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 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 True Kinematic Alignment Is Applicable in 44% of Patients Applying Restrictive Indication Criteria—A Retrospective Analysis of 111 TKA Using Robotic Assistance

2021 ◽  
Vol 11 (7) ◽  
pp. 662
Author(s):  
Kim Huber ◽  
Bernhard Christen ◽  
Sarah Calliess ◽  
Tilman Calliess
Keyword(s):  
Soft Tissue ◽  
Retrospective Analysis ◽  
Patient Specific ◽  
Kinematic Alignment ◽  
Postoperative Phase ◽  
Robotic Assistance ◽  
Component Position ◽  
Joint Stability ◽  
Robotic Assisted ◽  
Primary Tkas

Introduction: Image-based robotic assistance appears to be a promising tool for individualizing alignment in total knee arthroplasty (TKA). The patient-specific model of the knee enables a preoperative 3D planning of component position. Adjustments to the individual soft-tissue situation can be done intraoperatively. Based on this, we have established a standardized workflow to implement the idea of kinematic alignment (KA) for robotic-assisted TKA. In addition, we have defined limits for its use. If these limits are reached, we switch to a restricted KA (rKA). The aim of the study was to evaluate (1) in what percentage of patients a true KA or an rKA is applicable, (2) whether there were differences regarding knee phenotypes, and (3) what the differences of philosophies in terms of component position, joint stability, and early patient outcome were. Methods: The study included a retrospective analysis of 111 robotic-assisted primary TKAs. Based on preoperative long leg standing radiographs, the patients were categorized into a varus, valgus, or neutral subgroup. Initially, all patients were planned for KA TKA. When the defined safe zone had been exceeded, adjustments to an rKA were made. Intraoperatively, the alignment of the components and joint gaps were recorded by robotic software. Results and conclusion: With our indication for TKA and the defined boundaries, “only” 44% of the patients were suitable for a true KA with no adjustments or soft tissue releases. In the varus group, it was about 70%, whereas it was 0% in the valgus group and 25% in the neutral alignment group. Thus, significant differences with regard to knee morphotypes were evident. In the KA group, a more physiological knee balance reconstructing the trapezoidal flexion gap (+2 mm on average laterally) was seen as well as a closer reconstruction of the surface anatomy and joint line in all dimensions compared to rKA. This resulted in a higher improvement in the collected outcome scores in favor of KA in the very early postoperative phase.

scholarly journals Achieving a Balanced Knee in Robotic TKA

Sensors ◽  
2021 ◽  
Vol 21 (2) ◽  
pp. 535
Author(s):  
Alexander C Gordon ◽  
Michael A Conditt ◽  
Matthias A Verstraete
Keyword(s):  
Soft Tissue ◽  
Real Time ◽  
Consecutive Series ◽  
Component Position ◽  
Coronal Alignment ◽  
Robotic Assisted ◽  
Primary Tkas ◽  
Wide Range ◽  
Total Knee ◽  
Surgical Corrections

Total knee arthroplasty (TKA) surgery with manual instruments provides a quantitatively balanced knee in approximately 50% of cases. This study examined the effect of combining robotics technology with real-time intra-operative sensor feedback on the number of quantitatively balanced cases in a consecutive series of 200 robotic-assisted primary TKAs. The robotics platform was used to plan the implant component position using correctable poses in extension and a manual, centrally pivoting the balancer in flexion, prior to committing to the femoral cuts. During the initial trialing, the quantitative state of balance was assessed using an instrumented tibial tray that measured the intra-articular loads in the medial and lateral compartments. These sensor readings informed a number of surgical corrections, including bone recuts, soft-tissue corrections, and cement adjustments. During initial trialing, a quantitatively balanced knee was achieved in only 65% of cases. After performing the relevant soft-tissue corrections, bone recuts, and cement adjustments, 87% of cases ended balanced through the range of motion. Meanwhile, this resulted in a wide range of coronal alignment conditions, ranging from 6° valgus to 9° varus. It is therefore concluded that gaps derived from robotics navigation are not indicative for a quantitatively balanced knee, which was only consistently achieved when combining the robotics platform with real-time feedback from intra-operative load sensors.

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 After 25 years of computer-navigated total knee arthroplasty, where do we stand today?

Arthroplasty ◽  
2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Siddharth M. Shah
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Computer Navigation ◽  
Soft Tissue Release ◽  
Computer Assisted ◽  
Robotic Assisted ◽  
Total Knee ◽  
Implant Alignment ◽  
Navigated Tka

Abstract Background Limb and implant alignment along with soft tissue balance plays a vital role in the outcomes after total knee arthroplasty (TKA). Computer navigation for TKA was first introduced in 1997 with the aim of implanting the prosthetic components with accuracy and precision. This review discusses the technique, current status, and scientific evidence pertaining to computer-navigated TKA. Body The adoption of navigated TKA has slowly but steadily increased across the globe since its inception 25 years ago. It has been more rapid in some countries like Australia than others, like the UK. Contemporary, large console-based navigation systems help control almost every aspect of TKA, including the depth and orientation of femoral and tibial resections, soft-tissue release, and customization of femoral and tibial implant positions in order to obtain desired alignment and balance. Navigated TKA results in better limb and implant alignment and reduces outliers as compared to conventional TKA. However, controversy still exists over whether improved alignment provides superior function and longevity. Surgeons may also be hesitant to adopt this technology due to the associated learning curve, slightly increased surgical time, fear of pin site complications, and the initial set-up cost. Furthermore, the recent advent of robotic-assisted TKA which provides benefits like precision in bone resections and avoiding soft-tissue damage due to uncontrolled sawing, in addition to those of computer navigation, might be responsible for the latter technology taking a backseat. Conclusion This review summarizes the current state of computer-navigated TKA. The superiority of computer navigation to conventional TKA in improving accuracy is well established. Robotic-assisted TKA provides enhanced functionality as compared to computer navigation but is significantly more expensive. Whether robotic-assisted TKA offers any substantive advantages over navigation is yet to be conclusively proven. Irrespective of the form, the use of computer-assisted TKA is on the rise worldwide and is here to stay.

Use of the AO Wire Passer to Aid Placement of Obstetrical Saw Wire for Osteotomy

1994 ◽  
Vol 07 (04) ◽  
pp. 180-182
Author(s):  
N. Gofton ◽  
Joanne Cockshutt
Keyword(s):  
Soft Tissue ◽  
Close Contact ◽  
Soft Tissue Trauma ◽  
Wire Saw ◽  
Tissue Dissection ◽  
The Wire ◽  
Tissue Trauma

The AO wire passer can be used as an effective guide for passage of obstetrical saw wire for osteotomy. Use of the wire saw and passer reduces soft tissue trauma by minimizing tissue dissection, and promoting positioning of the saw in close contact with the bone.

scholarly journals Visualization Ability of Phase-Contrast Synchrotron-Based X-Ray Imaging Using an X-Ray Interferometer in Soft Tissue Tumors

2021 ◽  
Vol 20 ◽  
pp. 153303382110101
Author(s):  
Thet-Thet Lwin ◽  
Akio Yoneyama ◽  
Hiroko Maruyama ◽  
Tohoru Takeda
Keyword(s):  
Computed Tomography ◽  
Soft Tissue ◽  
Spatial Resolution ◽  
Phase Contrast ◽  
Soft Tissue Tumors ◽  
X Ray ◽  
3 Dimensional ◽  
Computed Tomography Images ◽  
X Ray Imaging ◽  
X Ray Computed

Phase-contrast synchrotron-based X-ray imaging using an X-ray interferometer provides high sensitivity and high spatial resolution, and it has the ability to depict the fine morphological structures of biological soft tissues, including tumors. In this study, we quantitatively compared phase-contrast synchrotron-based X-ray computed tomography images and images of histopathological hematoxylin-eosin-stained sections of spontaneously occurring rat testicular tumors that contained different types of cells. The absolute densities measured on the phase-contrast synchrotron-based X-ray computed tomography images correlated well with the densities of the nuclear chromatin in the histological images, thereby demonstrating the ability of phase-contrast synchrotron-based X-ray imaging using an X-ray interferometer to reliably identify the characteristics of cancer cells within solid soft tissue tumors. In addition, 3-dimensional synchrotron-based phase-contrast X-ray computed tomography enables screening for different structures within tumors, such as solid, cystic, and fibrous tissues, and blood clots, from any direction and with a spatial resolution down to 26 μm. Thus, phase-contrast synchrotron-based X-ray imaging using an X-ray interferometer shows potential for being useful in preclinical cancer research by providing the ability to depict the characteristics of tumor cells and by offering 3-dimensional information capabilities.

Soft Tissue Trauma Over the Nose

1992 ◽  
Vol 8 (04) ◽  
pp. 233-241 ◽  
Author(s):  
Fred Stucker ◽  
Denis Hoasjoe
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Trauma ◽  
Tissue Trauma

Total knee arthroplasty for valgus osteoarthritis: the results of a standardized soft-tissue release technique

2016 ◽  
Vol 24 (8) ◽  
pp. 2525-2531 ◽  
Author(s):  
Friedrich Boettner ◽  
Lisa Renner ◽  
Danik Arana Narbarte ◽  
Claus Egidy ◽  
Martin Faschingbauer
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Soft Tissue Release ◽  
Release Technique ◽  
Valgus Osteoarthritis ◽  
Total Knee
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