gms | German Medical Science

Deutscher Kongress für Orthopädie und Unfallchirurgie
74. Jahrestagung der Deutschen Gesellschaft für Unfallchirurgie
96. Tagung der Deutschen Gesellschaft für Orthopädie und Orthopädische Chirurgie
51. Tagung des Berufsverbandes der Fachärzte für Orthopädie und Unfallchirurgie

26. - 29.10.2010, Berlin

Does soft tissue balancing in navigated TKA improve the in vivo kinematics?

Meeting Abstract

  • G. Wassilew - Charité-Universitätsmedizin Berlin, CMSC, Klinik für Orthopädie, Berlin, Germany
  • C. Perka - Charité-Universitätsmedizin Berlin, Klinik für Orthopädie, Centrum für Musculoskeletale Chirurgie, Berlin, Germany
  • G. N. Duda - Charité-Universitätsmedizin Berlin, Centrum für Muskuloskeletale Chirurgie, Berlin, Germany
  • W. R. Taylor - Charité-Universitätsmedizin Berlin, Julius-Wolff Institut, Centrum für Sportwissenschaft und Sportmedizin Berlin, Berlin, Germany
  • P. Moewis - Charité-Universitätsmedizin Berlin, Julius Wolff Institut, Centrum für Musculoskeletale Chirurgie, Berlin, Germany
  • V. Janz - CMSC, Klinik für Orthopädie, Berlin, Germany

Deutscher Kongress für Orthopädie und Unfallchirurgie. 74. Jahrestagung der Deutschen Gesellschaft für Unfallchirurgie, 96. Tagung der Deutschen Gesellschaft für Orthopädie und Orthopädische Chirurgie, 51. Tagung des Berufsverbandes der Fachärzte für Orthopädie. Berlin, 26.-29.10.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocIN20-1393

DOI: 10.3205/10dkou120, URN: urn:nbn:de:0183-10dkou1205

Published: October 21, 2010

© 2010 Wassilew et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

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Objective: Previous in vivo kinematic studies have reported varying results even in patients with similar implant design. These findings suggest that surgical technique, especially soft tissue balancing, may play a role in postoperative kinematics. However, the uses of navigation systems have shown to improve the alignment and provide a helpful method for soft tissue balancing. The purpose of this study was to determine whether computer-assisted (CAOS+) total knee arthroplasties (TKA) is superior to the conventional surgical (CAOS-) method with regard to the postoperative in vivo kinematic.

Methods: Twenty subjects, with a posterior stabilized CAOS- (P.F.C. Sigma RP, DePuy, USA) and 20 with a CAOS+ posterior stabilized TKA (Emotion, Aesculap, Germany) were asked to perform maximum weight-bearing flexion, while under fluoroscopic surveillance. The 3D kinematics of the TKA`s was determined by analyzing fluoroscopic images at 10 degree increments from full extension to 90 degree knee flexion. We used the Kolmogorov-Smirnov test for normal distribution before further statistical analysis. The percentages of TKA with lift off were compared between groups with use of a chi-square test. As a twogroup comparison test we use the Mann-Whitney-Wilcoxon Test. P < 0.05 was considered to be the level of significance.

Results and conclusions: On average, the CAOS- TKA`s demonstrated medial 1.1 mm and lateral −2.1 mm of posterior femoral rollback, and 4.1° of axial rotation. The CAOS+ TKA`s averaged medial 1.4 mm and lateral −4.2 mm of posterior femoral rollback, and 7.3° of axial rotation. Sixteen subjects in the CAOS- and 4 in the CAOS+ group experienced greater than 1.0 mm of condylar lift-off. This was statistical significant.

We found in the CAOS+ TKA`s a more normal postoperative tibiofemoral kinematic than in the CAOS- knee arthroplasties. In addition, only 4 subjects having a CAOS+ TKA showed a condylar lift off greater than 1.0 mm. These data suggest that soft tissue balancing improve the postoperative kinematics.