Sensor guided unicompartmental to total knee arthroplasty revision: Surgical technique

  • Pier Francesco Indelli | pindelli@stanford.edu European Knee Associates (EKA), Luxembourg; Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA; Palo Alto Veterans Affairs Health Care System (PAVAHCS), Palo Alto, CA, United States. https://orcid.org/0000-0002-4752-8027
  • Salvatore Risitano European Knee Associates (EKA), Luxembourg.
  • Gennaro Pipino European Knee Associates (EKA), Italy.
  • Stefano Ghirardelli European Knee Associates (EKA), Luxembourg; Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA; Palo Alto Veterans Affairs Health Care System (PAVAHCS), Palo Alto, CA, United States.
  • Bruno Violante European Knee Associates (EKA), Italy.

Abstract

Unicompartmental Knee Arthroplasty (UKA) is an effective surgical option for managing unicompartmental knee osteoarthritis; it represents 10% of all knee arthroplasties worldwide, increasing 32.5% annually in the United States alone. Despite evolution in surgical technique and implant design, success rate and long-term survivorship of UKA have been historically lower than Total Knee Arthroplasty (TKA). The most common causes of UKA failure leading to revision are polyethylene wear, progression of arthritis, aseptic loosening and patella-femoral symptoms due to poor patient selection in many cases. Historically, UKA revisions have presented technical challenges mainly related to managing residual bone defects and ligament insufficiency ultimately leading to knee instability: the fear of instability has often pushed surgeons to lower the threshold for an increase of the intra-articular level of constraint. Unfortunately, the use of more constrained implants requires sacrificing bone stock and has been related to higher rates of re-revision secondary to recurrence of aseptic loosening. Because of these challenges, the authors developed a surgical technique that could combine balancing the knee during revision surgery with the use of the less constrained polyethylene option. To achieve this, we started evaluating a novel device (VERASENSE, Orthosensor, FL) designed to support soft tissue balancing during primary TKA. This intraoperative sensing technology dynamically quantifies intra-articular loads during TKA trial with the goal of correcting any residual imbalance in real time. Herein we propose a novel surgical technique, which might allow use of a primary TKA design characterized by a lower level of constraint, instead of a constrained or hinged revision knee system, during UKA revision. A key aspect of this technique is the use of sensing technology during intraoperative stability testing.

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Published
2021-01-27
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Section
Reviews
Keywords:
TKA; sensor; revision; total knee arthroplasty, instability
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How to Cite
Indelli, P. F., Risitano, S., Pipino, G., Ghirardelli, S., & Violante, B. (2021). Sensor guided unicompartmental to total knee arthroplasty revision: Surgical technique. Orthopedic Reviews, 12(4). https://doi.org/10.4081/or.2020.8806