Comparison of Gap Balancing vs Measured Resection Technique in Patients Undergoing Simultaneous Bilateral Total Knee Arthroplasty: One Technique per Knee

Tapasvi, Sachin; Shekhar, Anshu; Patil, Shantanu; Dipane, Matthew V.; Chowdhry, Madhav; McPherson, Edward J.

doi:10.1016/j.arth.2019.10.002

Cited by 21 publications

(20 citation statements)

References 44 publications

(42 reference statements)

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“…There are two ways to perform the gap balancing technique: extension first or flexion first. Balancing in extension first, as was done in our study, was considered more reliable, as releases were more precise [10]. Although surgical procedures to achieve this should follow a systematised and progressive order [1,11] STR increases the complexity of the procedure [12], so a correct alternative would be to do it only if necessary, knowing this could be helpful in pre-operative planning.…”

Section: Discussionmentioning

confidence: 75%

Can the need for soft tissue release in total knee replacement be predicted pre-operatively? A study based on surgical navigation

Hernández-Vaquero

Noriega-Fernandez

Roncero-Gonzalez

et al. 2021

International Orthopaedics (SICOT)

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Introduction In complex and deformed knees, soft tissue release (STR) is required to obtain symmetry in the femorotibial gap. The objective of this study was to attempt to predict the need for soft tissue release using surgical navigation in total knee replacement (TKR). Methods Prospective and non-randomized study. One hundred thirty knees. At the start of navigation, an attempt was made to correct the femorotibial mechanical axis by applying force to the medial or lateral side of the knee (varus-valgus stress angle test). A gap balanced technique with computer-assisted surgery (CAS) was performed in all cases. The ligaments were tensioned, and using CAS visualization and control, progressive STR was performed in the medial or lateral side until a symmetry of the femorotibial gap was achieved. Results Eighty-two patients had a varus axis ≥ 3° and 38 had a valgus axis (P < 0.001). STR was performed under navigation control in 38.5% of cases, lateral release (LR) in 12 cases, and medial release (MR) in 38 cases. After performing the varus-valgus stress angle test (VVSAT), the axis of 0° could be restored at some point during the manoeuvre in 28 cases. STR was required in 44.6% of varus cases and 27% of valgus cases (P = 0.05). A significant relationship was found between the previous deformity and the need for MR (P < 0.001) or LR (P = 0.001). STR was more common in male patients (P = 0.002) and as obesity increased. Conclusion This study shows that pre-operative factors favouring the need to perform STR in a TKR implant can be defined.

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Section: Discussionmentioning

confidence: 75%

Can the need for soft tissue release in total knee replacement be predicted pre-operatively? A study based on surgical navigation

Hernández-Vaquero

Noriega-Fernandez

Roncero-Gonzalez

et al. 2021

International Orthopaedics (SICOT)

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“…They conducted a retrospective study and concluded that gap balancing performed with a new balancing device and PSI could produce accurate femoral component alignment as well as outcomes similar to those of the measured resection technique at 3 years. Previous researchers [ 11 ] confirmed that there were indeed technical differences between GB and MR technology, but it was difficult to detect any consistent superiority of either technology by using functional outcome scores.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have reached similar conclusions on this point. In a comparative study of GB and MR techniques in patients undergoing simultaneous bilateral TKA, Tapasvi et al [ 11 ] found that the GB technique requires a larger bone resection from the posterior medial femur to achieve a rectangular flexion gap. The resection of the posterior condyle with the GB technique is greater than that with the MR technique, which has been confirmed by Cidambi et al [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…The MR technique uses anatomical markers such as the transepicondylar axis (TEA), anteroposterior (AP) axis, or the posterior condylar axis (PCA) to determine the rotation of the femoral prosthesis [ 5 , 7 , 11 ]. However, some researchers have shown that MR technology has great variability in setting the rotation of the femoral components due to individual differences in anatomical landmarks [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Spacer-based gap balancing is useful in total knee arthroplasty: a 3-year follow-up of a retrospective study

Song

Liu

et al. 2021

J Orthop Surg Res

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Background Which technique, gap balancing or measured resection, can obtain better femoral component alignment and soft tissue balance in total knee arthroplasty (TKA) is still controversial. This study aimed to determine whether the gap balancing technique using a modified spacer block in TKA can result in better postoperative clinical outcomes than the measured resection technique. Methods A total of 124 patients who underwent consecutive primary TKA between May 2016 and August 2018 were retrospectively reviewed. The gap balancing technique assisted by a modified spacer block was used in 61 patients, and the measured resection technique was used in 63 patients. The surgical, imaging and knee function outcomes of the two groups were compared. Results The thickness of the posterior medial condyle bone resection using the modified spacer block tool in gap balancing was significantly larger than that of the MR technique (P = 0.001). Compared with the measured resection group, the gap balancing group had a greater external rotation resection angle of the femur (4.06 ± 1.10° vs. 3.19 ± 0.59°, P < 0.001°). Despite these differences, the mean ROM, KSS scores, and WOMAC scores at the 6-week, 1-year, and 2-year follow-ups were not significantly different. Postoperatively, there was no significant difference between the two groups in mechanical axis measurements (P = 0.275), the number of HKA outliers (P = 0.795) or the joint line displacement (P = 0.270). Conclusion The functional outcomes of the gap balancing technique based on the modified spacer are similar to those of measured resection at 3 years. Compared with the MR technique, the GB technique resulted in a greater external rotation resection angle and thicker posterior medial condylar cuts in TKA with knee varus.

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“…Technique and philosophy vary. On a broad scale, differences include ultimate limb alignment (mechanical vs kinematic), sagittal and coronal reference positions, rotational axes land marks, and soft tissue balancing techniques (measured resection vs gap balancing) [2,3].…”

Section: Introductionmentioning

confidence: 99%

Comparison of Anterior-Posterior Axis Versus Transepicondylar Axis in Patients Undergoing Simultaneous Bilateral Total Knee Arthroplasty: One Technique per Knee

Tapasvi¹,

Shekhar²,

Chowdhry

et al. 2022

The Journal of Arthroplasty

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Comparison of Gap Balancing vs Measured Resection Technique in Patients Undergoing Simultaneous Bilateral Total Knee Arthroplasty: One Technique per Knee

Cited by 21 publications

References 44 publications

Can the need for soft tissue release in total knee replacement be predicted pre-operatively? A study based on surgical navigation

Can the need for soft tissue release in total knee replacement be predicted pre-operatively? A study based on surgical navigation

Spacer-based gap balancing is useful in total knee arthroplasty: a 3-year follow-up of a retrospective study

Comparison of Anterior-Posterior Axis Versus Transepicondylar Axis in Patients Undergoing Simultaneous Bilateral Total Knee Arthroplasty: One Technique per Knee

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