{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T23:36:13Z","timestamp":1792798573805,"version":"4.5.0"},"reference-count":27,"publisher":"BMJ","issue":"5","funder":[{"name":"Smith and Nephew, Australia","id":[{"id":"https:\/\/ror.org\/04fgq7x14","id-type":"ROR","asserted-by":"crossref"}]},{"name":"OrthoSensor","id":[{"id":"https:\/\/ror.org\/05n85jt88","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2019,3,14]]},"published-print":{"date-parts":[[2019,5]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Soft tissue imbalance is considered to be a major surgical cause of dissatisfaction following total knee arthroplasty (TKA). Surgeon-determined manual assessment of ligament tension has been shown to be a poor determinant of the true knee balance state. The recent introduction of intraoperative sensors, however, allows surgeons to precisely quantify knee compartment pressures and tibiofemoral kinematics, thereby optimising coronal and sagittal plane soft tissue balance. The primary hypothesis of this study is that achieving knee balance with use of sensors in TKA will improve patient-reported outcomes when compared with manual balancing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>\n                      A multicentred, randomised controlled trial will compare patient-reported outcomes in 222 patients undergoing TKA using sensor-guided balancing versus manual balancing. The sensor will be used in both arms for purposes of data collection; however, surgeons will be blinded to the pressure data in patients randomised to manual balancing. The primary outcome will be the change from baseline to 1\u2009year postoperatively in the mean of the four subscales of the Knee Injury and Osteoarthritis Outcome Score (KOOS\n                      <jats:sub>4<\/jats:sub>\n                      ) that are most specific to TKA recovery: pain, symptoms, function and knee-related quality of life. Secondary outcomes will include the surgeon\u2019s capacity to determine knee balance, radiographic and functional measures and additional patient-reported outcomes. Normality of data will be assessed, and a Student\u2019s t-test and equivalent non-parametric tests will be used to compare differences in means among the two groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>Ethics approval was obtained from South Eastern Sydney Local Health District, Approval (HREC\/18\/POWH\/320). Results of the trial will be presented at orthopaedic surgical meetings and submitted for publication in a peer-reviewed journal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>ACTRN#12618000817246<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2018-027812","type":"journal-article","created":{"date-parts":[[2019,5,11]],"date-time":"2019-05-11T06:55:19Z","timestamp":1557557719000},"page":"e027812","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":14,"title":["Does soft tissue balancing using intraoperative pressure sensors improve clinical outcomes in total knee arthroplasty? A protocol of a multicentre randomised controlled trial"],"prefix":"10.1136","volume":"9","author":[{"given":"Samuel J","family":"MacDessi","sequence":"first","affiliation":[{"name":"Orthopaedic Surgery, St George Private Hospital, Kogarah, New South Wales, Australia"},{"name":"Orthopaedic Surgery, The Canterbury Hospital, Campsie, New South Wales, Australia"},{"name":"Clinical Research, Sydney Knee Specialists, Kogarah, New South Wales, Australia"},{"name":"St George Clinical School, University of New South Wales, Kogarah, NSW, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aziz","family":"Bhimani","sequence":"additional","affiliation":[{"name":"Orthopaedic Surgery, Wollongong Private Hospital, Wollongong, New South Wales, Australia"},{"name":"Orthopaedic Surgery, Wollongong Public Hospital, Wollongong, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander W R","family":"Burns","sequence":"additional","affiliation":[{"name":"Orthopaedic Surgery, Canberra Private Hospital, Deakin, Australian Capital Territory, Australia"},{"name":"Orthopaedic Surgery, Calvary John James Private Hospital, Deakin, Australian Capital Territory, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darren B","family":"Chen","sequence":"additional","affiliation":[{"name":"Orthopaedic Surgery, St George Private Hospital, Kogarah, New South Wales, Australia"},{"name":"Orthopaedic Surgery, The Canterbury Hospital, Campsie, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony K L","family":"Leong","sequence":"additional","affiliation":[{"name":"Orthopaedic Surgery, Wollongong Private Hospital, Wollongong, New South Wales, Australia"},{"name":"Orthopaedic Surgery, Wollongong Public Hospital, Wollongong, New South Wales, Australia"},{"name":"Orthopaedic Surgery, Kareena Private Hospital, Caringbah, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert B","family":"Molnar","sequence":"additional","affiliation":[{"name":"Orthopaedic Surgery, St George Private Hospital, Kogarah, New South Wales, Australia"},{"name":"Orthopaedic Surgery, The Sutherland Hospital, Caringbah, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan S","family":"Mulford","sequence":"additional","affiliation":[{"name":"Orthopaedic Surgery, Calvary St Luke\u2019s Hospital, Launceston, Tasmania, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard M","family":"Walker","sequence":"additional","affiliation":[{"name":"Orthopaedic Surgery, Sydney Southwest Private Hospital, Liverpool, New South Wales, Australia"},{"name":"Orthopaedic Surgery, The Fairfield Hospital, Prairiewood, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian A","family":"Harris","sequence":"additional","affiliation":[{"name":"South West Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia"},{"name":"Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashish","family":"Diwan","sequence":"additional","affiliation":[{"name":"Orthopaedic Surgery, St George Private Hospital, Kogarah, New South Wales, Australia"},{"name":"St George Clinical School, University of New South Wales, Kogarah, NSW, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jil A","family":"Wood","sequence":"additional","affiliation":[{"name":"Clinical Research, Sydney Knee Specialists, Kogarah, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,5,10]]},"reference":[{"key":"2025101814122917000_9.5.e027812.1","doi-asserted-by":"publisher","DOI":"10.3109\/17453674.2014.916487"},{"key":"2025101814122917000_9.5.e027812.2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.5792\/ksrr.2016.28.1.1","article-title":"Patient Satisfaction after Total Knee Arthroplasty","volume":"28","author":"Choi","year":"2016","journal-title":"Knee Surg Relat Res"},{"key":"2025101814122917000_9.5.e027812.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.knee.2013.05.011"},{"key":"2025101814122917000_9.5.e027812.4","unstructured":"ACORN, A.C.O.R. 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