Publications by authors named "Edgar Wakelin"

Background: This study investigates the association between intra-operative balance and 2-year outcomes within subgroups defined by demographics and pre-operative joint balance. Our hypothesis is that patient demographics and the pre-operative state of the joint will impact patient sensitivity to post-operative balance and laxity and subsequent impact on outcome.

Methods: A retrospective analysis of prospectively captured data across 5 sites with 5 surgeons was performed.

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The objective of this study was to determine relationships between intraoperative posterior cruciate ligament (PCL) sacrificing posterior stabilized (PS) total knee arthroplasty (TKA) laxity measurements throughout flexion and patient outcomes at 2 years post-TKA and to define clinically relevant laxity thresholds to optimize patient outcomes.In a single-surgeon study, PCL sacrificing TKA using a robotics-assisted platform with a digital joint tensioning device was performed in 115 knees in 115 patients. Final intraoperative joint laxity was recorded, and 2-year Knee Injury and Osteoarthritis Outcome Scores (KOOSs) were obtained.

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Purpose: The purpose of this study is to evaluate the in vivo medial and lateral joint laxities across various total knee arthroplasty (TKA) alignment categories correlated to (1) hip-knee-ankle angle, (2) proximal tibial angle and (3) distal femoral angle in a consecutive group of patients undergoing robotic-assisted TKA.

Methods: Using ligament tensions acquired during 805 robotic-assisted TKA with a dynamic ligament tensor under a load of 70-90 N, the relationship between medial and lateral collateral ligament laxity and overall limb alignment was established. Only knees with neutral or mechanical varus alignment were included and divided into five groups: neutral (0°-3°), varus 3°-5°, varus 6°-9°, varus 10°-13° and varus ≥14°.

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Purpose: The purpose of this study was to investigate the influence of increasing the tibial boundaries in functional alignment on femoral component orientation in total knee arthroplasty (TKA).

Methods: A retrospective review of a database of robotic-assisted TKAs using a digital joint tensioning device was performed (BalanceBot®; Corin). A total of 692 TKAs with correctable deformity were included.

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Aims: Excessive posterior pelvic tilt (PT) may increase the risk of anterior instability after total hip arthroplasty (THA). The aim of this study was to investigate the changes in PT occurring from the preoperative supine to postoperative standing position following THA, and identify factors associated with significant changes in PT.

Methods: Supine PT was measured on preoperative CT scans and standing PT was measured on preoperative and one-year postoperative standing lateral radiographs in 933 patients who underwent primary THA.

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Background: Passive smartphone-based apps are becoming more common for measuring patient progress after total hip arthroplasty (THA). Optimum activity levels during early THA recovery have not been well documented.

Objectives: Correlations between step-count and patient reported outcome measures (PROMs) during early recovery were explored.

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Background: Early complications in total knee arthroplasty (TKA) associated with modern robotics platforms integrated with digital balancing technology have not been investigated.

Objective: The objective was to compare 90-day complication rates between a manual technique and a modern robotic-assisted ligament balancing TKA platform.

Methods: 895 primary TKA procedures from a single surgeon were retrospectively reviewed (614 manual TKA, 281 using a modern robotics platform with an integrated digitally controlled ligament balancing device).

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Purpose: The objective of this study was to determine if intra-operatively measured joint gaps are associated with 2-year pain outcomes in total knee arthroplasty (TKA) and whether balance and laxity windows could be defined throughout flexion to optimize 2-year pain outcomes. Our hypothesis is that intra-operative joint gaps are associated with 2 year post-operative pain outcome.

Methods: A prospective study investigating 310 robotically assisted TKAs was performed.

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Background: Kinematic alignment (KA) and related personalized alignment strategies in total knee arthroplasty (TKA) target restoration of native joint line obliquity and alignment. In practice, deviations from exact restoration of the prearthritic joint surface are tolerated for either the femur or tibia to achieve ligamentous balance. It remains unknown what laxity, balance, and alignment would result if a pure resurfacing of both femur and tibia were performed in a KA TKA technique.

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Article Synopsis
  • Instability after total knee arthroplasty (TKA) can lead to early failure, and the study aimed to evaluate the benefits of achieving a balanced knee joint during the procedure.
  • A Markov model assessed the cost-effectiveness of balanced knees by measuring reductions in revisions and improvements in quality-adjusted life years (QALY) over the first 5 years post-surgery, with a threshold set at $50,000 per QALY.
  • Results showed that a balanced knee provided significant value, especially in terms of QALY improvements, highlighting its clinical importance and assisting in evaluating technologies designed for better joint balancing.
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Background: Both restricted inverse kinematic alignment (iKA) and gap balancing aim for a balanced total knee arthroplasty by adjusting femoral component position based on ligamentous gaps. However, iKA targets a native tibial joint line vs resecting perpendicular to the mechanical axis. This study compares how these 2 techniques impact the balance and laxity throughout flexion and joint line obliquity (JLO), arithmetic hip-knee-ankle angle (aHKA), and the coronal plane alignment of the knee (CPAK).

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Purpose: To describe the mediolateral (ML) gap balance in pre-resection arthritic knees undergoing robot-assisted (RA) total knee arthroplasty (TKA) within the nine phenotypes of the Coronal Plane Alignment of the Knee (CPAK) classification.

Methods: A total of 1124 RA TKA cases were retrospectively reviewed. ML balance was calculated using a digital ligament tensioning device following tibial resection and prior to any femoral resection throughout flexion (10°, 40°, and 90°).

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Background: Recent developments in intra-operative sensor technology provide surgeons with predictive and real-time feedback on joint balance. It remains unknown, however, whether these technologies are better suited to femur-first or tibia-first workflows. This study investigates the balance accuracy, precision and early patient outcomes between the femur-first and tibial-first workflows using a digital gap-balancing tool.

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Article Synopsis
  • - The study analyzed the balance and joint laxity in total knee arthroplasty between two methods: measured resection (MR) and gap-balancing (GB), focusing on how often soft-tissue adjustments were needed to achieve mediolateral (ML) balance.
  • - A total of 95 surgeries were performed, comparing pre-planned GB (pGB) and final GB (fGB) results against planned MR (pMR), with findings showing that MR resulted in significantly tighter joints and higher rates of ML imbalance compared to pGB.
  • - While GB improved ML balance through the range of motion, it also increased variability in femoral positioning and required more bone resection than MR, indicating that while fGB may not show
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Background: The objective of this study was to investigate the impact of alignment and soft tissue release on patient outcomes following total knee arthroplasty (TKA).

Methods: In a multicenter study, soft tissue releases during TKA were prospectively documented in 330 robotic-assisted TKAs. Knee Injury and Osteoarthritis Outcome Scores (KOOS) were captured postoperatively.

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Article Synopsis
  • The study simulated a technique called calipered kinematic alignment total knee arthroplasty (cKATKA) using data from 607 robotic-assisted surgeries, focusing on how to adjust the femur and tibial resections to achieve balanced knee alignment.
  • Results showed that the amount of preoperative varus deformity affected the necessary tibial cuts for achieving balanced extension gaps, with higher deformities needing more adjustments.
  • Despite 95% of simulated knees achieving alignment within 0° ± 5°, nearly 50% showed flexion gaps that were looser on one side, indicating potential issues in achieving an optimal balance in flexion.
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Purpose: The purpose of this study was to compare ligament balance and laxity profiles achieved throughout flexion in restricted kinematic alignment (rKA) and gap balancing (GB). rKA and GB both aim to improve soft tissue balance and reduce ligament releases in total knee arthroplasty (TKA).

Methods: One surgeon performed 68 rKA, another performed 73 GB TKAs using the same CR implant and robotic system.

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Introduction: The impact of fulfillment of patient expectations throughout recovery on satisfaction in total knee arthroplasty (TKA) is not well understood. Utilizing a standardized TKA method with a robotically assisted (RA) platform, we investigated the impact of expectation fulfillment at 3-month (M) and 6-M on 1-year (Y) and 2-Y satisfaction. We hypothesize that early fulfillment of patient expectations is associated with improved midterm patient satisfaction.

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Introduction: New technologies exist which may assist surgeons to better predict final intra-operative joint balance. Our objectives were to compare the impact of (1) a predictive digital joint tensioning tool on intra-operative joint balance; and (2) joint balance and flexion joint laxity on patient-reported outcomes.

Materials And Methods: Two-hundred Eighty patients received posterior cruciate ligament sacrificing TKA with ultra-congruent tibial inserts using a robotic-assisted navigation platform.

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Aims: Neither a surgeon's intraoperative impression nor the parameters of computer navigation have been shown to be predictive of the outcomes following total knee arthroplasty (TKA). The aim of this study was to determine whether a surgeon, with robotic assistance, can predict the outcome as assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS) for pain (KPS), one year postoperatively, and establish what factors correlate with poor KOOS scores in a well-aligned and balanced TKA.

Methods: A total of 134 consecutive patients who underwent TKA using a dynamic ligament tensioning robotic system with a tibia first resection technique and a cruciate sacrificing ultracongruent TKA system were enrolled into a prospective study.

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Purpose: Achieving a balanced knee is accepted as an important goal in total knee arthroplasty; however, the definition of ideal balance remains controversial. This study therefore endeavoured to determine: (1) whether medio-lateral gap balance in extension, midflexion, and flexion are associated with improved outcome scores at one-year post-operatively and (2) whether these relationships can be used to identify windows of optimal gap balance throughout flexion.

Methods: 135 patients were enrolled in a multicenter, multi-surgeon, prospective investigation using a robot-assisted surgical platform and posterior cruciate ligament sacrificing gap balancing technique.

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Article Synopsis
  • The study focuses on creating and validating a predictive tool to help identify patients who may not benefit from total knee arthroplasty (TKA), addressing limitations in existing models.
  • The tool was developed using data from the Osteoarthritis Initiative and showed a significant shift in clinical outcomes during consultations, successfully identifying at-risk patients who are less likely to improve after surgery.
  • Key findings indicate that the tool can differentiate between patients who are more or less likely to improve, potentially guiding individualized treatment pathways and optimizing surgical candidates.
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Article Synopsis
  • Computer navigation, specifically using a robotic system, enhances the accuracy of total knee arthroplasty (TKA) by improving implant placement compared to traditional methods.
  • In a study involving 173 knees, measurements of alignment (like femoral and tibial angles) were taken and compared between navigated cuts and post-operative CT scans to assess accuracy.
  • Results indicated that the robotic navigation system achieved high accuracy for femoral and tibial coronal alignment, with slightly less precision for femoral sagittal alignment and hip-knee-ankle angles.
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Slow appositional growth of bone is a major problem associated with polyether ether ketone (PEEK) based orthopaedic implants. Early stage promotion of osteoblast activity, particularly bone nodule formation, would help to improve contact between PEEK implantable materials and the surrounding bone tissue. To improve interactions with bone cells, we explored here the use of plasma immersion ion implantation (PIII) treatment of PEEK to covalently immobilize biomolecules to the surface.

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