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

摘要

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 TM 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.