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 degrees. Mean femoral rotation required to achieve symmetry in flexion differed between varus (4.38 degrees ) and valgus (6.0 degrees ) knees. Of 83 knees, 7 had >3 mm of subjective laxity during component trialing and were associated with a preoperative deformity of >15 degrees; 19 knees required femoral rotation of >6 degrees 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.