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Tibial First Technique Using Predictive Balancing Improves Joint Balance Compared To Measured Resection

4 pagesPublished: September 26, 2020

Abstract

A well-balanced knee is a critical goal for total knee arthroplasty (TKA) across all surgical technique. Some controversy exists however about the method in which various techniques achieve soft tissue balance. Technology for balancing gaps in the tibia first approach has progressed from manual tensioners and laminar spreaders to digital tensioning tools integrated with robot-assisted navigation platforms, however there has been no comparison between femur first measured resection and tibia first techniques with this new technology. Our objective was to prospectively investigate joint balance accuracy and precision between a femur first measured resection and tibia first gap balancing technique utilizing a digital gap balancing tool.
A consecutive series cohort undergoing TKA were investigated. The cohort was divided in to 4 groups: 1) Femur First Blinded to gap data, 2) Femur First Non-Blinded to gap data, 3) Tibia first Blinded to gap data, 4) Tibia first Non-Blinded to gap data. Implanted medio-lateral (ML) gap difference was used to calculate joint balance.
94 patients were enrolled. No significant difference was found between the average ML gaps, however, the frequency of outlier balance throughout flexion, was significantly reduced in Group 4. Significant differences in the variance of the post-operative gap balance were also found, in which Group 4, reported reduced variance compared to group 3 and 2 throughout flexion and compared to group 1 at 90°.
Ideal joint balance may remain a controversial topic, nonetheless a tibia first approach with digital balancing allows surgeons to accurately achieve a desired joint balance target.

Keyphrases: digital sensors, Joint Balance, Tibia first gap balancing, Total knee arthroplasty

In: Ferdinando Rodriguez Y Baena and Fabio Tatti (editors). CAOS 2020. The 20th Annual Meeting of the International Society for Computer Assisted Orthopaedic Surgery, vol 4, pages 165--168

Links:
BibTeX entry
@inproceedings{CAOS2020:Tibial_First_Technique_Using,
  author    = {Edgar Wakelin and Sami Shalhoub and Jan Koenig and Christopher Plaskos},
  title     = {Tibial First Technique Using Predictive Balancing Improves Joint Balance Compared To Measured Resection},
  booktitle = {CAOS 2020. The 20th Annual Meeting of the International Society for Computer Assisted Orthopaedic Surgery},
  editor    = {Ferdinando Rodriguez Y Baena and Fabio Tatti},
  series    = {EPiC Series in Health Sciences},
  volume    = {4},
  pages     = {165--168},
  year      = {2020},
  publisher = {EasyChair},
  bibsource = {EasyChair, https://easychair.org},
  issn      = {2398-5305},
  url       = {https://easychair.org/publications/paper/xtXP},
  doi       = {10.29007/sbx3}}
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