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Updated: Aug 15, 2026
In Vitro Application of a Wireless Sensor in Flexion-Extension Gap Balance of Unicompartmental Knee Arthroplasty
Published on: May 5, 2023
Effect of Tibial Resection on Coronal and Sagittal Gap Balancing in Robot-Assisted Total Knee Arthroplasty
Unmesh S Mahajan1, Anurag H Daxini1, Sayyadshadab S Jafri1
1Department of Orthopaedics and Joint Replacement, Mahajan Ortho and Surgical Hospital, Nagpur, Maharashtra, India.
Introduction:
The essence of total knee arthroplasty (TKA) is achieving optimal soft tissue balance. While robotic systems provide real-time gap feedback, the isolated impact of tibial resection on gap symmetry remains underexplored.
Objective:
To evaluate the association between tibial resection and coronal and sagittal gap balancing in patients undergoing robot-assisted TKA (RATKA).
Materials And Methods:
A retrospective study of 1137 knees using the VELYS system was conducted. Medial-lateral gap differences in extension and flexion were compared before and after tibial resection. Mechanical alignment correction and insert size distribution were also analyzed.
Results:
Tibial resection was associated with improved extension gap symmetry in 88.4% of cases and flexion symmetry in 63.9%. Mean hip-knee-ankle correction was 5.2°, with 99.8% achieving neutral alignment. No meaningful correlation was found between post-tibial gaps and insert size.
Conclusion:
Tibial resection was associated with improved gap symmetry and mechanical axis correction during RATKA using a tibia-first workflow. These findings support the potential role of early tibial resection in optimizing gap balance; however, prospective multicenter studies incorporating long-term clinical and functional outcomes are needed to validate these observations.