Achieving a balanced total knee by controlling the component position using robotics and intra-operative sensor technology without soft tissue release
ESSKA Academy. Bardou-Jacquet J. Nov 8, 2019; 284361; epEKA-15 Topic: Joint Replacement
Dr. Julien Bardou-Jacquet
Dr. Julien Bardou-Jacquet
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Achieving a balanced total knee by controlling the component position using robotics and intra-operative sensor technology without soft tissue release

ePoster - epEKA-15

Topic: TKA

Bardou-Jacquet J.
Institut Chirurgie Robotique Euratlantique, Bordeaux, France

Introduction: With the introduction of robotics technology, total knee arthroplasty (TKA) has entered the era of detailed 3D component planning relative to the patients' bony anatomy. Whereas this has the potential to avoid component malpositioning as a reason for early revision following TKA surgery, it likely lacks the ability to minimize the risk for instability and / or stiffness. In that respect, the use of instrumented tibial trial components has recently been introduced and shown promising short term clinical outcomes.
Objectives: The primary objective of this paper is to demonstrate the ability of achieving a quantitatively balanced knee by combining two technologies to enhance the surgeons' intra-operative understanding of the pathological condition. This is supported by the current concepts of alignment in total knee arthroplasty
Aims: The goal is to achieve such balanced knees by avoiding softtissue correction and exploit the ability of the robotics platform to control and adjust if necessary the component positions. The feedback from the intraoperative load sensors thereby serves as a precise diagnostic tool.
Methods: During a consecutive series of 10 robotic total knee surgeries, intra-operative load sensors are used following the initial bony resections to assess the knees' quantitative state of balance through the range of motion with the trial components in place. Measurements are taken at 10 and 90 degrees of knee flexion. Based on previous literature, a balanced knee is thereby defined to have a mediolateral load difference below 66 N through the range of motion, with an absolute load magnitude per compartment not exceeding 180 N. The initial load numbers are thereby recorded as well as the number and type of corrections needed to achieve quantitative balance.
Results: Of the 10 robotics cases currently documented, three cases ended up balanced after the initial bony cuts. Two cases required only a 2mm increase in the polyethylene. The remaining five cases required a bone recut. In two cases, only on the femur, one case on the tibia and three cases combining bone recuts on the tibia and the femur. No release was done on the soft tissue in any of the ten cases.
Conclusions: Based on a preliminary series, this work demonstrates the ability of combining technologies and achieve a quantitatively balanced knee through the range of motion by only addressing the bony resections, sparing the soft tissue envelope around the knee joint.
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