PMID- 34255172
OWN - NLM
STAT- MEDLINE
DCOM- 20211125
LR  - 20211125
IS  - 1434-3916 (Electronic)
IS  - 0936-8051 (Linking)
VI  - 141
IP  - 12
DP  - 2021 Dec
TI  - Impact of intra-operative predictive ligament balance on post-operative balance 
      and patient outcome in TKA: a prospective multicenter study.
PG  - 2165-2174
LID - 10.1007/s00402-021-04043-3 [doi]
AB  - INTRODUCTION: New technologies exist which may assist surgeons to better predict 
      final intra-operative joint balance. Our objectives were to compare the impact of 
      (1) a predictive digital joint tensioning tool on intra-operative joint balance; 
      and (2) joint balance and flexion joint laxity on patient-reported outcomes. 
      MATERIALS AND METHODS: Two-hundred Eighty patients received posterior cruciate 
      ligament sacrificing TKA with ultra-congruent tibial inserts using a 
      robotic-assisted navigation platform. Patients were divided into those in which a 
      Predictive Plan with a digital joint-tensioning device was used (PP) and those in 
      which it was not (NPP), in all cases final post-operative joint gaps were 
      collected immediately before final implantation. Demographics and KOOS were 
      collected pre-operatively. KOOS, complications and satisfaction were collected at 
      3, 6 and 12 months post-operatively. Optimal balance difference between PP and 
      NPP was defined and compared using area-under-the-curve analysis (AUC). Outcomes 
      were then compared according to the results from the AUC. RESULTS: AUC analysis 
      yielded a balance threshold of 1.5 mm, in which the PP group achieved a higher 
      rate of balance throughout flexion compared to the NPP group: extension: 83 vs 
      52%; Midflexion: 82 vs 55%; Flexion 89 vs 68%; Flexion to Extension 80 vs 49%; 
      p </= 0.003. Higher KOOS scores were observed in knees balanced within 1.5 mm 
      across all sub-scores at various time points, however, differences did not exceed 
      the minimum clinically important difference (MCID). Patients with > 1.5 mm 
      flexion laxity medially or laterally had an increased likelihood of 2.2 (1.1-4.4) 
      and 2.5 (1.3-4.8), respectively, for failing to achieve the Patient Acceptable 
      Symptom State for KOOS Pain at 12 months. Patient satisfaction was high in both 
      the PP and NPP groups (97.4 and 94.7%, respectively). CONCLUSIONS: Use of a 
      predictive joint tensioning tool improved the final balance in TKA. Improved 
      outcomes were found in balanced knees; however, this improvement did not achieve 
      the MCID, suggesting further studies may be required to define optimal balance 
      targets. Limiting medial and lateral flexion laxity resulted in an increased 
      likelihood of achieving the Patient Acceptable Symptom State for KOOS Pain.
CI  - (c) 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, 
      part of Springer Nature.
FAU - Keggi, John M
AU  - Keggi JM
AD  - Connecticut Joint Replacement Institute, Hartford, CT, USA.
FAU - Wakelin, Edgar A
AU  - Wakelin EA
AUID- ORCID: 0000-0001-5433-5824
AD  - Corin USA, 480 Paramount Drive, Raynham, MA, 02767, USA. 
      edgar.wakelin@coringroup.com.
FAU - Koenig, Jan A
AU  - Koenig JA
AD  - NYU Langone Hospital, Department of Orthopedic Surgery, Long Island, NY, USA.
FAU - Lawrence, Jeffrey M
AU  - Lawrence JM
AD  - Gundersen Health System, Viroqua, WI, USA.
FAU - Randall, Amber L
AU  - Randall AL
AD  - Flagstaff Bone and Joint, Flagstaff, AZ, USA.
FAU - Ponder, Corey E
AU  - Ponder CE
AD  - Oklahoma Sports and Orthopedics Institute, Edmond, OK, USA.
FAU - DeClaire, Jeffrey H
AU  - DeClaire JH
AD  - DeClaire LaMacchia Orthopaedic Institute, Rochester Hills, MI, USA.
FAU - Shalhoub, Sami
AU  - Shalhoub S
AD  - Corin USA, 480 Paramount Drive, Raynham, MA, 02767, USA.
FAU - Lyman, Stephen
AU  - Lyman S
AD  - Hospital for Special Surgery, New York, NY, USA.
AD  - Kyushu University School of Medicine, Fukuoka, Japan.
FAU - Plaskos, Christopher
AU  - Plaskos C
AD  - Corin USA, 480 Paramount Drive, Raynham, MA, 02767, USA.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
DEP - 20210713
PL  - Germany
TA  - Arch Orthop Trauma Surg
JT  - Archives of orthopaedic and trauma surgery
JID - 9011043
SB  - IM
MH  - *Arthroplasty, Replacement, Knee
MH  - Humans
MH  - Knee Joint/surgery
MH  - Ligaments
MH  - *Osteoarthritis, Knee/surgery
MH  - Prospective Studies
OTO - NOTNLM
OT  - Digital balance
OT  - Flexion balance
OT  - Outcomes
OT  - PROMS
OT  - Soft tissue balance
OT  - Total knee arthroplasty
EDAT- 2021/07/14 06:00
MHDA- 2021/11/26 06:00
CRDT- 2021/07/13 12:25
PHST- 2021/03/07 00:00 [received]
PHST- 2021/07/01 00:00 [accepted]
PHST- 2021/07/14 06:00 [pubmed]
PHST- 2021/11/26 06:00 [medline]
PHST- 2021/07/13 12:25 [entrez]
AID - 10.1007/s00402-021-04043-3 [pii]
AID - 10.1007/s00402-021-04043-3 [doi]
PST - ppublish
SO  - Arch Orthop Trauma Surg. 2021 Dec;141(12):2165-2174. doi: 
      10.1007/s00402-021-04043-3. Epub 2021 Jul 13.