Skip to main content
SpringerLink
Log in

Variability between the trial and final implant measurements during the sensor-guided total knee arthroplasty

  • KNEE
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Compartmental load-sensing technology has been used in the attempt to achieve optimal soft tissue balance during total knee arthroplasty (TKA). This study was conducted to investigate the validity of such use of intraoperative sensing technology.

Methods

Ninety-three knees scheduled to undergo total knee arthroplasty for knee osteoarthritis with a tibial sensor were prospectively enrolled. Measurements were divided into three groups according to the three different time points of intraoperative load testing: group Trial (with the trial components), group Final (with the definitive cemented implants and an open joint capsule), and group Closed (with the definitive cemented implants and a closed joint capsule). Load measurements and component rotational alignments were documented at 10°, 30°, 45°, 90°, and 120° of flexion for all three groups, and compared. One year postoperatively, the joint line obliquity angle was obtained radiographically in the valgus and varus stress views at 10° and 30° flexion to evaluate the clinical instability. The Knee Society, Hospital for Special Surgery, and Western Ontario McMaster Universities Osteoarthritis Index scores were used to determine functional outcomes. The correlations of the above outcomes with intraoperative load were evaluated.

Results

There were significant differences in medial and lateral loads at all flexion angles (except at a 120° lateral load) between group Trial and group Final (p < 0.05). Tibial trays were internally rotated to a significantly higher degree in group Final than in group Trial (p = 0.010). The lateral compartmental load significantly decreased after patellar inversion (p = 0.037). There were no correlations of intraoperative load with clinical instability and functional outcomes.

Conclusion

Significant variability was observed between the trial and final implant measurements and intraoperative sensing data were not correlated with instability or functional outcomes over a 1-year period. Therefore, intraoperative sensor technology provides limited feedback and clinical efficacy in the adjustment of the soft tissue balance during TKA.

Level of evidence

Level II.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

Abbreviations

HSS:

Hospital for Special Surgery

KS:

Knee Society

ROM:

Range of motion

TKA:

Total knee arthroplasty

WOMAC:

Western Ontario McMaster Universities Osteoarthritis Index

References

  1. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW (1988) Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 15:1833–1840

    CAS  PubMed  Google Scholar 

  2. Chow J, Wang K, Elson L, Anderson C, Roche M (2017) Effects of cementing on ligament balance during total knee arthroplasty. Orthopedics 40:e455–e459

    PubMed  Google Scholar 

  3. Geller JA, Lakra A, Murtaugh T (2017) The Use of electronic sensor device to augment ligament balancing leads to a lower rate of arthrofibrosis after total knee arthroplasty. J Arthroplasty 32:1502–1504

    Article  Google Scholar 

  4. Ghirardelli S, Bala A, Peretti G, Antonini G, Indelli PF (2019) Intraoperative sensing technology to achieve balance in primary total knee arthroplasty: a review of the literature. JBJS Rev 7:e4

    Article  Google Scholar 

  5. Gustke KA (2014) Soft-tissue and alignment correction: the use of smart trials in total knee replacement. Bone Joint J 96-b:78–83

    Article  CAS  Google Scholar 

  6. Gustke KA, Golladay GJ, Roche MW, Elson LC, Anderson CR (2014) A new method for defining balance: promising short-term clinical outcomes of sensor-guided TKA. J Arthroplasty 29:955–960

    Article  Google Scholar 

  7. Gustke KA, Golladay GJ, Roche MW, Elson LC, Anderson CR (2014) Primary TKA patients with quantifiably balanced soft-tissue achieve significant clinical gains sooner than unbalanced patients. Adv Orthop 2014:628695

    Article  Google Scholar 

  8. Han HS, Lee MC (2017) Cementing technique affects the rate of femoral component loosening after high flexion total knee arthroplasty. Knee 24:1435–1441

    Article  Google Scholar 

  9. Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the knee society clinical rating system. Clin Orthop Relat Res 1:13–14

    Google Scholar 

  10. Kim JK, Ro DH, Lee HJ, Park JY, Han HS, Lee MC (2020) Efficacy of systemic steroid use given one day after total knee arthroplasty for pain and nausea: a randomized controlled study. J Arthroplasty 35:69–75

    Article  Google Scholar 

  11. Livermore AT, Erickson JA, Blackburn B, Peters CL (2020) Does the sequential addition of accelerometer-based navigation and sensor-guided ligament balancing improve outcomes in TKA? Bone Joint J 102-b:24–30

    Article  Google Scholar 

  12. MacDessi SJ, Cohen DA, Wood JA, Diwan AD, Harris IA (2021) Does the use of intraoperative pressure sensors for knee balancing in total knee arthroplasty improve clinical outcomes? A comparative study with a minimum two-year follow-up. J Arthroplasty 36:514–519

    Article  Google Scholar 

  13. Manning WA, Ghosh K, Blain A, Longstaff L, Deehan DJ (2017) Tibiofemoral forces for the native and post-arthroplasty knee: relationship to maximal laxity through a functional arc of motion. Knee Surg Sports Traumatol Arthrosc 25:1669–1677

    Article  Google Scholar 

  14. McClelland JA, Webster KE, Ramteke AA, Feller JA (2017) Total knee arthroplasty with computer-assisted navigation more closely replicates normal knee biomechanics than conventional surgery. Knee 24:651–656

    Article  Google Scholar 

  15. Nicolet-Petersen SJ, Howell SM, Hull M (2018) Force and contact location measurement errors of the VERASENSE. J Biomech Eng. https://doi.org/10.1115/1.4040601

    Article  PubMed  Google Scholar 

  16. Nodzo SR, Franceschini V, Gonzalez Della Valle A (2017) Intraoperative load-sensing variability during cemented, posterior-stabilized total knee arthroplasty. J Arthroplasty 32:66–70

    Article  Google Scholar 

  17. Ranawat CS, Shine JJ (1973) Duo-condylar total knee arthroplasty. Clin Orthop Relat Res 94:185–195

    Article  Google Scholar 

  18. Roche MW, Elson LC, Anderson CR (2015) A novel technique using sensor-based technology to evaluate tibial tray rotation. Orthopedics 38:e217-222

    Article  Google Scholar 

  19. Schnaser E, Lee YY, Boettner F, Gonzalez Della Valle A (2015) The position of the patella and extensor mechanism affects intraoperative compartmental loads during total knee arthroplasty: a pilot study using intraoperative sensing to guide soft tissue balance. J Arthroplasty 30:1348-1353.e1343

    Article  Google Scholar 

  20. Sculco P, Gruskay J, Nodzo S, Carrol K, Shanaghan K, Haas S et al (2018) The role of the tourniquet and patella position on the compartmental loads during sensor-assisted total knee arthroplasty. J Arthroplasty 33:S121-s125

    Article  Google Scholar 

  21. Siddiqi A, Smith T, McPhilemy JJ, Ranawat AS, Sculco PK, Chen AF (2020) Soft-tissue balancing technology for total knee arthroplasty. JBJS Rev 8:e0050

    Article  Google Scholar 

  22. Song SJ, Kang SG, Lee YJ, Kim KI, Park CH (2019) An intraoperative load sensor did not improve the early postoperative results of posterior-stabilized TKA for osteoarthritis with varus deformities. Knee Surg Sports Traumatol Arthrosc 27:1671–1679

    Article  Google Scholar 

  23. van der Linde JA, Leong AKL (2019) Does bone cement influence soft tissue balancing in total knee arthroplasty? Knee 26:405–409

    Article  Google Scholar 

Download references

Funding

There is no funding source.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Heung-K Hospital, Seoul, South Korea

    Jong-Keun Kim

  2. Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea

    Do Weon Lee, Du Hyun Ro, Hyuk-Soo Han & Myung Chul Lee

Authors
  1. Jong-Keun Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Do Weon Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Du Hyun Ro
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hyuk-Soo Han
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Myung Chul Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Myung Chul Lee.

Ethics declarations

Conflict of interest

The author(s) declare that they have no competing interests.

Ethical approval

This study obtained ethical approval from the institutional review board of Seoul National University Hospital.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kim, JK., Lee, D.W., Ro, D.H. et al. Variability between the trial and final implant measurements during the sensor-guided total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 30, 2846–2853 (2022). https://doi.org/10.1007/s00167-021-06795-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-021-06795-2

Keywords

Search

Navigation