A Comparison of Recovery Curves in Total Knee Arthroplasty With and Without Soft-Tissue Releases

The use of alternative alignment strategies has become commonplace in performing total knee arthroplasty (TKA). A primary reported benefit of these techniques is a reduction in the need for soft-tissue releases for appropriate balance. Using patient-reported outcome measures (PROMs), we compared the incidence, demographics, and recovery curves of TKAs performed with and without the need for a soft-tissue release.

Between 2018 and 2023, all TKAs performed using either navigation or robotics at a single academic institution were reviewed. We recorded demographic data, preoperative alignment, intraoperative releases performed the need for manipulations, and PROMs preoperatively and two weeks, six weeks, and one year postoperatively. Preoperative radiographs were reviewed for hip-knee-angle alignment.

We identified a total of 1,123 TKAs, of which 565 (50.3%) required no intraoperative release to balance and 558 (49.7%) did require a release. Patients requiring a release were younger (P = 0.04), more likely to be men (P = 0.003), and have a severe deformity (less than -6 or greater than 6 hip-knee-angle alignment) (P < 0.001). Of the patients who required a release, the majority were medial releases (N = 433, 78%). We identified no significant difference in recovery PROMs at any interval. This did not change with subanalysis of type of release, preoperative deformity, or severity. Manipulation rates were similar between the two groups (3.0 versus 5.3%, P > 0.05).

Our review of patients undergoing TKA with and without soft-tissue release found no significant difference in PROMs-based recovery curves at any time point out to a year. The results indicate that alternative alignment techniques that seek to avoid soft-tissue release may not improve conventional PROMs.