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Gap balanced adjusted mechanical alignment versus measured resection mechanical alignment: a randomised controlled

Hugh Waterson1, Robert Walker2, Petra Koopmans3

  • 1Exeter Knee Reconstruction Unit, RD+E Hospital, Exeter, UK. benwaterson@nhs.net.

Archives of Orthopaedic and Trauma Surgery
|June 12, 2022
PubMed
Summary
This summary is machine-generated.

Individualized alignment using a gap balancer (GB) technique in total knee replacement (TKR) did not improve quadriceps strength. However, this approach showed significant improvements in pain scores and some functional outcomes compared to measured resection (MR).

Keywords:
AlignmentFunctional assessmentGap balancingIndividualised alignmentKnee outcomesLigament balancingMeasured resectionMechanical alignmentTKR

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Area of Science:

  • Orthopedic Surgery
  • Biomedical Engineering

Background:

  • Total knee replacement (TKR) alignment is crucial for functional outcomes.
  • Two alignment philosophies exist: measured resection (MR) and individualized alignment using a gap balancer (GB).

Purpose of the Study:

  • To compare short-term functional outcomes and patient-reported outcome measures (PROMs) between MR and GB techniques in TKR.
  • To evaluate the impact of alignment philosophy on quadriceps strength and knee range of motion (ROM).

Main Methods:

  • A randomized controlled trial involving 94 knees.
  • Surgical groups: MR for mechanical alignment vs. GB for individualized alignment.
  • Primary outcome: quadriceps strength; secondary outcomes: functional tests, PROMs, patient satisfaction.

Main Results:

  • No significant difference in quadriceps strength between MR and GB at 12 months.
  • GB group showed improved ROM at 3 months, but not at 1 year.
  • PROMs favored the GB group, with statistically significant improvements in KOOS pain scores at multiple time points.

Conclusions:

  • Individualized alignment with GB did not enhance quadriceps strength post-TKR.
  • The GB technique demonstrated significant improvements in patient-reported pain scores up to 1 year.
  • GB may offer short-term benefits in pain, ROM, and some functional aspects compared to MR in TKR.