Balancing of total knee arthroplasty by bone cuts achieves accurately balanced soft tissues without the need for soft tissue releases and leaves the limb in natural alignment
ESSKA Academy. Firer P. 11/08/19; 286403 Topic: G4 - Tricompartmental (Simple) arthroplasty
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Balancing of total knee arthroplasty by bone cuts achieves accurately balanced soft tissues without the need for soft tissue releases and leaves the limb in natural alignment

EKA Free Papers

Topic: TKA

Firer P.1,2, Gelbart B.R.1,2
1Witwatersrand University Medical School, Orthopaedic Surgery, Johannesburg, South Africa, 2Linksfield Knee Surgery and Orthopaedic Sports Rehabilitation Clinic, Johannesburg, South Africa

Introduction: Patient satisfaction, after mechanically aligned Total Knee Arthroplasty(TKA) is only 80%-85%. There is an inabilty to consistently get perfect soft tissue balance with this technique.
Objectives: It is postulated that soft tissue balance within 2°can be achieved by the boney cuts (Bone Balancing) without soft tissue releases, accepting whatever coronal mechanical alignment (CMA) this produces; that the alignment produced would be similar to natural (constitutional) alignment and that balanced knees would improve patient satisfaction.
Materials and methods: We report on 914 consecutive TKAs using Bone Balancing: The femoral rotation for the flexion gap; and the distal femoral cut and valgus angle for the extension gap are adjusted to give equal gap sizes with soft tissues balanced within 2° of medio-lateral laxity.
Long leg X-rays were used to measure post operative coronal alignment. Satisfaction beyond 1 year post operation was assessed by an independent researcher, using a question on satisfaction and a VAS score.
All data was collected prospectively. Patient consent and ethics approval from the Physicans Advisory Board of Linksfield Clinic was obtained.
Results: 782(85.5%) TKAs with satisfactory x-rays were available at 2-7yrs follow up. Their CMA had a similar distribution profile to reported natural alignment studies. Of these 672 (86%) had a CMA of 0°±3°('aligned' group) Overall patient satisfaction was 92.8%, with satisfied patients having a mean (range) VAS score of 9.53 (7.3-10.0) and the dissatisfied patients 3.78 (0.0-6.3) ( p< 0.0001). There was no difference in satisfaction between 'aligned' knees (92.7%) and those 'outliers' whose CMA was >±3°(93.6%) (p=0.853). All balance measurements were within 3°with 92.2% being ≤2°. Gap size difference between extension and 90° flexion was ≤2mm in 98.7% of cases. Midflexion (45°flexion) balance was within 3° in all cases and the gap size difference was ≤2mm in 89%.
Conclusion: Balancing by bone cuts is able to achieve accurately balanced soft tissues without the need for soft tissue releases. The coronal alignment profile produced matches that of the normal population.This technique improves satisfaction compared to the literature for mechanically aligned TKAs. Acurate and measured soft tissue balancing needs further consideration in TKAs. Level of evidence IV.
Balancing of total knee arthroplasty by bone cuts achieves accurately balanced soft tissues without the need for soft tissue releases and leaves the limb in natural alignment

EKA Free Papers

Topic: TKA

Firer P.1,2, Gelbart B.R.1,2
1Witwatersrand University Medical School, Orthopaedic Surgery, Johannesburg, South Africa, 2Linksfield Knee Surgery and Orthopaedic Sports Rehabilitation Clinic, Johannesburg, South Africa

Introduction: Patient satisfaction, after mechanically aligned Total Knee Arthroplasty(TKA) is only 80%-85%. There is an inabilty to consistently get perfect soft tissue balance with this technique.
Objectives: It is postulated that soft tissue balance within 2°can be achieved by the boney cuts (Bone Balancing) without soft tissue releases, accepting whatever coronal mechanical alignment (CMA) this produces; that the alignment produced would be similar to natural (constitutional) alignment and that balanced knees would improve patient satisfaction.
Materials and methods: We report on 914 consecutive TKAs using Bone Balancing: The femoral rotation for the flexion gap; and the distal femoral cut and valgus angle for the extension gap are adjusted to give equal gap sizes with soft tissues balanced within 2° of medio-lateral laxity.
Long leg X-rays were used to measure post operative coronal alignment. Satisfaction beyond 1 year post operation was assessed by an independent researcher, using a question on satisfaction and a VAS score.
All data was collected prospectively. Patient consent and ethics approval from the Physicans Advisory Board of Linksfield Clinic was obtained.
Results: 782(85.5%) TKAs with satisfactory x-rays were available at 2-7yrs follow up. Their CMA had a similar distribution profile to reported natural alignment studies. Of these 672 (86%) had a CMA of 0°±3°('aligned' group) Overall patient satisfaction was 92.8%, with satisfied patients having a mean (range) VAS score of 9.53 (7.3-10.0) and the dissatisfied patients 3.78 (0.0-6.3) ( p< 0.0001). There was no difference in satisfaction between 'aligned' knees (92.7%) and those 'outliers' whose CMA was >±3°(93.6%) (p=0.853). All balance measurements were within 3°with 92.2% being ≤2°. Gap size difference between extension and 90° flexion was ≤2mm in 98.7% of cases. Midflexion (45°flexion) balance was within 3° in all cases and the gap size difference was ≤2mm in 89%.
Conclusion: Balancing by bone cuts is able to achieve accurately balanced soft tissues without the need for soft tissue releases. The coronal alignment profile produced matches that of the normal population.This technique improves satisfaction compared to the literature for mechanically aligned TKAs. Acurate and measured soft tissue balancing needs further consideration in TKAs. Level of evidence IV.
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