Comparison of intraoperative soft tissue balance measurement between two tensor systems in total knee arthroplasty

Differences in measurement outcomes using different tensors in total knee arthroplasty (TKA) remain unknown. This study aimed to compare intraoperative soft tissue balance between two measurement systems in TKA.

This study included 24 cruciate-retaining (CR) and 27 posterior-stabilized (PS) TKAs for varus-type osteoarthritis. All TKAs were performed with the measured resection technique. Intraoperative soft tissue balance was assessed with femoral component placement and patellofemoral joint reduction throughout the range of motion. Measurements were performed using the Offset Repo-Tensor (Zimmer) and Ligament Sensor Tensor (Depuy). Joint component gaps and varus/valgus ligament balance were compared statistically in CR and PS TKAs.

Joint component gaps with the Offset Repo-Tensor were significantly larger at 0°, 10°, 30°, and 60° of knee flexion in CR TKA and at all knee flexion angles, except 0° and 135°, in PS TKA than those with the Ligament Sensor Tensor (P < .05). Varus balance with the Offset Repo-Tensor was significantly larger at 0°, 10°, and 30° of knee flexion in CR TKA and at 10°, 30°, 60°, 90°, and 120° of knee flexion in PS TKA than that with the Ligament Sensor Tensor (P < .05).

Surgeons should consider the discrepancy in assessing intraoperative soft tissue balance depending on the tensor used. The Ligament Sensor Tensor tended to underestimate soft tissue balance in CR and PS TKAs compared with the Offset Repo-Tensor, especially in PS TKA. Thus, surgeons should know the difference in values between the offset-type tensor with consistent distraction force and a spring-loaded tensor.