Connecticut Joint Replacement Institute, Hartford, CT, USA.
Corin USA, 480 Paramount Drive, Raynham, MA, 02767, USA.
Arch Orthop Trauma Surg. 2021 Dec;141(12):2165-2174. doi: 10.1007/s00402-021-04043-3. Epub 2021 Jul 13.
New technologies exist which may assist surgeons to better predict final intra-operative joint balance. Our objectives were to compare the impact of (1) a predictive digital joint tensioning tool on intra-operative joint balance; and (2) joint balance and flexion joint laxity on patient-reported outcomes.
Two-hundred Eighty patients received posterior cruciate ligament sacrificing TKA with ultra-congruent tibial inserts using a robotic-assisted navigation platform. Patients were divided into those in which a Predictive Plan with a digital joint-tensioning device was used (PP) and those in which it was not (NPP), in all cases final post-operative joint gaps were collected immediately before final implantation. Demographics and KOOS were collected pre-operatively. KOOS, complications and satisfaction were collected at 3, 6 and 12 months post-operatively. Optimal balance difference between PP and NPP was defined and compared using area-under-the-curve analysis (AUC). Outcomes were then compared according to the results from the AUC.
AUC analysis yielded a balance threshold of 1.5 mm, in which the PP group achieved a higher rate of balance throughout flexion compared to the NPP group: extension: 83 vs 52%; Midflexion: 82 vs 55%; Flexion 89 vs 68%; Flexion to Extension 80 vs 49%; p ≤ 0.003. Higher KOOS scores were observed in knees balanced within 1.5 mm across all sub-scores at various time points, however, differences did not exceed the minimum clinically important difference (MCID). Patients with > 1.5 mm flexion laxity medially or laterally had an increased likelihood of 2.2 (1.1-4.4) and 2.5 (1.3-4.8), respectively, for failing to achieve the Patient Acceptable Symptom State for KOOS Pain at 12 months. Patient satisfaction was high in both the PP and NPP groups (97.4 and 94.7%, respectively).
Use of a predictive joint tensioning tool improved the final balance in TKA. Improved outcomes were found in balanced knees; however, this improvement did not achieve the MCID, suggesting further studies may be required to define optimal balance targets. Limiting medial and lateral flexion laxity resulted in an increased likelihood of achieving the Patient Acceptable Symptom State for KOOS Pain.
现已有新技术可帮助外科医生更好地预测术中关节平衡。我们的目的是比较（1）预测性数字关节张力工具对术中关节平衡的影响；以及（2）关节平衡和屈曲关节松弛度对患者报告结果的影响。
280 例接受后交叉韧带切除的 TKA 患者，使用机器人辅助导航平台，采用超一致胫骨插入物。将患者分为使用预测计划和数字关节张力装置（PP）的患者和未使用的患者（NPP），在所有情况下，在最终植入物之前立即收集最终术后关节间隙。收集术前的人口统计学和 KOOS。术后 3、6 和 12 个月收集 KOOS、并发症和满意度。使用曲线下面积分析（AUC）定义并比较 PP 和 NPP 之间的最佳平衡差异。然后根据 AUC 的结果比较结果。
AUC 分析得出平衡阈值为 1.5mm，其中 PP 组在整个屈曲过程中比 NPP 组达到更高的平衡率：伸展：83 对 52%；中弯：82 对 55%；屈曲：89 对 68%；屈曲至伸展：80 对 49%；p≤0.003。在各个时间点，所有亚评分中平衡在 1.5mm 以内的膝关节观察到更高的 KOOS 评分，但差异未超过最小临床重要差异（MCID）。内侧或外侧屈曲松弛度>1.5mm 的患者在 12 个月时无法达到 KOOS 疼痛的患者可接受症状状态的可能性分别增加 2.2（1.1-4.4）和 2.5（1.3-4.8）。PP 和 NPP 两组患者的满意度均较高（分别为 97.4%和 94.7%）。
使用预测性关节张力工具可改善 TKA 的最终平衡。在平衡的膝关节中发现了更好的结果；然而，这种改善没有达到 MCID，这表明可能需要进一步的研究来确定最佳的平衡目标。限制内侧和外侧屈曲松弛度可增加达到 KOOS 疼痛患者可接受症状状态的可能性。
