Abstract
INTRODUCTION
Achieving balance in TKA is critical in assuring favorable outcomes. But, in order to achieve quantifiably balanced loading values, is it more advantageous to make bony corrections or release soft-tissue? The answer to this question will be paramount in evaluating the most appropriate surgical techniques for use with new dynamic technology, thereby maximizing favorable clinical outcomes. Therefore, the purpose of this investigation was to evaluate a possible quantitative loading threshold, using intraoperative sensors, which may dictate surgical correction of bone versus soft-tissue release.
METHODS
A retrospective analysis of 122 multicenter patients, in receipt of sensor-assisted primary TKA, was conducted. 40 lbs. was used as a threshold, above which bone was corrected; below which soft-tissue was corrected. All patients were categorized in to the following groups: Group A – candidates for bony correction, but received soft-tissue correction; Group B – candidates for soft-tissue/receiving soft-tissue; Group C – candidates for bony correction/receiving bony correction.
RESULTS
The patient groups that followed the surgical algorithm appropriately (loading ≥ 40 lbs. dictates bony correction; loading < 40 lbs. dictates soft-tissue correction) reported significantly higher clinical outcomes scores (KSS and WOMAC) and satisfaction, 1-year following primary TKA.
DISCUSSION AND CONCLUSIONS
Novel technology, such as intraoperative sensing, has provided surgeons with unprecedented access to information regarding the kinetic/kinematic nature of knee joints. In order to mitigate recurring complications after primary TKA, it is imperative that sensing output and clinical outcomes are correlated and studied in order to maximize patient benefits. In this investigation, it was observed that a 40 lb. threshold provided a clinically relevant delineation between when to correct bone, and when to adjust soft-tissue. When that algorithm was applied, patients reported significantly better clinical outcomes than when the algorithm was not applied.
