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Tibial forces are more useful than varus-valgus laxities for identifying and correcting overstuffing in kinematically aligned total knee arthroplasty.

Authors
  • Roth, Joshua D1, 2, 3
  • Howell, Stephen M4
  • Hull, Maury L4, 5, 6
  • 1 Biomedical Engineering Graduate Group, University of California, Davis, California.
  • 2 Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin.
  • 3 Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, Wisconsin.
  • 4 Department of Biomedical Engineering, University of California, Davis, California.
  • 5 Department of Mechanical Engineering, University of California, Davis, California.
  • 6 Department of Orthopaedic Surgery, University of California, Davis, California.
Type
Published Article
Journal
Journal of Orthopaedic Research®
Publisher
Wiley (John Wiley & Sons)
Publication Date
Jun 01, 2021
Volume
39
Issue
6
Pages
1271–1280
Identifiers
DOI: 10.1002/jor.24779
PMID: 32543736
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Identifying and correcting varus-valgus (V-V) malalignment of the tibial component is important when balancing a kinematically aligned total knee arthroplasty (TKA). Accordingly, the primary objective was to determine whether the tibial forces or V-V laxities are more sensitive to, and thus more useful for identifying and correcting, V-V malalignments of the tibial component that overstuff a compartment. Calipered kinematically aligned TKA was performed on nine human cadaveric knees. Medial and lateral tibial forces and V-V laxities were measured from 0° to 120° flexion with an unmodified reference tibial component and modified tibial components that introduced ±1° and ±2° V-V malalignments from the reference component to overstuff either the medial or lateral compartment. Changes in the tibial forces were most sensitive to V-V malalignments at 0° flexion (medial = 118 ± 34 N/deg valgus malalignment and lateral = 79 ± 20 N/deg varus malalignment). The varus and valgus laxities were most sensitive to V-V malalignments at 30° flexion (-0.6 ± 0.1 deg/deg varus malalignment) and 120° flexion (-0.4 ± 0.2 deg/deg valgus malalignment), respectively. The maximum average signal-to-noise ratios of the sensitivities in tibial forces and V-V laxities (ie, signals) to reported measurement errors using current intraoperative technologies (14 N and 0.7°) (ie, noise) were 8.4 deg-1 and 0.9 deg-1 , respectively. Because of the greater signal-to-noise ratios, measuring tibial forces is more useful than measuring V-V laxities for identifying and correcting V-V malalignments of the tibial component that overstuff a compartment. Clinical Significance: The sensitivities of tibial forces provide objective guidance to surgeons performing V-V recuts of the tibia. © 2020 Orthopaedic Research Society. Published by Wiley Periodicals LLC.

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