Different pattern in gap balancing between the cruciate-retaining and posterior-stabilized total knee arthroplasty

Purpose

In order to permit soft tissue balance under more physiological conditions during total knee arthroplasties (TKAs), an offset-type tensor was developed to obtain soft tissue balancing throughout the range of motion with reduced patello-femoral (PF) and aligned tibiofemoral joints. The main purpose of the present study was to assess intra-operative soft tissue balance using a navigation system with the offset-type tensor in both cruciate-retaining (CR) and posterior-stabilized (PS) TKAs.

Methods

One hundred and twenty TKAs—80 CR and 40 PS—were performed in patients with varus-type osteoarthritis using a computed tomography–free navigation system. The offset-type TKA tensor with a reduced and repaired PF joint and femoral component in place was used with the tibia first gap technique to balance soft tissues (joint component gap and ligament balance) at 0°, 10°, 30°, 60°, 90°, and 120° of flexion. The achievement in equalized rectangular gap at extension and flexion—joint component gap within ±3 mm between extension and flexion and ligament balance within ±3° at extension and flexion—was assessed retrospectively.

Results

Both types of implants showed similar patterns of soft tissue balance throughout the range of motion, whereas PS TKA had larger values especially at 60° or 90° of flexion than did CR TKA. In the achievement of equalized rectangular gaps at extension and flexion, CR TKA was superior to PS TKA.

Conclusion

Using the tibia first gap technique with the tensor allows appropriate soft tissue balancing, especially in CR TKA.

Level of evidence

Therapeutic studies, Level II.