Abstract
Introduction
Sensoric soft tissue balancing in performing TKA is an upcoming topic to improve the results in TKA. A well balanced knee is working more proper together with the muscular stabilizing structures.
Dynamic ligament balancing (DLB)R give us the opportunity to check the balance of the ligaments at the beginning and the end of the surgery before implanting the definitive prosthesis. It is a platform independent, single-use device, which can be combined with all common types of knee prosthesis.
Materials and Methods
DLBR consists of a set of 10 different sizes of baseplates including a spring coil of 20N (A). Connected to a tablet all datas can be shown during surgery and stored for patient security. During the surgery the tibial cut is performed first, rectangular to the longitudinal axis respecting the right slope. A navigation system is recommended to ensure this request. Measurement before femoral cuts are performed and give an information about distance between tibial plate and femoral condyles, joint angle and calculated contact pressure. The femoral cuts can be performed with the original cutting block.
After positioning the femoral trial, testing is repeated and should show a balanced situation over all the ROM. The overall period datas were stored and compared to the subjective feeling of the patients.
Results
Performing the first 20 patients (DLB) a better balanced situation is visible in all knees respecting the including factors in comparison to the 20 patients of control group (CG). No extension of the surgical time was seen. All PROMs show good and excellent results. By example there was an improvement of the result of the OKS at the end of 10% by a much worse initial situation; so the overall progress was in the CG about 50%, in the DLB group 150%. The AKSS shows especially in the functional score a similar improvement (Fig. 1–4)
Discussion
DLBR is a new concept using single-use devices and is platform independant. Further measurements and comparisons are necessary to value these first excellent results. By the moment the inclusion factors are settled narrow, but the future will show, where the borders of this method will be.
Conclusion
Measuring the gap and ligament tension all over the ROM from 0 to 90° continuously gives the possibility to value the accuracy of the procedure together with marking points to compare it to the clinical postoperative result. Matching the procedure shows an increasing satisfaction of the patients due to a better balanced situation. Although there are limiting factors (no severe deformities, muscular deseases, ligament failure) it is a hopeful opportunity to increase the results in TKA in the future.
