Gap balancing versus measured resection in TKA—Brief comparison of the techniques

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Accurate soft tissue tensioning, and appropriate component positioning are critical to the success of TKA. If a knee is not balanced correctly then patient outcomes are compromised. What evidence exists to support surgeons’ use of gap balancing or measured resection? Is one of these techniques superior to the other? The discussion around this question is quite controversial. In Part 1 of this article series we look at the debate surrounding these techniques and compare the two. Does one technique come out on top?

 

 

Globally, total knee arthroplasty (TKA) is being performed at a rapidly increasing rate [1]. There have been projections of 3.48 million annual procedures by 2030 in the US alone, which is growth of 673% from 2007 [1]. While a number of problems, such as osteo- and inflammatory arthritis, obesity, tumors, and congenital deformities [2], could prompt this procedure, especially in the elderly population, the reality is that TKA is increasingly performed on younger, active patients [1].

The success of TKA is dependent on many factors, but if soft tissue tensioning and component positioning are not accurately achieved then the resulting instability can cause early failure of the implant, pain in the joint, and even necessitate revision [3]. Gustkey et al. found that “balanced joints” were the “most significant contributing factor to improved postoperative outcomes” [4]. Sharkey et al. report that up to 35% of early TKA revisions in the US may be triggered by soft tissue imbalance [5].

 

Two techniques for balancing

Historically, there have been two balancing techniques used during TKA: gap balancing or measured resection [6]. These techniques are widely used around the globe, and have each been shown to successfully balance knees and deliver good TKA outcomes; but, each technique has its pros and cons. Part 2 of this article series looks at gap balancing, and Part 3 examines measured resection in more depth. In this article we present a side-by-side comparison of gap balancing and measured resection; what are the benefits and disadvantages of each? Are there indications that suggest the selection of one over the other? Is one technique superior to the other?

We interviewed Mathew Abdel, from the Mayo Clinic in Rochester, US, and Philipp von Roth from the Charité-University Hospital in Berlin, Germany, about gap balancing and measured resection. They offer their unique perspectives on these techniques and assert what they think is really happening in the OR when it comes to the use of gap balancing and measured resection.

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  • In discussion: gap balancing or measured resection?
  • Gap balancing: brief introduction, pros and cons
  • Measured resection: brief introduction, pros and cons
  • Comparing the two techniques
  • Conclusion
  • References

Part 2 | Evidence for/against gap balancing

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Part 3 | Evidence for/against measured resection

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Contributing experts

This series of articles was created with the support of the following specialists (in alphabetical order):

Matthew P Abdel MD

Mayo Clinic
Rochester, United States

Philipp von Roth MD

Charité—University Medicine Berlin
Berlin, Germany

This issue was created by Word+Vision Media Productions, Switzerland

 

References

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