The Influence of Preimplant Balancing on Manipulation under Anesthesia Rates following Imageless Robotic-Assisted Total Knee Arthroplasty

Abstract

Acquired idiopathic stiffness (AIS) following total knee arthroplasty (TKA) often requires manipulation under anesthesia (MUA). Robotic-assisted TKA (RA-TKA) systems provide gap balance templates for objective correlation with the rate of AIS. The purpose of this study was to assess intraoperative balancing parameters that were associated with MUA utilizing an “anatomical” implant design.

We performed a retrospective chart review of 265 imageless RA-TKA procedures performed by R.M. and K.D. between 2018 and 2020. The primary outcome for AIS or clinically significant “arthrofibrosis” was MUA. Patient intraoperative gap planning data were examined for association.

The rate of MUA was 8.7% (23/265), which was performed at a mean follow-up time of 75.9 ± 32.2 days. The lateral to medial gap difference in extension was significantly less in patients requiring MUA (odds ratio [OR] = 0.86, 95% confidence interval [CI], 0.75–0.99) (p = 0.034). Significantly less preoperative varus mechanical axis was associated with knees requiring MUA (1.83° vs. 4.04°, OR = 1.09, 95% CI, 1.00–1.19). Decreased templated mechanical axis correction was associated with MUA (2.09° vs. 4.75°, p < 0.0001).

A tighter lateral-to-medial gap in extension, less preoperative varus, and smaller templated mechanical axis corrections were associated with increased rates of MUA.

Keywords

robotic total knee arthroplasty - gap balancing - acquired idiopathic stiffness - arthrofibrosis - manipulation under anesthesia

Publikationsverlauf

Eingereicht: 18. März 2024

Angenommen: 04. September 2024

Accepted Manuscript online:
05. September 2024

Artikel online veröffentlicht:
01. Oktober 2024

• References

• 1 Inacio MCS, Paxton EW, Graves SE, Namba RS, Nemes S. Projected increase in total knee arthroplasty in the United States—an alternative projection model. Osteoarthritis Cartilage 2017; 25 (11) 1797-1803
• 2 Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KDJ. Patient satisfaction after total knee arthroplasty: who is satisfied and who is not?. Clin Orthop Relat Res 2010; 468 (01) 57-63
• 3 Tibbo ME, Limberg AK, Salib CG. et al. Acquired idiopathic stiffness after total knee arthroplasty: a systematic review and meta-analysis. J Bone Joint Surg Am 2019; 101 (14) 1320-1330
• 4 Kalson NS, Borthwick LA, Mann DA. et al. International consensus on the definition and classification of fibrosis of the knee joint. Bone Joint J 2016; 98-B (11) 1479-1488
• 5 Cheuy VA, Foran JRH, Paxton RJ, Bade MJ, Zeni JA, Stevens-Lapsley JE. Arthrofibrosis associated with total knee arthroplasty. J Arthroplasty 2017; 32 (08) 2604-2611
• 6 Kim J, Nelson CL, Lotke PA. Stiffness after total knee arthroplasty. Prevalence of the complication and outcomes of revision. J Bone Joint Surg Am 2004; 86 (07) 1479-1484
• 7 Owen AR, Tibbo ME, van Wijnen AJ, Pagnano MW, Berry DJ, Abdel MP. Acquired idiopathic stiffness after contemporary total knee arthroplasty: incidence, risk factors, and results over 25 years. J Arthroplasty 2021; 36 (08) 2980-2985
• 8 Cates HE, Schmidt JM. Closed manipulation after total knee arthroplasty: outcome and affecting variables. Orthopedics 2009; 32 (06) 398
• 9 Bawa HS, Wera GD, Kraay MJ, Marcus RE, Goldberg VM. Predictors of range of motion in patients undergoing manipulation after TKA. Clin Orthop Relat Res 2013; 471 (01) 258-263
• 10 Scuderi GR. The stiff total knee arthroplasty: causality and solution. J Arthroplasty 2005; 20 (4, Suppl 2) 23-26
• 11 Su EP, Su SL, Della Valle AG. Stiffness after TKR: how to avoid repeat surgery. Orthopedics 2010; 33 (09) 658
• 12 Rodríguez-Merchán EC. The stiff total knee arthroplasty: causes, treatment modalities and results. EFORT Open Rev 2019; 4 (10) 602-610
• 13 Ross KA, Wiznia DH, Long WJ, Schwarzkopf R. The use of computer navigation and robotic technology in complex total knee arthroplasty. JBJS Rev 2021; 9 (05) e20.00200
• 14 Siddiqi A, Horan T, Molloy RM, Bloomfield MR, Patel PD, Piuzzi NS. A clinical review of robotic navigation in total knee arthroplasty: historical systems to modern design. EFORT Open Rev 2021; 6 (04) 252-269
• 15 Moon YW, Ha CW, Do KH. et al. Comparison of robot-assisted and conventional total knee arthroplasty: a controlled cadaver study using multiparameter quantitative three-dimensional CT assessment of alignment. Comput Aided Surg 2012; 17 (02) 86-95
• 16 Vaidya N, Jaysingani TN, Panjwani T, Patil R, Deshpande A, Kesarkar A. Assessment of accuracy of an imageless hand-held robotic-assisted system in component positioning in total knee replacement: a prospective study. J Robot Surg 2022; 16 (02) 361-367
• 17 Seon JK, Song EK, Park SJ, Lee DS. The use of navigation to obtain rectangular flexion and extension gaps during primary total knee arthroplasty and midterm clinical results. J Arthroplasty 2011; 26 (04) 582-590
• 18 Pang HN, Yeo SJ, Chong HC, Chin PL, Ong J, Lo NN. Computer-assisted gap balancing technique improves outcome in total knee arthroplasty, compared with conventional measured resection technique. Knee Surg Sports Traumatol Arthrosc 2011; 19 (09) 1496-1503
• 19 Han SB, Nha KW, Yoon JR, Lee DH, Chae IJ. The reliability of navigation-guided gap technique in total knee arthroplasty. Orthopedics 2008;31(10, Suppl 1)
• 20 Hampp EL, Sodhi N, Scholl L. et al. Less iatrogenic soft-tissue damage utilizing robotic-assisted total knee arthroplasty when compared with a manual approach: a blinded assessment. Bone Joint Res 2019; 8 (10) 495-501
• 21 Keggi JM, Wakelin EA, Koenig JA. et al. Impact of intra-operative predictive ligament balance on post-operative balance and patient outcome in TKA: a prospective multicenter study. Arch Orthop Trauma Surg 2021; 141 (12) 2165-2174
• 22 Baum KS, Luo TD, Comadoll S, Marois A, Langfitt M, Shields J. Alternative technique for knee manipulation under anesthesia. Arthroplast Today 2017; 4 (04) 452-453
• 23 Zhang J, Ng N, Scott CEH. et al. Robotic arm-assisted versus manual unicompartmental knee arthroplasty: a systematic review and meta-analysis of the MAKO robotic system. Bone Joint J 2022; 104-B [phone]
• 24 Okazaki K, Miura H, Matsuda S. et al. Asymmetry of mediolateral laxity of the normal knee. J Orthop Sci 2006; 11 (03) 264-266
• 25 Liebs TR, Kloos SA, Herzberg W, Rüther W, Hassenpflug J. The significance of an asymmetric extension gap on routine radiographs after total knee replacement: a new sign and its clinical significance. Bone Joint J 2013; 95-B [phone]
• 26 Victor JMK, Bassens D, Bellemans J, Gürsu S, Dhollander AAM, Verdonk PCM. Constitutional varus does not affect joint line orientation in the coronal plane. Clin Orthop Relat Res 2014; 472 (01) 98-104
• 27 Ryan J, Mora JP, Scuderi GR, Tria Jr AJ. Total knee arthroplasty design and kinematics: past, present, and future. J Long Term Eff Med Implants 2021; 31 (03) 1-14
• 28 Takagi K, Inui H, Taketomi S. et al. Both intraoperative medial and lateral soft tissue balances influence intraoperative rotational knee kinematics in bi-cruciate stabilized total knee arthroplasty: a retrospective investigation. BMC Musculoskelet Disord 2021; 22 (01) 830
• 29 Inui H, Taketomi S, Yamagami R. et al. Comparison of intraoperative kinematics and their influence on the clinical outcomes between posterior stabilized total knee arthroplasty and bi-cruciate stabilized total knee arthroplasty. Knee 2020; 27 (04) 1263-1270
• 30 Dennis DA, Komistek RD, Scuderi GR, Zingde S. Factors affecting flexion after total knee arthroplasty. Clin Orthop Relat Res 2007; 464 (464) 53-60
• 31 Goutham GDV, Jain VK, Sinha S, Arya RK. Effect of posterior condylar offset in post operative range of motion in cruciate retaining and sacrificing TKR: a comparative analysis. J Orthop 2020; 20: 342-346 [published correction appears in J Orthop 2020;23:273]
• 32 Issa K, Banerjee S, Kester MA, Khanuja HS, Delanois RE, Mont MA. The effect of timing of manipulation under anesthesia to improve range of motion and functional outcomes following total knee arthroplasty. J Bone Joint Surg Am 2014; 96 (16) 1349-1357
• 33 Issa K, Rifai A, Boylan MR, Pourtaheri S, McInerney VK, Mont MA. Do various factors affect the frequency of manipulation under anesthesia after primary total knee arthroplasty?. Clin Orthop Relat Res 2015; 473 (01) 143-147