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Gap-balancing technique combined with patient-specific instrumentation in TKA

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Combining patient-specific instrumentation (PSI) with a balancer device in total knee arthroplasty (TKA) to achieve functional femoral rotational alignment is a novel technique. The primary goal of this study was to introduce a new method to combine PSI with a gap-balancing technique and to determine the impact of the technique on rotation of the femoral component.

Materials and methods

Twenty-five primary TKAs (15 women, 10 men) were prospectively studied. All TKAs involved PSI with an associated gap-balancing device. Front plane alignment was performed intraoperatively with the PSI, followed by rectangular, symmetrical extension and creation of a flexion gap using the balancer device to set the femoral rotation.

Results

Femoral component rotation was between 3° internal and 6° external rotation versus the transepicondylar axis. There were no postoperative signs of patellofemoral dysfunction. In no cases was the resulting joint line displacement >3 mm. The mean elevation was 1.2 ± 0.9 mm (range 0–3). The leg axis was straight in all cases (±3°), at a mean of 1.6° ± 1.0° varus (range 0°–3° varus).

Conclusions

PSI was with the gap-balancing technique was successfully used without affecting anatomical alignment. With the balancer device, PSI can be used more widely than techniques based solely on landmarks, as the soft-tissue tension can be taken into account, thus virtually eliminating flexion instabilities.

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Authors and Affiliations

  1. Orthopedic Department, Hospital Märkisch Oderland, Section Wriezen, Sonnenburger Weg 3, 16269, Wriezen, Germany

    Hagen Hommel

  2. Center for Musceloskeletal Surgery, Orthopedic Department, Charité Universitätsmedizin, Berlin, Germany

    Carsten Perka

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  1. Hagen Hommel
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  2. Carsten Perka
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Correspondence to Hagen Hommel.

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Conflict of interest

Preparation of this manuscript was supported by Smith & Nephew GmbH, Marl, Germany. Smith & Nephew had no involvement in the collection, analysis or interpretation of the data, in the writing of the report or in the decision to submit the results for publication.

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Hommel, H., Perka, C. Gap-balancing technique combined with patient-specific instrumentation in TKA. Arch Orthop Trauma Surg 135, 1603–1608 (2015). https://doi.org/10.1007/s00402-015-2315-6

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