Can Intraoperative Sensors Determine the "Target" Ligament Balance? Early Outcomes in Total Knee Arthroplasty.

BACKGROUND: The optimal "target" ligament balance for each patient undergoing total knee arthroplasty (TKA) remains unknown. The study purpose was to determine if patient outcomes are affected by intraoperative ligament balance measured with force-sensing implant trials and if an optimal "target" balance exists. METHODS: A multicenter, retrospective study reviewed consecutive TKAs performed by 3 surgeons. TKA's were performed with standard surgical techniques and ligament releases. After final implants were made, sensor-embedded smart tibial trials were inserted, and compartment forces recorded throughout the range of motion. Clinical outcome measures were obtained preoperatively and at 4 months. Statistical analysis correlated ligament balance with clinical outcomes. RESULTS: One hundred eighty-nine consecutive TKAs were analyzed. Patients were grouped by average medial and lateral compartment force differences. Twenty-nine TKAs (15%) were balanced within 15 lbs and 53 (28%) were "balanced" greater than 75 lbs. Greater improvement in University of California Los Angeles activity level was associated with a mediolateral force difference <60 lbs. (P = .006). Knee Society objective, function, and satisfaction scores, and self-reported health state were unrelated to mediolateral balance in the knee. CONCLUSION: Intraoperative force-sensing has potential in providing real-time objective data to optimize TKA outcomes. These data support some early outcomes may improve by balancing TKAs within 60 lbs difference. Close follow-up is warranted to determine if gait pattern adaptations affect longer term outcomes with greater or less ligament "imbalance."

Tibia pain at end of stem with stemmed revision total knee arthroplasty: treatment with cortical strut graft technique.

End-of-stem pain related to stemmed revision total knee arthroplasty has been described in the literature as being caused by the elastic modulus mismatch from the stem tip and the native bone. This phenomenon has also been described after total hip arthroplasty, which can be successfully treated by placement of a cabled cortical strut graft at the tip of the femoral stem. Currently, the treatment option for this tibial-sided end-of-stem pain is a re-revision total knee arthroplasty in attempts of alleviating the modulus mismatch. This case report is the first to describe a cabled cortical strut graft technique for the tibial end-of-stem pain associated with stemmed revision total knee arthroplasty.