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J Knee Surg 2025; 38(02): 053-061
DOI: 10.1055/a-2410-2668
Original Article

The Influence of Preimplant Balancing on Manipulation under Anesthesia Rates following Imageless Robotic-Assisted Total Knee Arthroplasty

Justin T. Butler 
1   The CORE Institute, Hip and Knee Reconstruction, Phoenix, Arizona
,
Samuel D. Stegelmann
2   Department of Orthopaedic Surgery, Medical City Denton, Denton, Texas
,
Trent Davis
3   Heritage College of Osteopathic Medicine, Ohio University, Athens, Ohio
,
Amy Singleton
4   Department of Orthopaedics, Mercy Health—St. Vincent Medical Center, Toledo, Ohio
,
Hunter Ostlie
4   Department of Orthopaedics, Mercy Health—St. Vincent Medical Center, Toledo, Ohio
,
Richard Miller
4   Department of Orthopaedics, Mercy Health—St. Vincent Medical Center, Toledo, Ohio
,
Kirk Davis
5   Fulton County Health Center, FCHC Orthopedics, Wauseon, Ohio
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Abstract

Acquired idiopathic stiffness (AIS) following total knee arthroplasty (TKA) often requires manipulation under anesthesia (MUA). Robotic-assisted TKA (RA-TKA) systems provide gap balance templates for objective correlation with the rate of AIS. The purpose of this study was to assess intraoperative balancing parameters that were associated with MUA utilizing an “anatomical” implant design.

We performed a retrospective chart review of 265 imageless RA-TKA procedures performed by R.M. and K.D. between 2018 and 2020. The primary outcome for AIS or clinically significant “arthrofibrosis” was MUA. Patient intraoperative gap planning data were examined for association.

The rate of MUA was 8.7% (23/265), which was performed at a mean follow-up time of 75.9 ± 32.2 days. The lateral to medial gap difference in extension was significantly less in patients requiring MUA (odds ratio [OR] = 0.86, 95% confidence interval [CI], 0.75–0.99) (p = 0.034). Significantly less preoperative varus mechanical axis was associated with knees requiring MUA (1.83° vs. 4.04°, OR = 1.09, 95% CI, 1.00–1.19). Decreased templated mechanical axis correction was associated with MUA (2.09° vs. 4.75°, p < 0.0001).

A tighter lateral-to-medial gap in extension, less preoperative varus, and smaller templated mechanical axis corrections were associated with increased rates of MUA.

Keywords

robotic total knee arthroplasty - gap balancing - acquired idiopathic stiffness - arthrofibrosis - manipulation under anesthesia


Publication History

Received: 18 March 2024

Accepted: 04 September 2024

Accepted Manuscript online:
05 September 2024

Article published online:
01 October 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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