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Gap balancing versus measured resection for primary total knee arthroplasty: a meta-analysis study
Filippo Migliorini1, Jörg Eschweiler2, Yasser El Mansy2,3
1Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Pauwelsstraße, 30, 52074, Aachen, Germany. migliorini.md@gmail.com.
Archives of Orthopaedic and Trauma Surgery
|May 16, 2020
Summary
This meta-analysis found that gap balancing (GB) and measured resection (MR) techniques yield similar outcomes for total knee arthroplasty (TKA). While GB may elevate the joint line and extend surgery time, both methods show comparable results in function and complications.
Area of Science:
- Orthopedic Surgery
- Biomechanical Engineering
Background:
- Total knee arthroplasty (TKA) relies on standardized techniques, yet debate exists regarding the superiority of gap balancing (GB) over measured resection (MR).
- Comparative effectiveness of surgical approaches in TKA requires rigorous evaluation to optimize patient outcomes.
Purpose of the Study:
- To conduct a meta-analysis comparing the clinical and functional outcomes, radiological measurements, and complication rates of GB versus MR techniques in primary TKA.
- To resolve the ongoing debate regarding the advantages of GB over MR in total knee arthroplasty.
Main Methods:
- A systematic literature search adhering to PRISMA guidelines was performed in November 2019.
- Included were clinical studies quantitatively comparing GB and MR for primary TKA, with data analyzed using Review Manager Software.
- Methodological quality assessment and statistical analyses were conducted to ensure robust findings.
Main Results:
- Data from 25 trials (2971 procedures) showed no significant differences between GB and MR in clinical scores (SF-12, ROM, KSS, OKS, WOMAC) or radiological alignment.
- The gap balancing technique resulted in a significantly elevated joint line and longer operating time compared to measured resection.
- No differences were observed in revision surgery rates, aseptic loosening, or prosthetic infections between the two techniques.
Conclusions:
- Gap balancing and measured resection techniques achieve comparable clinical and functional outcomes in total knee arthroplasty.
- While gap balancing may lead to joint line elevation and increased operative time, overall patient results and complication profiles are similar.
- The findings support the interchangeability of both techniques regarding key outcome measures in TKA.
