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

Roland Becker¹, Markus Malzdorf, Christian Stärke

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

Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA

|February 28, 2012

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Computer-assisted total knee replacement using either the femur-first or tibia-first technique yields comparable joint stability and clinical outcomes. Surgeons can confidently use their preferred method with computer assistance for optimal results.

Area of Science:

Orthopedic Surgery
Biomechanical Engineering
Medical Technology

Background:

Total knee replacement (TKR) involves two main surgical philosophies: measured resection and gap balancing.
The optimal technique for computer-assisted TKR remains under investigation.
This study investigates the hypothesis that gap balancing enhances joint stability due to its reliance on soft tissue balancing.

Purpose of the Study:

To compare the efficacy of the femur-first (group F) versus tibia-first (group T) techniques in computer-assisted total knee replacement.
To evaluate differences in joint stability and clinical outcomes between the two surgical approaches.

Main Methods:

A prospective controlled study involving 116 patients undergoing TKR with the Columbus system and Orthopilot navigation.

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Patients were randomized to either the femur-first (n=63) or tibia-first (n=53) technique.

Clinical outcomes (KSS, KOOS, SF-36) and radiographic assessments (ligament alignment, varus/valgus stress radiographs) were performed at a mean 11.4-month follow-up.

Main Results:

No significant differences were observed in lateral or medial joint space opening between the femur-first and tibia-first groups.
While the femorotibial mechanical axis showed a trend towards varus in the femur-first group, this was not statistically significant (p=0.138).
Both groups demonstrated significant improvements in KSS, KOOS, and SF-36 scores, with no significant differences between the techniques.

Conclusions:

Computer-assisted total knee replacement using either the femur-first or tibia-first technique results in comparable joint stability and clinical outcomes.
Surgeons can utilize their preferred technique when employing computer assistance for TKR.
Further research is needed to determine if these findings apply to conventional (non-computer-assisted) TKR.