Perfect balance in total knee arthroplasty: The elusive compromise

A Tensor/Balancer device (Stryker Howmedica Osteonics, Allendale, NJ) was used to restore optimal stability and alignment during 83 consecutive total knee arthroplasties with a minimum of 6-week clinical and radiographic follow-up. The surgical technique is described. Mean flexion-extension symmetry was restored to within 1[deg ]. Mean femoral rotation required to achieve symmetry in flexion differed between varus (4.38[deg ]) and valgus (6.0[deg ]) knees. Of 83 knees, 7 had [gt ]3 mm of subjective laxity during component trialing and were associated with a preoperative deformity of [gt ]15[deg ]; 19 knees required femoral rotation of [gt ]6[deg ] and were associated with greater preoperative malalignment. Postoperative knee alignment, range of motion, Knee Society score, and lateral release rate were similar between the 2 groups. The use of a Tensor/Balancer device in total knee arthroplasty can achieve outcomes comparable to existing techniques with potential for improved technical accuracy.