Abstract
Background
Surgeons generally perform total knee replacement using either a gap balancing or measured resection approach. In gap balancing, ligamentous releases are performed first to create an equal joint space before any bony resections are performed. In measured resection, bony resections are performed first to match anatomical landmarks, and soft tissue releases are subsequently performed to balance the joint space. Previous studies have found a greater rate of coronal instability and femoral component lift-off using the measured resection technique, but it is unknown how potential differences in loading translate into component stability and fixation.
Methods
Patients were randomly assigned at the time of referral to a surgeon performing either the gap balancing or measured resection technique (n = 12 knees per group). Both groups received an identical cemented, posterior-stabilized implant. At the time of surgery, marker beads were inserted in the bone around the implants to enable radiostereometeric analysis (RSA) imaging. Patients underwent supine RSA exams at 0–2 weeks, 6 weeks, 3 months, 6 months, and 12 months. Migration of the tibial and femoral components including maximum total point motion (MTPM) was calculated using model-based RSA software. Knee Society Scores were also recorded for each group.
Results
At 12 months follow-up, there were no revisions or adverse events. There were no differences in translation or rotation between the measured resection and gap balancing groups at 12 months, including for MTPM of the tibial component (mean 0.67 mm vs. 0.69 mm, p = 0.77, Fig. 1) and the femoral component (mean 0.71 mm vs. 0.51 mm, p = 0.25, Fig. 2). At 6 weeks, tibial components had greater (p = 0.01) anterior tilt in the measured resection group (0.08 deg) while the gap balancing group had greater posterior tilt (0.14 deg), but there were no differences from 3 months onwards (Fig. 3). Patients in both groups improved in Knee Society scores from pre- to post-operatively, with no difference in score between the groups at pre-operation (p = 0.56) or post-operation (p = 0.54).
Discussion
Implants in both the gap balancing and measured resection groups were well fixed after 12 months, with no differences in translations or rotations between the two groups as of the latest time points. Both surgical techniques result in adequate fixation for total knee replacement. Future work will include measuring the contact location and possible condylar lift-off with flexion within this cohort.
For any figures or tables, please contact authors directly (see Info & Metrics tab above).
