Comparison of Gap Balancing vs Measured Resection Technique in Patients Undergoing Simultaneous Bilateral Total Knee Arthroplasty: One Technique per Knee (original) (raw)
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The Journal of Arthroplasty
Background: Total knee arthroplasty requires careful surgical technique to attain the goal of a wellaligned and symmetrically balanced knee. Soft tissue balance and correct femoral component rotation are paramount in achieving these goals. The two competing techniques to select femoral component rotation and soft tissue balance are the gap balance technique and the measured resection technique. Methods: We performed a randomized, prospective study to compare the two techniques in patients undergoing simultaneous bilateral total knee arthroplasty, whereby one technique was performed in each knee. Fifty (50) subjects were enrolled into the study. The inclusion criteria were osteoarthritic varus knee deformities with similar deformities in both knees. Subjects were followed up for a minimum of two years. Results: The knees balanced via the gap balance technique had significantly more posterior medial bone removed from the femur than those knees balanced via the measured resection technique (P < .001). Knees in the gap balance group tended to require more medial knee releases in extension and tended to have smaller sized femoral components as a result of cutting more bone from the femur in flexion. The modular tibial polyethylene bearing tended to be thicker in the gap balance group. Despite these differences, average knee flexion and functional revised Oxford Knee Scores at 2-year follow-up were not statistically different. Conclusion: At 2-year follow-up, there were no differences between the function and scores using the two techniques. Long-term follow-up will be necessary to evaluate any differences in long-term durability.
Gap Balancing versus Measured Resection Technique for Total Knee Arthroplasty
Clinical Orthopaedics & Related Research, 2009
Multiple differing surgical techniques are currently utilized to perform total knee arthroplasty (TKA). We compared knee arthroplasties performed using either a measured resection or gap balancing technique to determine if either operative technique provides superior coronal plane stability as measured by assessment of the incidence and magnitude of femoral condylar lift-off. We performed 40 TKA using a measured resection technique (20 PCLretaining and 20 PCL-substituting) and 20 PCL-substituting TKA were implanted using gap balancing. All subjects were analyzed fluoroscopically while performing a deep knee bend. The incidence of coronal instability (femoral condylar lift-off) was then determined using a 3-D model fitting technique. The incidence of lift-off greater than 0.75 mm was 80% (maximum, 2.9 mm) and 70% (maximum, 2.5 mm) for the PCL-retaining and substituting TKA groups performed using measured resection versus 35% (maximum, 0.88 mm) for the gap-balanced group. Lift-off greater than 1 mm occurred in 60% and 45% of the PCL-retaining and-substituting TKA using measured resection versus none in the gap-balanced group. Rotation of the femoral component using a gap balancing technique resulted in better coronal stability which we suggest will improve functional performance and reduce polyethylene wear. An institution of the authors (Center for Musculoskeletal Research) and one author (DAD) have received funding from DePuy, Inc. (Warsaw, IN). Each author certifies that his or her institution has approved the reporting of these cases, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.
Relationship between surgical balancing and outcome measures in total knees
Arthroplasty Today, 2019
Background: The purpose of the study was to investigate the accuracy of balancing which could be achieved at total knee surgery and its relation to functional outcomes. Methods: During surgery, the forces on the medial and lateral plateaus were measured at 10-15 degrees flexion in 101 patients, using an instrumented tibial trial, with equal forces being targeted. Of the initial 101 cases, 71 cases completed all follow-up visits to 1 year. At each follow-up visit, the function was measured using the Knee Society Scoring System, and varus and valgus laxity angles were measured. Results: The mean medial/(medial þ lateral) compartmental force ratio was 0.52, with a standard deviation of 0.09. The total contact force was 217 Newtons, with a standard deviation of 72 Newtons. No correlations were found between the functional scores and the compartmental force ratio or total contact force. However, the mean varus and valgus laxity angles, 2.8 and 2.3 degrees, respectively, were very close to the angles of normal intact knees. Conclusions: The likely reason for the lack of correlation of function was that the large majority of the balancing ratios were within the range 0.4-0.6 but with a wide spread of functional scores typical of total knee study groups. However, the normal varus and valgus angles achieved at follow-up indicated that equal balancing in early flexion was a reasonable surgical target. Using instrumented tibial trials enabled accurate and consistent balancing values to be achieved, as well as normal varus and valgus laxity angles, which may be important in obtaining optimal outcomes.
The Journal of Arthroplasty, 2011
The gap technique could lead to undesirable rotation of the femoral component in some knees. Using a navigation system, femoral component external rotations and varus-valgus laxities at 0°and 90°of flexion were measured intraoperatively in 44 patients. Significant improvements were observed at a minimum follow-up of 4 years with regard to clinical and radiologic outcomes. The balanced gap technique in total knee arthroplasty provided good intraoperative alignments and laxities of knees at 0°and 90°. However, increased femoral component external rotation was found to be correlated with increased varus alignment at 90°of knee flexion. This study shows that excessive external rotation of the femoral component during flexion gap balancing using the balanced gap technique in total knee arthroplasty can be avoided by additional soft tissue balancing guided by navigation.
Indian Journal of Orthopaedics Surgery, 2021
Introduction: Total knee arthroplasty is one of the commonest musculoskeletol pain relieving surgery now a days. The long legacy of the different surgical techniques attracts the orthopaedic surgeons to opt for better results oriented techniques. Since in the mid 19s of origin of early knee arthroplasty to 2014 of gap balancing vs measured resection technique from US to the recent navigation & robotics era, different study showed improved results. For developing countries with financial constrains cost effective & results oriented more studies warranted. Objectives: To study the results of all femoral cuts first followed by tibial cuts as a measured resection technique based on anatomical landmarks followed by scientific soft tissue balancing for total knee arthroplasty. Materials and Methods: We have analyzed total (n= 126) the total knee replacement surgeries operated by our team during last 48 months retrospectively. Mean age was 66 years. All the Knee arthritis classified by Kel...
Total knee arthroplasty, different alignment and balance methods-A review
Indian Journal of Orthopaedics Surgery, 2023
The two most frequent techniques used to implant a total knee replacement (TKR) are measured resection and gap balancing. Both methods have been around for a while and are currently in widespread usage, and both have shown to be effective in the real world. Plus, new technologies have evolved in the recent past to help surgeons achieve soft tissue balance and limb alignment. Proper alignment of a knee replacement is crucial to its effective functioning. It has to be in the right axial and rotational planes for this to work. Patellofemoral instability and early wear can be caused by improper alignment, as can loosening of the prosthesis. Altering the prosthesis's orientation might potentially affect the tension of the surrounding soft tissues. We have extensively reviewed 50 studies (Level 1- Level 4) published in many prestigious journals by searching through platforms like PUBMED, MEDLINE and EMBASE databases. In this research, we have attempted to document the relationship between alignment and the equilibrium of soft tissues and to summarize the present state of our understanding of this connection. Keywords: TKA, Alignment, Balancing, Review, Kinematics.
The Journal of Bone & Joint Surgery, 2013
Background: Soft-tissue releases are commonly necessary to achieve symmetrical flexion and extension gaps in primary total knee arthroplasty performed with a measured resection technique. We reviewed the frequency of required releases according to preoperative alignment and the clinical and radiographic results; associations with failure, reoperations, and complications are presented. Methods: We reviewed 1216 knees that underwent primary total knee arthroplasty from 2004 to 2009; 774 (64%) were in female patients and 442 (36%), in male patients. In the coronal plane, 855 knees had preoperative varus deformity, 123 were neutral, and 238 had valgus deformity. The mean age at the time of the index procedure was 62.7 years (range, twenty-three to ninety-four years), and the mean body mass index was 32.7 kg/m 2 (range, 17.4 to 87.9 kg/m 2). Clinical outcomes included the Knee Society Score (KSS), implant failure, reoperation, and complications. Radiographs were analyzed for component alignment. Results: The only difference in the total KSS was found at the time of final follow-up between valgus knees with zero releases (total KSS = 178) and those with one or two releases (KSS = 160, p = 0.026). Overall, 407 knees (33.5%) required zero releases, 686 (56.4%) required oneor two releases, and 123 (10.1%) required three or more releases. Among varus knees, 37% required zero releases, 55% required one or two releases, and 7.5% required three or more releases. Among neutral knees, 39% required zero releases, 55% required one or two releases, and 5.7% required three or more releases. Only 17% of valgus knees required zero releases whereas 61% required one or two releases and 21.8% required three or more releases. Valgus knees required more releases than neutral or varus knees did (p < 0.001). Conclusions: Selective soft-tissue release for gap balancing in primary total knee arthroplasty is an effective technique that produced excellent clinical and radiographic results regardless of preoperative alignment. Consistent anatomic continued Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.
2009
Ligament balancing affects many of the postoperative criteria for a successful knee replacement. A balanced knee contributes to improved alignment and stability. Ligament balancing helps reduce wear and loosening of the joint. A patient with a balanced knee is more likely to have increased range of motion and proprioception, and decreased pain. All these factors help minimize the need for revision surgery. Complications associated with ligament balancing can include instability caused by overbalancing and the possibility of neurovascular damage during or as a result of ligament balancing. This article attempts to summarize the literature, to define a balanced knee, and outline the benefits and possible complications of ligament balancing. Different techniques, sequences, and tools used in ligament balancing, and their relevance in correcting various deformities are reviewed.