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Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

15-08-2022 | KNEE

Joint gap produced by manual stress is dependent on the surgeon’s experience and is smaller in flexion in robotic-assisted total knee arthroplasty

Authors: Kazuki Sohmiya, Hiroyasu Ogawa, Yutaka Nakamura, Masaya Sengoku, Tetsuya Shimokawa, Kazuichiro Ohnishi, Haruhiko Akiyama

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 3/2023

Abstract

Purpose

This study aimed to retrospectively investigate (1) the reproducibility of gap measurements by manual stress using the Z-shaped retractor depending on the surgeon’s experience with this maneuver and (2) the consistency of the gap distraction force produced by manual stress throughout the range of motion (ROM) in the robotic-assisted total knee arthroplasty (TKA). It was hypothesized that the joint gap produced by manual stress is not reproducible depending on the surgeon’s experience, and the distraction force applied by manual stress throughout the ROM is not constant.

Methods

Medial and lateral joint gaps were obtained throughout the ROM by manual stress or a tensioner by two surgeons with different levels of experience in robotic-assisted TKA. The association between the differences in gap measurement by the two surgeons and the preoperative radiographic parameters, including the hip-knee-ankle (HKA) angle and absolute and relative varus/valgus laxities were analyzed.

Results

The experienced surgeon produced significantly greater gaps than the inexperienced surgeon from 0° to 100° flexion, with a mean difference of 0.35 ± 0.12 mm in the medial gap (p < 0.0001), and from 10° to 120° flexion with a mean difference of 0.57 ± 0.13 mm in the lateral gap (p < 0.0001). The tensioner produced a significantly greater medial gap from 70° to 110° flexion with a mean difference of 0.32 ± 0.01 mm in the medial gap (p < 0.0001) and from 0° to 110° flexion with a mean difference of 1.12 ± 0.26 mm in the lateral gap (p < 0.0001). The differences in gap distance by manual stress between experienced and inexperienced surgeons were moderately correlated with the HKA angle in the lateral gap (r = 0.40, p = 0.01). The gap differences due to manual stress and a tensioner showed moderate negative correlation with the HKA angle in the medial gap (r = − 0.50, p = 0.001) and weak negative correlation with the absolute valgus laxity in the lateral gap (r = − 0.35, p = 0.03).

Conclusions

The joint distraction force by manual stress may differ depending on the surgeon’s experience and tended to be smaller in deep flexion; therefore, the flexion gap may be underestimated. Surgeons should determine implant positioning considering gap balance by manual stress, taking into account these characteristics of the manual stress maneuver.

Level of evidence

Level III, retrospective cohort study.

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Title: Joint gap produced by manual stress is dependent on the surgeon’s experience and is smaller in flexion in robotic-assisted total knee arthroplasty
Authors: Kazuki Sohmiya
Hiroyasu Ogawa
Yutaka Nakamura
Masaya Sengoku
Tetsuya Shimokawa
Kazuichiro Ohnishi
Haruhiko Akiyama
Publication date: 15-08-2022
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 3/2023
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-022-07107-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Joint gap produced by manual stress is dependent on the surgeon’s experience and is smaller in flexion in robotic-assisted total knee arthroplasty

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

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