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

4 pagesPublished: October 27, 2019

Abstract

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.

Keyphrases: CT, Robotic-Arm Assisted, Soft Tissue Releases, Total knee arthroplasty

In: Patrick Meere and Ferdinando Rodriguez Y Baena (editors). CAOS 2019. The 19th Annual Meeting of the International Society for Computer Assisted Orthopaedic Surgery, vol 3, pages 440--443

Links:
BibTeX entry
@inproceedings{CAOS2019:Does_Use_of_CT,
  author    = {Jingwei Zhang and Manoshi Bhowmik-Stoker and Laura Scholl and Caitlin Condrey and Kirby Hitt and Kevin Marchand and Robert Marchand},
  title     = {Does the Use of a CT Based 3D Plan Improve Joint Balancing in Total Knee Arthroplasty? A Multi-Center Study},
  booktitle = {CAOS 2019. The 19th Annual Meeting of the International Society for Computer Assisted Orthopaedic Surgery},
  editor    = {Patrick Meere and Ferdinando Rodriguez Y Baena},
  series    = {EPiC Series in Health Sciences},
  volume    = {3},
  pages     = {440--443},
  year      = {2019},
  publisher = {EasyChair},
  bibsource = {EasyChair, https://easychair.org},
  issn      = {2398-5305},
  url       = {https://easychair.org/publications/paper/qf5F},
  doi       = {10.29007/sptw}}
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