Soft-tissue balancing in total knee arthroplasty: cruciate-retaining versus posterior-stabilised, and measured-resection versus gap technique

Abstract

Purpose The purpose of this study was to prove the hypothesis that soft tissues are well balanced using the gap technique with a navigation system in cruciate-retaining (CR) and posterior-stabilised (PS) total knee arthroplasty (TKA), leading to better clinical outcomes compared with the measuredresection technique. Methods One hundred and thirty-five TKAs (90 CR and 45 PS) were performed in patients with varus-type osteoarthritis using the gap technique guided by the offset-type tensor and a navigation system. Soft-tissue balance (joint-component gap and ligament balance) were intraoperatively assessed with the tensor under 40 lb of joint-distraction force. The achievement in the equalised rectangular gap at extension and flexion was assessed and retrospectively compared with the previous series in which the measured-resection technique was used (20 CR and 100 PS TKAs). In addition, clinical outcomes, including range of motion and Knee Society Score were assessed at a minimum two year follow-up. Results In achieving equalised rectangular gaps at extension and flexion, CR TKAs met criteria in more cases [66.7 % (64/90) vs.

Gap-balancing technique combined with patient-specific instrumentation in TKA

“…Rotational adjustment deviations of up to 6°are, however, not an uncommon feature when using the gap-balancing technique [20], and a symmetrical flexion gap is crucial to its success [18,19]. Comparable clinical results are reported with both techniques [21][22][23].…”

Partial versus Intact Posterior Cruciate Ligament‐retaining Total Knee Arthroplasty: A Comparative Study of Early Clinical Outcomes

“…Numerous studies have reported on the kinematics, clinical efficacy and life‐span of CR TKA and posterior stabilized TKA. Each type of prosthesis has advantages and disadvantages. The aim of TKA is to reconstruct the mechanical axis of the knee via bone resection and/or soft tissue balance.…”

Section of the anterior cruciate ligament in the rabbit as animal model for osteoarthritis progression

“…In patients with a total knee replacement (TKA), retaining PCL can assist in maintaining the natural knee movements and increasing the 'normal' feeling [30]. A clinical study demonstrated that retaining the PCL in TKA performed better than posterior-stabilised TKA in terms of achieving an equalized rectangular gap which contributed to ensure proper kinematics of the knee joint [31]. The result indicated that, in patients with severe OA knees who received TKA, retaining the ligament of the joint may conduce to the dynamic stability of the joint and help to improve the patient satisfaction of sensation.…”