Abstract
Although total knee arthroplasty has a high success rate, poor outcomes and early revision are associated with ligament imbalance. This multicenter evaluation was performed in order to provide 1-year followup of a previously reported group of patients who had sensor-assisted TKA, comparing the clinical outcomes of quantitatively balanced versus unbalanced patients. At 1 year, the balanced cohort scored 179.3 and 10.4 in KSS and WOMAC, respectively; the unbalanced cohort scored 156.1 and 17.9 in KSS and WOMAC (P < 0.001; P = 0.085). The average activity level scores of quantitatively balanced patients were 68.6 (corresponding to tennis, light jogging, and heavy yard work), while the average activity level of unbalanced patients was 46.7 (corresponding to light housework, and limited walking distances) (P = 0.015). Out of all confounding variables, a balanced articulation was the most significant contributing factor to improved postoperative outcomes (P < 0.001).
Highlights
Advances in implant technology and surgical technique have contributed to the long withstanding success of total knee arthroplasty (TKA), such that the procedural survivorship is as high as 95.6% at 10 years [1]
Due to the novelty of this study—having no precedent—the multicenter evaluation was initiated for observational purposes, guided by data extracted from biomechanical analyses, as mentioned previously. The majority of these unbalanced patients presented early in the enrollment period, which is consistent with the learning curve that can typically be expected with the implementation of new technology [14]
Total knee arthroplasty is consistently reported to successfully return function to patients suffering from late-stage osteoarthritis [15]
Summary
Advances in implant technology and surgical technique have contributed to the long withstanding success of total knee arthroplasty (TKA), such that the procedural survivorship is as high as 95.6% at 10 years [1]. As the projected annual number of primary TKA procedures continues to rise [3], it has become imperative that a priority be placed on developing new methods to avoid costly postoperative complications One such method includes the integration of intraoperative sensing technology into the surgical workflow, allowing surgeons to dynamically quantify in vivo kinetics associated with soft-tissue balancing. The balancing standards must have necessarily been maintained through the range of motion, based on quantitative measurement in extension (10 degrees), in midflexion (45 degrees), and at 90 degrees of flexion These loading values were selected based on (1) biomechanical research conducted to elucidate condylar contact pressures while the joint is in a passive state [13], (2) intraoperative observations made by experienced surgeons that quantified 2 mm of opening with Varus/Valgus stress and load changes coupled with navigation, and (3) the observation of significant declination in postoperative outcomes scores in patients with an intercompartmental loading difference which exceeded 20 lbs. Significance for all analyses was defined as a P value
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