Abstract
ObjectiveThe purpose of this study was to determine whether the gap-balancing technique with patient-specific instrumentation (PSI) and a new balancing device in total knee arthroplasty (TKA) can improve knee function to a greater extent than can the measured resection technique.Materials and methodsData from 150 patients who underwent TKA from August 2014 to June 2016 were studied retrospectively. The gap-balancing technique assisted by PSI and the new balancing device was used in 80 patients (82 knees), and the measured resection technique was used in 70 patients (70 knees). The surgical, imaging, and knee function data were compared.ResultsThe gap-balancing technique assisted by PSI and the new balancing device was found to be feasible in all operated knees and reliable. In total, 150 patients (152 knees) of ages ranging from 52 to 78 years (mean 67 years) underwent TKA during the study period. The follow-up period ranged from 35 to 52 months (mean 45 months). Only one patient, who was included in the gap-balancing group, underwent a revision surgery at 2 years postoperatively due to infection. There were no differences in the incidence of anterior knee pain between the two groups. The mean flexion angle, KSS scores, and VAS scores did not significantly differ between the measured resection group and gap-balancing group at 12 weeks or 36 weeks postoperatively. The average joint line displacement was 1.3 ± 1.1 mm (range 0–3) proximally in the GB (gap-balancing) group and 1.2 ± 1.4 mm in the MR (measured-resection) group. No outliers >5 mm in either group were recorded. The mean leg axis deviation from the neutral mechanical axis was 1.8°±1.5° varus (range 0°–3°varus) versus the neutral mechanical axis in the GB group and 1.4°±1.2°(range 0°–3°)in the MR group. No outliers with >3° deviation in either group were recorded.ConclusionsThe gap-balancing technique performed with the new balancing device and PSI can yield accurate femoral component alignment as well as outcomes similar to those of measured resection at 3 years. The new balancing device can be taken into consideration by surgeons who prefer performing the gap-balancing technique with PSI.
Highlights
Total knee arthroplasty (TKA) is considered the most successful surgical treatment for end-stage knee osteoarthritis available in the twenty-first century
The gap-balancing technique performed with the new balancing device and patient-specific instrumentation (PSI) can yield accurate femoral component alignment as well as outcomes similar to those of measured resection at 3 years
The new balancing device can be taken into consideration by surgeons who prefer performing the gap-balancing technique with PSI
Summary
Total knee arthroplasty (TKA) is considered the most successful surgical treatment for end-stage knee osteoarthritis available in the twenty-first century. A successful knee replacement hinges on appropriate soft-tissue balancing and accurate bony alignment. With ideal limb alignment and soft-tissue balance, patients may be able to regain near-normal knee function, avoiding the early TKA failure caused by uneven forces being exerted on prosthesis and cement, and forces under the maximum limit ensure the integrity of the extensor mechanism [1, 2]. Previous discussions on the TKA surgical technique have focused on how to assess femoral component rotation. The rotational alignment of the femoral component involves the bony anatomy and soft tissue [3, 6]. There are two standard surgical techniques for prosthesis implantation that are utilized in TKA: measured resection and gap balancing
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