Clin Orthop Surg.  2012 Sep;4(3):188-192. 10.4055/cios.2012.4.3.188.

Development of a Pneumatic Tensioning Device for Gap Measurement during Total Knee Arthroplasty

Affiliations
  • 1Department of Anatomy, Catholic Institute for Applied Anatomy, The Catholic University of Korea School of Medicine, Seoul, Korea.
  • 2Department of Orthopaedic Surgery, The Catholic University of Korea School of Medicine, Seoul, Korea. iy1000@catholic.ac.kr

Abstract

BACKGROUND
Despite the importance of soft tissue balancing during total knee arthroplasty (TKA), all estimating techniques are dependent on a surgeon's manual distraction force or subjective feeling based on experience. We developed a new device for dynamic gap balancing, which can offer constant load to the gap between the femur and tibia, using pneumatic pressure during range of motion.
METHODS
To determine the amount of distraction force for the new device, 3 experienced surgeons' manual distraction force was measured using a conventional spreader. A new device called the consistent load pneumatic tensor was developed on the basis of the biomechanical tests. Reliability testing for the new device was performed using 5 cadaveric knees by the same surgeons. Intraclass correlation coefficients (ICCs) were calculated.
RESULTS
The distraction force applied to the new pneumatic tensioning device was determined to be 150 N. The interobserver reliability was very good for the newly tested spreader device with ICCs between 0.828 and 0.881.
CONCLUSIONS
The new pneumatic tensioning device can enable us to properly evaluate the soft tissue balance throughout the range of motion during TKA with acceptable reproducibility.

Keyword

Total knee arthroplasty; Soft tissue balancing; Gap measurement; Pneumatic tensor

MeSH Terms

Arthroplasty, Replacement, Knee/*instrumentation/methods
Biomechanics
Equipment Design
Femur/surgery
Humans
Knee Joint/physiology/*surgery
Mechanical Processes
Range of Motion, Articular
Reproducibility of Results
Tibia/surgery

Figure

  • Fig. 1 A conventional spreader was set on the Instron universal tester to quantify the usual amount of a surgeon's manual distraction force.

  • Fig. 2 The new pneumatic tensioning device consists of air connectors, air cylinders, and femoral and tibial plates.

  • Fig. 3 Feasibility testing was performed by placing the new tensioning device into the gap space of the knee joint. The pneumatic force was applied through the air tube and cylinder to the plates.


Reference

1. Mihalko WM, Saleh KJ, Krackow KA, Whiteside LA. Soft-tissue balancing during total knee arthroplasty in the varus knee. J Am Acad Orthop Surg. 2009. 17(12):766–774.
Article
2. Peters CL. Soft-tissue balancing in primary total knee arthroplasty. Instr Course Lect. 2006. 55:413–417.
3. Winemaker MJ. Perfect balance in total knee arthroplasty: the elusive compromise. J Arthroplasty. 2002. 17(1):2–10.
Article
4. D'Lima DD, Patil S, Steklov N, Colwell CW Jr. An ABJS best paper: dynamic intraoperative ligament balancing for total knee arthroplasty. Clin Orthop Relat Res. 2007. 463:208–212.
5. Swany MR, Scott RD. Posterior polyethylene wear in posterior cruciate ligament-retaining total knee arthroplasty: a case study. J Arthroplasty. 1993. 8(4):439–446.
Article
6. Pagnano MW, Hanssen AD, Lewallen DG, Stuart MJ. Flexion instability after primary posterior cruciate retaining total knee arthroplasty. Clin Orthop Relat Res. 1998. 356:39–46.
Article
7. Schwab JH, Haidukewych GJ, Hanssen AD, Jacofsky DJ, Pagnano MW. Flexion instability without dislocation after posterior stabilized total knees. Clin Orthop Relat Res. 2005. 440:96–100.
Article
8. Tanzer M, Smith K, Burnett S. Posterior-stabilized versus cruciate-retaining total knee arthroplasty: balancing the gap. J Arthroplasty. 2002. 17(7):813–819.
9. Griffin FM, Insall JN, Scuderi GR. Accuracy of soft tissue balancing in total knee arthroplasty. J Arthroplasty. 2000. 15(8):970–973.
Article
10. In Y, Kim SJ, Kim JM, Woo YK, Choi NY, Kang JW. Agreements between different methods of gap balance estimation in cruciate-retaining total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2009. 17(1):60–64.
Article
11. Lee DH, Park JH, Song DI, Padhy D, Jeong WK, Han SB. Accuracy of soft tissue balancing in TKA: comparison between navigation-assisted gap balancing and conventional measured resection. Knee Surg Sports Traumatol Arthrosc. 2010. 18(3):381–387.
Article
12. Song EK, Seon JK, Park SJ. Flexion-extension gaps balanced using navigation assistance in TKA. Orthopedics. 2009. 32:10 Suppl. 26–30.
Article
13. Portney LG, Watkins MP. Foundations of clinical research: applications to practice. 2000. Upper Saddle River, NJ: Prentice Hall.
14. Asano H, Muneta T, Sekiya I. Soft tissue tension in extension in total knee arthroplasty affects postoperative knee extension and stability. Knee Surg Sports Traumatol Arthrosc. 2008. 16(11):999–1003.
Article
15. Yagishita K, Muneta T, Ikeda H. Step-by-step measurements of soft tissue balancing during total knee arthroplasty for patients with varus knees. J Arthroplasty. 2003. 18(3):313–320.
Article
16. Muratsu H, Matsumoto T, Kubo S, et al. Femoral component placement changes soft tissue balance in posteriorstabilized total knee arthroplasty. Clin Biomech (Bristol, Avon). 2010. 25(9):926–930.
Article
17. Bathis H, Perlick L, Tingart M, Luring C, Perlick C, Grifka J. Flexion gap configuration in total knee arthroplasty following high tibial osteotomy. Int Orthop. 2004. 28(6):366–369.
18. Nowakowski AM, Majewski M, Muller-Gerbl M, Valderrabano V. Development of a force-determining tensor to measure "physiologic knee ligament gaps" without bone resection using a total knee arthroplasty approach. J Orthop Sci. 2011. 16(1):56–63.
Article
19. Swank M, Romanowski JR, Korbee LL, Bignozzi S. Ligament balancing in computer-assisted total knee arthroplasty: improved clinical results with a spring-loaded tensioning device. Proc Inst Mech Eng H. 2007. 221(7):755–761.
Article
20. Viskontas DG, Skrinskas TV, Johnson JA, King GJ, Winemaker MJ, Chess DG. Computer-assisted gap equalization in total knee arthroplasty. J Arthroplasty. 2007. 22(3):334–342.
Article
21. Wasielewski RC, Galat DD, Komistek RD. Correlation of compartment pressure data from an intraoperative sensing device with postoperative fluoroscopic kinematic results in TKA patients. J Biomech. 2005. 38(2):333–339.
Article
22. Marmignon C, Leimnei A, Lavallee S, Cinquin P. Automated hydraulic tensor for total knee arthroplasty. Int J Med Robot. 2005. 1(4):51–57.
Article
Full Text Links
  • CIOS
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr