Evidence map›Paper›PMID 33580346›Full record

ArticleKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2022

Improved total knee arthroplasty pain outcome when joint gap targets are achieved throughout flexion.

Edgar A Wakelin, Sami Shalhoub, Jeffrey M Lawrence, John M Keggi, Jeffrey H DeClaire, Amber L Randall, Corey E Ponder, Jan A Koenig, Stephen Lyman, Christopher Plaskos

Abstract readMulticenter Study
PubMed Publisher
In one paragraph

Article in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
28citing papers in PubMed, 4 pooled it
–field-weighted citation impact
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

28 citing papers in PubMed, 4 syntheses or guidelines pooled it.

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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

10 authors.

Edgar A WakelinCorin Ltd, Raynham, MA, USA. Edgar.wakelin@coringroup.com.ORCID http://orcid.org/0000-0001-5433-5824
Sami ShalhoubCorin Ltd, Raynham, MA, USA.
Jeffrey M LawrenceGundersen Health System, Viroqua, WI, USA.
John M KeggiConnecticut Joint Replacement Institute, Hartford, CT, USA.
Jeffrey H DeClaireDeClaire LaMacchia Orthopaedic Institute, Rochester Hills, MI, USA.
Amber L RandallFlagstaff Bone and Joint, Flagstaff, AZ, USA.
Corey E PonderOklahoma Sports and Orthopedics Institute, Edmond, OK, USA.
Jan A KoenigNYU Langone Long Island Hospital, Mineola, NY, USA.
Stephen LymanHospital for Special Surgery, New York, NY, USA.
Christopher PlaskosCorin Ltd, Raynham, MA, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeAchieving a balanced knee is accepted as an important goal in total knee arthroplasty; however, the definition of ideal balance remains controversial. This study therefore endeavoured to determine: (1) whether medio-lateral gap balance in extension, midflexion, and flexion are associated with improved outcome scores at one-year post-operatively and (2) whether these relationships can be used to identify windows of optimal gap balance throughout flexion.

methods135 patients were enrolled in a multicenter, multi-surgeon, prospective investigation using a robot-assisted surgical platform and posterior cruciate ligament sacrificing gap balancing technique. Joint gaps were measured under a controlled tension of 70-90 N from 10°-90° flexion. Linear correlations between joint gaps and one-year KOOS outcomes were investigated. KOOS Pain and Activities of Daily Living sub-scores were used to define clinically relevant joint gap target thresholds in extension, midflexion, and flexion. Gap thresholds were then combined to investigate the synergistic effects of satisfying multiple targets.

resultsSignificant linear correlations were found throughout extension, midflexion, and flexion. Joint gap thresholds of an equally balanced or tighter medial compartment in extension, medial laxity ± 1 mm compared to the final insert thickness in midflexion, and a medio-lateral imbalance of less than 1.5 mm in flexion generated subgroups that reported significantly improved KOOS pain scores at one year (median ∆ = 8.3, 5.6 and 2.8 points, respectively). Combining any two targets resulted in further improved outcomes, with the greatest improvement observed when all three targets were satisfied (median ∆ = 11.2, p = 0.002).

conclusionGap thresholds identified in this study provide clinically relevant and achievable targets for optimising soft tissue balance in posterior cruciate ligament sacrificing gap balancing total knee arthroplasty. When all three balance windows were achieved, clinically meaningful pain improvement was observed. LEVEL OF EVIDENCE: Level II.

Indexed as

Arthroplasty, Replacement, KneeOsteoarthritis, KneeActivities of Daily LivingHumansKnee JointPainProspective StudiesRange of Motion, ArticularGap balanceLigament balanceOutcomePROMSRobot-assisted TKATotal knee arthroplastyTotal knee replacement

Identifiers

PMID33580346

What OpenQuestion holds

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Registered trials

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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.