Soft-tissue penetration of the oscillating saw during tibial resection in total knee arthroplasty

Stijn Herregodts; Mathijs Verhaeghe; Rico Paridaens; Jan Herregodts; Hannes Vermue; Nele Arnout; Patrick De Baets; Jan Victor

doi:10.1302/0301-620X.102B10.BJJ-2019-1602.R2

Soft-tissue penetration of the oscillating saw during tibial resection in total knee arthroplasty

Bone Joint J. 2020 Oct;102-B(10):1324-1330. doi: 10.1302/0301-620X.102B10.BJJ-2019-1602.R2.

Authors

Stijn Herregodts¹, Mathijs Verhaeghe², Rico Paridaens², Jan Herregodts², Hannes Vermue², Nele Arnout², Patrick De Baets³, Jan Victor²

Affiliations

¹ Department of Physical Medicine and Orthopaedic Surgery, Department of Electrical Energy, Metal, Mechanical Construction and Systems, Ghent University, Ghent, Belgium.
² Department of Physical Medicine and Orthopaedic Surgery, Ghent University, Ghent, Belgium.
³ Department of Electrical Energy, Metal, Mechanical Construction and Systems, Ghent University, Ghent, Belgium.

PMID: 32993324
DOI: 10.1302/0301-620X.102B10.BJJ-2019-1602.R2

Abstract

Aims: Inadvertent soft tissue damage caused by the oscillating saw during total knee arthroplasty (TKA) occurs when the sawblade passes beyond the bony boundaries into the soft tissue. The primary objective of this study is to assess the risk of inadvertent soft tissue damage during jig-based TKA by evaluating the excursion of the oscillating saw past the bony boundaries. The second objective is the investigation of the relation between this excursion and the surgeon's experience level.

Methods: A conventional jig-based TKA procedure with medial parapatellar approach was performed on 12 cadaveric knees by three experienced surgeons and three residents. During the proximal tibial resection, the motion of the oscillating saw with respect to the tibia was recorded. The distance of the outer point of this cutting portion to the edge of the bone was defined as the excursion of the oscillating saw. The excursion of the sawblade was evaluated in six zones containing the following structures: medial collateral ligament (MCL), posteromedial corner (PMC), iliotibial band (ITB), lateral collateral ligament (LCL), popliteus tendon (PopT), and neurovascular bundle (NVB).

Results: The mean 75^th percentile value of the excursion of all cases was mean 2.8 mm (SD 2.9) for the MCL zone, mean 4.8 mm (SD 5.9) for the PMC zone, mean 3.4 mm (SD 2.0) for the ITB zone, mean 6.3 mm (SD 4.8) for the LCL zone, mean 4.9 mm (SD 5.7) for the PopT zone, and mean 6.1 mm (SD 3.9) for the NVB zone. Experienced surgeons had a significantly lower excursion than residents.

Conclusion: This study showed that the oscillating saw significantly passes the edge of the bone during the tibial resection in TKA, even in experienced hands. While reported neurovascular complications in TKA are rare, direct injury to the capsule and stabilizing structures around the knee is a consequence of the use of a hand-held oscillating saw when making the tibial cut. Cite this article: Bone Joint J 2020;102-B(10):1324-1330.

Keywords: Iatrogenic soft tissue damage; Knee arthroplasty; Oscillating saw; TKA.

MeSH terms

Aged
Aged, 80 and over
Arthroplasty, Replacement, Knee / instrumentation*
Cadaver
Equipment Design
Humans
Iatrogenic Disease*
Risk Factors
Soft Tissue Injuries / etiology*
Tomography, X-Ray Computed