Evidence map›Paper›PMID 31516978›Full record

ArticleArthroplasty today2019

Imageless, robotic-assisted total knee arthroplasty combined with a robotic tensioning system can help predict and achieve accurate postoperative ligament balance.

Sami Shalhoub, Jeffrey M Lawrence, John M Keggi, Amber L Randall, Jeffrey H DeClaire, Christopher Plaskos

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Arthroplasty today, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 35 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
35citing papers in PubMed, 3 pooled it
7.1field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

35 citing papers in PubMed, 3 syntheses or guidelines pooled it, 70 citations in OpenAlex.

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  19. Intra-operative laxity and balance impact 2-year pain outcomes in TKA: a prospective cohort study.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2023
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 4 institutions in 1 country.

Sami ShalhoubCorin Ltd., Department of Technology and Clinical Research, Raynham, MA, USA.
Jeffrey M LawrenceGundersen Health System, Viroqua, WI, USA.
John M KeggiConnecticut Joint Replacement Institute, Hartford, CT, USA.
Amber L RandallFlagstaff Bone and Joint, Flagstaff, AZ, USA.
Jeffrey H DeClaireDeClaire LaMacchia Orthopaedic Institute, Rochester Hills, MI, USA.
Christopher PlaskosCorin Ltd., Department of Technology and Clinical Research, Raynham, MA, USA.
DeClaire LaMacchia Orthopaedic Institute · USFlagstaff Medical Center · USGundersen Health System · USJoint Replacement Institute · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAchieving balanced gaps is a key surgical goal in total knee arthroplasty, yet most methods rely on subjective surgeon feel and experience to assess and achieve knee balance intraoperatively. Our objective was to evaluate the ability to quantitatively plan and achieve a balanced knee throughout the range of motion using robotic-assisted instrumentation in a tibia-first, gap-balancing technique.

methodsA robotic-assisted, gap-balancing technique was used in 121 consecutive knees. After resection of the proximal tibia, a computer-controlled tensioning device was inserted into the knee joint and the pre-femoral-resection knee gaps were acquired dynamically throughout flexion under controlled load. Predicted gap profiles were used to plan the femoral implant by adjusting the implant alignment and position within certain boundaries to achieve a balanced knee throughout the range of flexion. Femoral cuts were then made according to this plan using a miniature robotic-assisted cutting guide. The tensioning device used to measure the pre-femoral-resection gaps was then reinserted into the joint to quantify the final gap balance under known tension. The final gap profiles were then compared with the predictive gap plans.

resultsThe overall root mean square error between the predicted and achieved gaps was 1.3 mm and 1.5 mm for the medial and lateral sides, respectively. Use of robotic assistance resulted in over 90% of knees having mediolateral balance within 2 mm across the flexion range. Gaps at 0° flexion were 2 mm smaller than the gaps at 90°. This difference decreased to less than 1 mm when comparing the tibiofemoral gaps at 10°, 45°, and 90°.

conclusionsImageless, robotic-assisted total knee arthroplasty accurately predicts postoperative gaps before femoral resections. This allows surgeons to virtually plan femoral implant alignment and optimize gap balance throughout the range of motion. The accurate prediction of gaps throughout the arc of motion combined with precise, robotically assisted femoral resection produces accurate postoperative ligament balance consistently.

Indexed as

GapsKinematicsPredictionRobotic-assistedSoft-tissue balanceTotal knee arthroplasty

Identifiers

PMID31516978
PMCPMC6728592
OpenAlexW2967724989

What OpenQuestion holds

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LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.