An electronic force sensor accurately detects increased but not decreased soft tissue tension in total knee arthroplasty

Abstract

BackgroundPostoperative knee instability is a leading cause of revision total knee arthroplasty (TKA). This study used a commercially available insert-shaped electronic force sensor to measure joint loads and facilitate ligament balance adjustment, and assessed the ability of this sensor to detect increased or decreased soft tissue tension during primary TKA. MethodsChanges in medial and lateral tibiofemoral joint loads during knee flexion were evaluated with sensor thicknesses ranging from 10 to 16 mm using six varus osteoarthritis cadaver knees with intact medial collateral ligaments (MCLs), and the measurements were repeated after MCL resection. Correlations between joint loads and maximum knee extension angle were also evaluated. To validate the efficacy of the sensor, the values were compared with those obtained using a conventional tension device. ResultsFor MCL-intact knees in extension, the medial joint load increased with sensor thickness. The maximum knee extension angle decreased with sensor thickness (ρ = −0.4), resulting in extension restriction up to −20°. Knee flexion contracture was below 5° when the total tibiofemoral joint load was below a cut-off of 42 lb. After the MCL was resected, medial joint loads remained unchanged at low values, even with increased sensor thickness. In contrast, the tension device clearly detected an increased gap as the degree of tension decreased. ConclusionsThe electronic sensor identified increased joint loads associated with increased ligament tension, and could predict knee flexion contracture during TKA. However, unlike the tension device, it did not accurately detect excessively decreased ligament tension.