Abstract
Soft tissue balance is known to be an important factor for the success of Total Knee Arthroplasty.Traditional surgical techniques involve soft tissue releases and bony cuts to achieve the correct balance. Evaluation of balance is currently based on subjective intra-operative clinical assessment, or the feel of the knee. More recently, an instrument to objectively measure soft tissue balance following bony cuts has been developed. Soft tissues releases using this instrument may be extensive.
Hypothesis. The hypothesis is that patients who undergo more extensive releases will have poorer short-term outcome and increased complication rates compared to those who undergo less extensive releases.
Method. 506 patients aged 40–90 years underwent 526 Kinemax TKAs, performed by seven surgeons in five centres between October 1999 and December 2002. Five surgeons used traditional methods for soft tissue balancing and only took balancer measurements pre-cementation. The other two were guided by the balancer instrument and took measurements pre- and post-releases, therefore quantifying how imbalanced the knees were at the beginning of the operation. Patients were assessed by an independent observer using the Oxford Knee Score, the American Knee Society Clinical Rating System and the Roentographic and Evaluation Scoring System, with a minimum follow-up of 12 months.
Results. Extensive soft tissue releasing procedures showed no significant difference in outcome in comparison with minimal releases. For the 2 surgeons using the balancer technique, a significant difference was seen with the change in knee scores. The knees left imbal-anced had substantially lower change scores and the imbalanced – balanced group showed the most improvement. Regarding surgical technique, there was no significant difference between the groups with the Oxford Knee Score or with the Clinical Rating System. Range of movement and outcome also showed no significant difference between any of the groups. Complication rates were low, clinically representative and showed no significant difference between the groups.
Conclusions. Extensive soft tissue releases do not result in an increase in complication rate or a poorer short-term outcome. When comparing traditional and balancer guided techniques there is no difference in outcomes. Balancing an imbalanced knee significantly improves knee outcome.
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
