No difference between tibia-first and femur-first techniques in TKA using computer-assisted surgery

Becker, Roland; Malzdorf, Markus; Stärke, Christian; Randolf, Pirtkien; Lohmann, Christoph
October 2012
Knee Surgery, Sports Traumatology, Arthroscopy;Oct2012, Vol. 20 Issue 10, p2007
Academic Journal
Purpose: The measured resection technique and the gap-balancing technique are two philosophies used in total knee surgery. It is still unknown whether one or the other technique provides superior results when computer-assisted surgery is performed. We hypothesized that the gap-balancing technique improves joint stability because the technique relies primarily on the soft tissue. Methods: A prospective controlled study was performed in 116 patients using the tibia-first or femur-first technique. The Columbus total knee system and the Orthopilot (Aesculap AG, Tuttlingen, Germany) navigation system were used in all cases. Sixty-three patients were allocated to the femur-first technique (group F) and 53 patients to the tibial first technique (group T). The mean follow-up time was 11.4 ± 1.1 months. The KSS, KOOS and SF-36 were taken prior to surgery and at the time of follow-up for clinical assessment. Long-leg weight-bearing radiographs were performed to assess ligament alignment. Radiographs in varus and valgus stress were performed using the Telos-Instrument (Telos GmbH, Greisheim, Germany) under a force of 15 N at the time of follow-up for the assessment of medial-lateral stability. The nonparametric t test (Mann-Whitney U-test) was used in order to compare the ligament stability and the scores between group F and group T. Results: The lateral joint space opening for groups F and T was 3.4° ± 1.4° and 3.9° ± 1.7°, respectively (n.s.), and the medial joint space opening for groups F and T was 4° ± 1.4° and 4.1° ± 1.7°, respectively (n.s.). The femorotibial mechanical axis for groups F and T revealed 1.4° ± 1.2° and 0.7° ± 2.0° of varus, respectively ( p = 0.138). The clinical assessment showed significant improvement according to KSS, KOOS and SF-36 in all subscales. Neither of the sores showed significant differences between the two groups. Conclusion: The surgeon should use his/her preferred surgical technique providing the implantation is performed with computer assistance. It remains unclear whether the same findings will occur after conventional surgery. Level of evidence: II.


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