Accuracy of Manual Surgeon-Defined Assessment of Soft Tissue Balance in TKA In Comparison to Sensor-Guided Measures and its Effect on Final Balance
Accuracy of Manual Surgeon-Defined Assessment of Soft Tissue Balance in TKA In Comparison to Sensor-Guided Measures and its Effect on Final Balance
复制标题
与传感器引导测量相比，外科医生在 TKA 中手动定义的软组织平衡评估的准确性及其对最终平衡的影响
DOI：
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发表时间：
2017
影响因子：
2.6
通讯作者：
Monther A. Gharaibeh
中科院分区：
文献类型：
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作者：
S. MacDessi;Monther A. Gharaibeh
目的：目前的文献支持全膝关节置换术（TKA）中最终对齐和软组织平衡对假体存活和临床结果的重要性。目前的软组织平衡技术大多依赖于主观的静态测量，不允许定量确定韧带张力。传感器引导技术（Verasense, Orthosensor）允许以动态方式展示负载的大小和位置，提供有关膝关节平衡的定量数据。本研究的目的是测试与Verasense相比，外科医生人工评估判断膝关节平衡的准确性。我们还旨在确定Verasense是否可以帮助软组织从不平衡状态达到平衡。方法：58例患者入组前瞻性队列研究。记录了SDA和Verasense在10度、45度和90度处的一致程度。记录和比较释放或重新切割后的初始试验压力和最终压力。然后记录最终的压力测量，以评估是否达到了适当的膝关节平衡（在2个或更多的角度位置上的隔室差压为15磅/英寸）。结果：该队列的平均年龄为67.5岁，畸形范围从-16度内翻到+20度（平均-1.26度内翻）。外科医生手动识别不平衡膝关节的能力较低，测试灵敏度为33.3%。手工检测确定平衡膝关节的特异性更好，特异性为77.3%。人工检测阳性预测值为59.2%，阴性预测值为54%。46.5%（58例中的27例）的病例中，Verasense导致不同于最初由人工评估确定的手术计划。23例均行韧带松解或胫骨重切。在其余4例中，Verasense阻止了韧带的松解。95%的套管在15磅/英寸压力范围内达到平衡状态，100%的套管在25磅/英寸压力范围内达到平衡状态。结论：手工手术评估软组织平衡是不平衡膝关节的不良预测指标。Verasense有能力随后在一个可接受的压力范围内平衡膝盖，如先前的研究所定义的。进一步分析确定对患者预后和种植体存活的影响是必要的。
Objectives: Present literature supports the importance of final alignment and soft tissue balance in total knee arthroplasty (TKA) on implant survivorship and clinical outcomes. Current soft tissue balance techniques mostly depend on subjective static measures that don’t allow for quantitative determination of ligament tension. Sensor guided technique (Verasense, Orthosensor) allows demonstration of the magnitude and location of load in a dynamic way providing quantitative data about knee balance. The aim of this study is to test the accuracy of the surgeon’s manual assessment in judging knee balance in comparison to Verasense. We also aimed to determine whether Verasense can assist in achieving soft tissue balance from the unbalanced state. Methods: 58 patients were enrolled in this prospective cohort study. The level of agreement between SDA and Verasense at 10, 45, 90 degrees was recorded. Initial trial pressures and final pressures after release or re-cut were recorded and compared. Final pressure measurements were then documented to assess whether appropriate knee balance (differential compartmental pressure of 15 lb/inch on 2 or more angular positions) had been achieved. Results: The mean age of the cohort was 67.5 years with deformities ranging from -16 degrees of varus to +20 degrees of valgus (mean -1.26 degrees varus). The capacity for the surgeon to manually identify an unbalanced knee was low with a test sensitivity of 33.3%. Manual test specificity to define a balanced knee was better with a specificity of 77.3%. The manual test had a positive predicitive value of 59.2% and a negative predictive value of 54%. There were 46.5% (27 of 58) of cases where the Verasense lead to a different surgical plan to that initially determined by the manual assessment. In 23 cases, either ligament release or tibial bone recut was performed. In the remaining 4 cases, the Verasense prevented a ligament release being performed. 95% of cases achieved a balanced state within 15lb/inch of pressure between compartments, with 100% balanced within 25 lb/inch. Conclusion: Manual surgeon assessment of soft tissue balance is a poor predictor of unbalanced knees. Verasense has the capacity to subsequently balance the knee within an acceptable pressure range as defined by prior studies. Further analysis to determine the impact on patient outcomes and implant survivorship is warranted.