Function, Pain, and Alignment Following Knee Replacement for the Treatment of Osteoarthritis
Knee Replacement, Total, Pain, Postoperative, Functional Independence
About this trial
This is an interventional treatment trial for Knee Replacement, Total
Eligibility Criteria
Inclusion Criteria:
- undergoing unilateral TKR for the treatment of osteoarthritis
- between the age of 18 and 85 years of age
- able to read, speak and understand English, have a telephone
- are able to provide consent
Exclusion Criteria:
- enrolled in another study, are
- undergoing revision surgery or bilateral surgery, and are
- over the age of 85 years. Patients will also be excluded if they
- have a cognitive impairment (as indicated in the medical record) affecting their ability to comprehend the questions being asked
Sites / Locations
- North York General HospitalRecruiting
Arms of the Study
Arm 1
Arm 2
Arm 3
Active Comparator
Experimental
Experimental
Manual Adjusted Mechanical Alignment
Robotic Assisted Adjusted Mechanical Alignment
Robotic Assisted Kinematic Alignment: (Joint line restoration)
Usual care: Midline incision, no tourniquet, medial Parapatellar arthrotomy, resect anterior osteophytes Distal femoral cut with 3-5 degrees of valgus from the anatomical axis (Based on the angle measurement on the 4 foot standing Xray). Correct for flexion contracture. Measure the femoral size with the anterior referencing guides. Use 3 degrees external rotation to the Posterior condylar axis Perform anterior, posterior and chamfer cuts with the 4 in 1 in appropriate external rotation Extramedullary tibial alignment guide with 3-5 degrees posterior slope, and orthogonal cut to the tibial axis. Resect posterior osteophytes Place trial components and perform appropriate release/balance the gaps Patellar replacement based on surgeon's discretion Cementing the components with tourniquet inflation
Midline incision, no tourniquet, medial Parapatellar arthrotomy, resect anterior osteophytes Place the femoral pins in the proximal incision and the tibial pins 4 finger breadths under the joint line Map the knee and perform evaluation Assess gaps, adjust the femoral axis to decrease soft tissue release (+/- 2 degrees), correct for flexion contracture Verify and perform distal femoral cut, proximal tibial cut orthogonal (90 Degrees) to the tibial axis Assess and balance extension gap with appropriate releases Remap the posterior condylar axis, assess the flexion space, 3 degrees external rotation to the posterior condylar axis Perform anterior, posterior and chamber cuts with the 4 in 1 (appropriate external rotation), followed by posterior osteophyte resection Place trial components and balance the knee, soft tissue releases (1-2 mm) Patellar replacement based on surgeon's discretion Cementing the components with tourniquet inflation
-- Midline incision, no tourniquet, medial parapatellar arthrotomy, resect anterior osteophytes Place femoral pins in proximal incision, tibial pins 4 finger breadths under joint line Map and evaluate the knee, ROM, varus valgus testing at 0 & 90 degrees flexion Distal femoral cut based on cartilage loss on medial and lateral femoral condyle (9mm total cut/condyle). Perform distal femoral cut, maintain the joint line (femoral axis +/- 5 degrees) Perform proximal tibial cut within +/- 3 degrees, balance the gaps, differential between medial and lateral gaps = 1- 3mm. Assess extension space, resect posterior osteophytes Remap posterior condylar axis, place 4 in 1 at 0 degrees to the post condylar axis (aim = 9mm posterior condylar cuts) Resect posterior osteophytes, place trial components. Adjust cuts to achieve a balanced knee, maintain HKA axis +/- 3 degrees Patellar replacement per surgeon discretion Cement the components with tourniquet inflation