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

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

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 ColumbusTM 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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Acknowledgments

We thank Viktor Breul and Aesculap AG for programming and statistical analysis.

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Authors and Affiliations

  1. Department of Orthopaedic and Trauma Surgery, City Hospital Brandenburg, Hochstrasse 26, 14770, Brandenburg an der Havel, Germany

    Roland Becker

  2. Praxisclinic, Werdau, Germany

    Markus Malzdorf

  3. Department of Orthopaedic and Trauma Surgery, Hospital Erlabrunn, Breitenbrunn, Germany

    Markus Malzdorf & Pirtkien Randolf

  4. Department of Orthopaedics, Otto-von-Guericke University of Magdeburg, Magdeburg, Germany

    Roland Becker, Christian Stärke & Christoph Lohmann

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  1. Roland Becker
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  2. Markus Malzdorf
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Correspondence to Roland Becker.

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Becker, R., Malzdorf, M., Stärke, C. et al. No difference between tibia-first and femur-first techniques in TKA using computer-assisted surgery. Knee Surg Sports Traumatol Arthrosc 20, 2011–2016 (2012). https://doi.org/10.1007/s00167-012-1928-3

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  • DOI: https://doi.org/10.1007/s00167-012-1928-3

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