Maintaining Outcomes for Total Knee Arthroplasty – The Big Updates From BASK 2023

In this series we will cover the big topics discussed at British Association of Surgery of the Knee (BASK), including the contributions of alignment and balance to total knee arthroplasty (TKA) outcomes, how to make a day-case arthroplasty service work, and if modern technologies can help you achieve optimal results.

TKA was the centre of many conversations at BASK and for good reason. The procedure is one of the most high-volume surgeries within our health service, with around 90,000 procedures performed annually and numbers increasing year-on-year. Compounding this, it’s at a time when teams across the NHS are being asked to do more with less, and extreme waiting lists increase daily. Stephen Key, J&J MedTech UK Medical Affairs Lead, explores below how he thinks outcomes can be maintained or even improved in this sort of environment? 

Quality of Surgery can Reduce Quantity of Stay

Across the two days, key topics discussed at BASK centred around driving better outcomes and how this can be done in a way that reduces resource utilisation within the NHS. This came in the form of talks from Deepak Herlaker, Hilary Young, and Luke Jones discussing enhanced recovery and day case arthroplasty during the industry breakout sessions. This was followed by the focused session on the topic of day-case knee arthroplasty specifically, highlighting how pressing this issue is at present. The recurring sentiment that quality is the principal driver to reducing the length of stay is not new; Porter and Teisberg put forward the notion that quality of procedure outcomes drives value back in 2006 . But in a time where day case surgery is becoming the standard of care, how can we ensure high-quality joints with optimal long-term outcomes are achieved?

Balance Could be a Better Technique than Alignment for the Long-term TKA Success

Whilst some discussions focused on the perioperative period, many discussed the intraoperative window and the effects this can have on patients and healthcare systems. Largely this centred around alignment and the continuing debate of what is the gold-standard method to align a joint; when it comes to implant survival and function, what truly makes the difference? Will Jackson weighed up Mechanical and Kinematic alignment protocols, while Jo Banks discussed the impact of patient morphology using Coronal Plane Alignment of the Knee, and how this impacts the alignment goals of the knee. 

Beyond this, the suggestion that alignment may be a secondary goal to balance off the soft tissues, could be an explanation as to why no alignment technique has proved to be perfect: while some alignment strategies inherently lend themselves to achieving soft tissue balance, without achieving that, poor outcomes may still be seen despite alignment goals being met. This gives us food for thought as to what needs to be the aim for surgeons when thinking about what a ‘good’ joint procedure looks like. Is balance the key to best outcomes, and now we have more widely available methods of objectively assessing it intra-operatively, should we be looking beyond alignment to make that our primary technical objective?

New Technologies Could be the Difference in Making Long-lasting and Functional Joints

Interestingly, Dinesh Nathwani went on to speak about new technologies aiding in the alignment process, which raises the question: with the added insight provided by technology, is it time to move on from alignment and instead look for a quantifiable surgical goal that consistently correlates with outcomes? Is that “balance”, and should we start judging the technical performance of TKA not only on x-rays, but also on objective measures of intra-operatively achieved balance? After all, better initial procedures will drive better care and fewer reinterventions giving the Healthcare System better value, something people are desperately striving for as mentioned above. Will computer-assisted surgery be the difference-maker in improving outcomes and producing long-lasting and functional joints?

Read the in-depth review of the key topics of BASK 2023 in the upcoming releases. 

1. Joint Alignment or Balance – what makes a difference? 
2. Enabling Technology- How do we achieve an aligned and balanced Knee
3. Impact- How does this Impact Your Procedure, Your Patient, and Your Health System
4. The Future Potential of TKA