Algorithmic pie-crusting of the medial collateral ligament guided by sensing technology affects the use of constrained inserts during total knee arthroplasty. Academic Article uri icon

Overview

abstract

  • BACKGROUND: Intra-operative sensing technology is an alternative to standard techniques in total knee arthroplasty (TKA) for determining balance by providing quantitative analysis of loads and point of contact throughout a range of motion. We used intra-operative sensing (VERASENSE-OrthoSensor, Inc.) to examine pie-crusting release of the medial collateral ligament in knees with varus deformity (study group) in comparison to a control group where balance was obtained using a classic release technique and assessed using laminar spreaders, spacer blocks, manual stress, and a ruler. METHODS: The surgery was performed by a single surgeon utilizing measured resection and posterior-stabilized, cemented implants. Seventy-five study TKAs were matched 1:3 with 225 control TKAs. Outcome variables included the use of a constrained insert, functional- and knee-specific Knee Society score (KSS) at six weeks, four months, and one year post-operatively. Outcomes were analyzed in a multivariate model controlling for age, sex, BMI, and severity of deformity. RESULTS: The use of a constrained insert was significantly lower in the study group (5.3 vs. 13.8%; p = 0.049). The use of increased constraint was not significant between groups with increasing deformity. There was no difference in functional KSS and knee-specific KSS between groups at any follow-up interval. CONCLUSION: An algorithmic pie-crusting technique guided by intra-operative sensing is associated with decreased use of constrained inserts in TKA patients with a pre-operative varus deformity. This may cause a positive shift in value and cost savings.

publication date

  • February 10, 2017

Research

keywords

  • Arthroplasty, Replacement, Knee
  • Genu Varum
  • Knee Prosthesis
  • Medial Collateral Ligament, Knee
  • Osteoarthritis, Knee

Identity

Scopus Document Identifier

  • 85012164801

Digital Object Identifier (DOI)

  • 10.1007/s00264-017-3413-6

PubMed ID

  • 28188394

Additional Document Info

volume

  • 41

issue

  • 6