial bone cuts (mechanical alignment by measured resection). Another two cases were too loose and required an increase in the polyethylene thickness size of two millimeters to achieve a well-balanced knee without further bone resection. In 14 cases, a bone recut was required to balance the knee. More specifically, four cases required a recut of the femur, ten cases required a recut of the tibia. Eventually, one case was left unbalanced in flexion with a mediolateral load differential of 20 lbf. It should be noted explicitly that no soft tissue releases were done for any of the 29 cases. At the end, all 29 knees were considered well balanced in extension and all but six (79%) at 90° of flexion. For these six cases with balance issue at 90° of flexion, absolute load magnitude in both compartments was below 45 lbf and above 5lbf, though the mediolateral load differential was between 15lbf and 30lbf.DISCUSSION Based on a preliminary series, this work demonstrates the opportunity of combining multiple technologies to achieve a quantitatively balanced knee through the range of motion without any soft tissue release.

scholarly journals Less iatrogenic soft-tissue damage utilizing robotic-assisted total knee arthroplasty when compared with a manual approach

2019 ◽  
Vol 8 (10) ◽  
pp. 495-501 ◽  
Author(s):  
Emily L. Hampp ◽  
Nipun Sodhi ◽  
Laura Scholl ◽  
Matthew E. Deren ◽  
Zachary Yenna ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Tissue Damage ◽  
Soft Tissues ◽  
Soft Tissue Damage ◽  
Anatomical Structures ◽  
Cruciate Retaining ◽  
Robotic Assisted ◽  
Total Knee

Objectives The use of the haptically bounded saw blades in robotic-assisted total knee arthroplasty (RTKA) can potentially help to limit surrounding soft-tissue injuries. However, there are limited data characterizing these injuries for cruciate-retaining (CR) TKA with the use of this technique. The objective of this cadaver study was to compare the extent of soft-tissue damage sustained through a robotic-assisted, haptically guided TKA (RATKA) versus a manual TKA (MTKA) approach. Methods A total of 12 fresh-frozen pelvis-to-toe cadaver specimens were included. Four surgeons each prepared three RATKA and three MTKA specimens for cruciate-retaining TKAs. A RATKA was performed on one knee and a MTKA on the other. Postoperatively, two additional surgeons assessed and graded damage to 14 key anatomical structures in a blinded manner. Kruskal–Wallis hypothesis tests were performed to assess statistical differences in soft-tissue damage between RATKA and MTKA cases. Results Significantly less damage occurred to the PCLs in the RATKA versus the MTKA specimens (p < 0.001). RATKA specimens had non-significantly less damage to the deep medial collateral ligaments (p = 0.149), iliotibial bands (p = 0.580), poplitei (p = 0.248), and patellar ligaments (p = 0.317). The remaining anatomical structures had minimal soft-tissue damage in all MTKA and RATKA specimens. Conclusion The results of this study indicate that less soft-tissue damage may occur when utilizing RATKA compared with MTKA. These findings are likely due to the enhanced preoperative planning with the robotic software, the real-time intraoperative feedback, and the haptically bounded saw blade, all of which may help protect the surrounding soft tissues and ligaments. Cite this article: Bone Joint Res 2019;8:495–501. DOI: 10.1302/2046-3758.810.BJR-2019-0129.R1.

scholarly journals Does the Use of a CT Based 3D Plan Improve Joint Balancing in Total Knee Arthroplasty? A Multi-Center Study

10.29007/sptw ◽  
2019 ◽  
Author(s):  
Jingwei Zhang ◽  
Manoshi Bhowmik-Stoker ◽  
Laura Scholl ◽  
Caitlin Condrey ◽  
Kirby Hitt ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Release ◽  
Component Position ◽  
Bone Resection ◽  
Robotic Assisted ◽  
Component Size ◽  
3 Dimensional ◽  
Patient Demographics ◽  
Multi Center Study ◽  
Tissue Trauma

Studies have shown that dissatisfaction following TKA may stem from poor component placement and iatrogenic factors related to variability in surgical execution. A CT-based robotic assisted system allows surgeons to dynamically balance the joint prior to bone resection. This study aimed to determine if this system could improve TKA planning, reduce soft tissue releases, minimize bone resection, and accurately predict component size.Six hundred and sixty-six cases undergoing primary robotic assisted TKA we enrolled in a prospective, multicenter study. Seven surgeons participated from seven US centers. Patient demographics and intraoperative surgical details were collected. Initial and final 3-dimensional alignment, component position, bone resection depths, use of soft tissue releases, knee balancing gaps, and component size were collected intraoperatively. Descriptive statistics were applied to determine the changes in these parameters between initial and final values.In this study, 513 varus knees, 86 valgus knees, and 26 neutral knees were captured and stratified for analysis. Native deformity ranged from 12 degrees of valgus to 19 degrees of varus. 85% of all patients in this study did not require a soft tissue release. Complex deformities who required a soft tissue release were corrected on average to 3.36 degrees while cases without releases were corrected to 1.1 degree on average. All surgeons achieved their planned sizes on the tibia and femur more than 97.5% of the time within one size, and 100% of the time within two sizes. Flexion and extension gaps during knee balancing were within 2mm (mean 1mm) for all knees.New tools may allow for enhanced execution and predictable balance for TKA, which may improve patient outcomes. In this study, preoperative planning via CT scan allowed surgeons to assess bony deformities and subtly adjust component position to reduce soft tissue trauma. Patient follow up is needed to determine clinical outcomes.

scholarly journals The Incidence of Soft-Tissue Releases in Robotic-Assisted Total Knee Arthroplasty Technology

10.29007/lbgj ◽  
2020 ◽  
Author(s):  
Bertrand Kaper
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Soft Tissues ◽  
Historical Cohort ◽  
Robotic Assisted ◽  
Total Knee

The incidence of formal soft tissues releases required in TKA surgery performed utilizing the NAVIO robotic-assisted (RA)-TKA technique was assessed and compared to a historical cohort of conventional, manually instrumented (CI) TKA’s.

The Influence of Posterior Cruciate Ligament Resection on Tibiofemoral Joint Gap in Varus Osteoarthritic Knees

2020 ◽  
Author(s):  
Yasushi Oshima ◽  
Tokifumi Majima ◽  
Norishige Iizawa ◽  
Naoya Hoshikawa ◽  
Kenji Takahashi ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Posterior Cruciate Ligament ◽  
Soft Tissues ◽  
Cruciate Ligament ◽  
Soft Tissue Balance ◽  
Soft Tissue Release ◽  
Bone Resection ◽  
Tibiofemoral Joint ◽  
Joint Gap ◽  
Valgus Instability

AbstractPosterior cruciate ligament (PCL) resection during posterior-stabilized total knee arthroplasty (PS-TKA) has been reported to preferentially increase the tibiofemoral joint gap in flexion compared with extension. However, previous assessments of the joint gaps have been performed after bone resection and medial soft tissue release. Thus, these procedural steps may have the potential to influence soft tissue balance. In native knees, soft tissue laxity is generally greater in the lateral compartment than in the medial compartment both with the knee in extension and in flexion. Some surgeons may retain this natural soft tissue balance with less aggressive medial release during TKA. We performed this study to evaluate the impact of the PCL resection on the extension and flexion gaps in the absence of bone resection or medial soft tissue release. Tibiofemoral joint gaps for 41 patients (10 males and 31 females) in full extension and at 90 degrees of flexion both before and after the resections of both the anterior cruciate ligament (ACL) and PCL were assessed using a ligament tensioner device. The statistical analyze was performed using the Mann–Whitney U test. The results showed that medial gap in extension and flexion were 6.7 ± 1.0 and 7.3 ± 0.9 mm, and lateral gap in extension and flexion were 7.6 ± 1.1 and 8.4 ± 1.6 mm, respectively. Thus, physiological tibiofemoral gaps just after knee arthrotomy were trapezoidal and asymmetric shape with the significantly wider gaps in lateral and flexion, compared with the medial and extension, respectively (p < 0.05). However, the increases of the gaps with the ACL and PCL resections were less than 1 mm under the existence of medial soft tissues. As the medial collateral ligament is the primary restraint for the valgus instability, it was also considered to prevent the increase of the flexion gap although the PCL—which is the secondary restraint for the valgus instability—was resected. This finding is critically important for orthopedic surgeons applying PS-TKA implants, particularly for preserving soft tissues to achieve natural knee kinematics postoperatively.

scholarly journals Soft Tissue Imbalance Resulting from a Simulated Measured Resection Model as Predicted by the Use of Robotic-Assisted Total Knee Arthroplasty Technology

10.29007/mrbg ◽  
2020 ◽  
Author(s):  
Bertrand Kaper
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Surgical Technique ◽  
Knee Arthroplasty ◽  
Soft Tissue Balance ◽  
Robotic Assisted ◽  
Accuracy And Precision ◽  
Measured Resection ◽  
Soft Tissue Laxity ◽  
Total Knee

In this study, patients undergoing RA-TKA were critically assessed to understand the accuracy and precision of a simulated MR model used historically in manually instrumented TKA surgery. Using a 3mm threshold of soft-tissue laxity, knees were identified that would have been expected to require the application of a “reactive” CI-TKA surgical technique to achieve adequate soft-tissue balance.

scholarly journals Accuracy of Soft Tissue Balancing in Robotic-Assisted Measured-Resection TKA Using a Robotic Distraction Tool

10.29007/h8kn ◽  
2019 ◽  
Author(s):  
Jan Koenig ◽  
Sami Shalhoub ◽  
Eric Chen ◽  
Christopher Plaskos
Keyword(s):  
Soft Tissue ◽  
Range Of Motion ◽  
Measurement Data ◽  
Soft Tissue Balance ◽  
Maximum Difference ◽  
Robotic Assisted ◽  
Soft Tissue Balancing ◽  
Gap Measurement ◽  
Measured Resection ◽  
Patient Reported

Achieving proper soft tissue balance during total knee arthroplasty (TKA) can reduce post- operative instability and stiffness as well as improve patient reported outcomes. The objective of this study was to compare final intra-operative coronal balance throughout the knee range of motion in navigated robotic-assisted TKA when performed with quantifiable feedback from a robotic ligament tensioning tool versus with standard trials and navigation measurements alone.The study included a prospective cohort of 52 patients undergoing robotic-assisted TKA using a measured resection technique. The cohort was divided into two sequential groups: a non-sensor-assisted group (n=25) and a subsequent sensor-assisted group (n=27). Once bony cuts and soft tissue balancing was performed in the non-sensor cohort, the final tibiofemoral gaps were measured throughout the knee range of motion using a robotic-assisted tensioner with the surgeon blinded to the measurements. For the sensor cohort, the surgeon preformed soft-tissue releases or re-cuts in order to balance the knee using the gap measurement data from the robotic tensioner. The robotic-assisted tensioner was then used to measure the final medial and lateral gap measurements.The average mediolateral gap difference throughout the range of flexion was 1.9 ± 0.7 mm with maximum difference of 7.8 mm for the non-sensor cohort. The sensor cohort had an average mediolateral difference of 1.5 ± 0.6 mm and a maximum difference of 3.8 mm. The difference between the two groups was statistically significant from 60 to 90 degrees of flexion. 38-41% of knees were balanced to within 1 mm mediolaterally in the non-sensor group compared to 48-70% for the sensor group when measured at various flexion angles. 65-76% of knees were balanced to within 2 mm for the non-sensor group compared to 78-86% for the sensor-assisted group. The number of knees requiring subsequent soft tissue releases was similar in each group. Soft tissue balancing with the aid of a robotic tensioning tool resulted in significantly more accurate soft tissue balance than when using navigation measurements and standard trials alone in this single surgeon study.

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