Ligament balancing in computer-assisted total knee arthroplasty: Improved clinical results with a spring-loaded tensioning device

Abstract Total knee arthroplasty (TKA) remains one of the most successful procedures in orthopaedic surgery. Complications certainly exist and are often related to failure of knee ligament balance. This asymmetry subsequently leads to component mal-alignment and loosening often secondary to deviatio...

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Bibliographic Details
Published in:Proceedings of the Institution of Mechanical Engineers. Part H, Journal of engineering in medicine Journal of engineering in medicine, 2007-10, Vol.221 (7), p.755-761
Main Authors: Swank, M, Romanowski, J R, Korbee, L L, Bignozzi, S
Format: Article
Language:English
Subjects:
Alignment
Anatomy
Arthroplasty (knee)
Arthroplasty, Replacement, Knee - instrumentation
Arthroplasty, Replacement, Knee - methods
Asymmetry
Biomedical materials
Complications
Computer Graphics
Computer Simulation
Deviation
Equipment Design
Equipment Failure Analysis
Evolution
Failure
Human mechanics
Humans
Integration
Joint replacement surgery
Joint surgery
Knee
Knee Joint - pathology
Knee Joint - physiopathology
Knee Joint - surgery
Ligaments
Ligaments, Articular - physiopathology
Ligaments, Articular - surgery
Loosening
Mechanics (physics)
Models, Biological
Orthopedic apparatus
Orthopedics
Robotics - instrumentation
Robotics - methods
Software
Spring (season)
Surgery
Surgery, Computer-Assisted - instrumentation
Surgery, Computer-Assisted - methods
Surgical implants
Surgical techniques
Tensioning
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Summary:Abstract Total knee arthroplasty (TKA) remains one of the most successful procedures in orthopaedic surgery. Complications certainly exist and are often related to failure of knee ligament balance. This asymmetry subsequently leads to component mal-alignment and loosening often secondary to deviation of the lower extremity mechanical axis. Understanding knee mechanics is essential, and recent technological advances have begun to minimize postoperative problems. A tensioning device that respects the native patellofemoral anatomy as well as the natural ligamentous strains has been developed. The surgical integration of computer-assisted navigation has allowed for enhanced accuracy and subsequently better results. The purpose of the current paper is to discuss the evolution of an improved ligament tensioning device, in the setting of classic mechanical guidance versus computer assistance and its postoperative impact on total knee outcomes in terms of manipulation rates and two-year radiographic alignment data. Based on a single surgeon series, mechanically guided arthroplasties resulted in a 16 per cent manipulation rate. Computer assistance with spacer blocks decreased the manipulation rate to 14 per cent, while using a novel tensioner device further decreased the manipulation rate to 7 per cent, a significant difference of p
ISSN:0954-4119
2041-3033
DOI:10.1243/09544119JEIM269