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Computer-assisted ligament balancing of the femoral tibial joint using pressure sensors

Navigation and MIS in Orthopaedic Surgery, Page: 175-181
2007
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Book Chapter Description

Many variables contribute to successful total knee arthroplasty (TKA) including patient factors, implant design, and surgical technique. Patient factors, such as bone quality, weight, compliance, and activity level, are difficult to mitigate. Implant design factors that optimize implant longevity (such as large contact areas and high conformity) have been defined and implemented. But surgical technique has been more difficult to quantitatively evaluate because it is more subjective and surgeon dependent. Consequently, advances in surgical technique that lead to improved implant longevity have been difficult to define. Soft-tissue balancing requires correct limb alignment and simultaneous release of contracted ligaments around the knee. When balance is optimized, medial and lateral compartment pressures should be approximately equal. However, an easy and accurate method of measuring these pressures has been difficult to develop. To address this issue, an intra-operative, computer-instrumented tibial insert trial that measures knee compartment pressures through a passive range of motion was developed [1]. Results from this sensor help quantify ligament balancing. It is then possible to compare compartment balance with what the surgeon feels and with postoperative kinematic function. Real-time evaluation of ligament balancing via measurement of compartment pressures may allow surgeons to better optimize implant function and longevity. It may also lead to a better understanding of polyethylene bearing wear on TKA retrievals [2, 3]. © 2007 Springer Medizin Verlag Heidelberg.

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