Comparison of outcomes between gap balancing and measured resection techniques for total knee arthroplasty: A prospective, randomized, controlled trial

Özet

Objective: The aim of this study was to compare the effect of Gap Balancing (GB) versus Measured Resection (MR) techniques onthe early clinical and radiological results of Total Knee Arthroplasty (TKA).Methods: In this prospective study, 99 patients (99 knees) who underwent unilateral TKA between March 2018 and January 2019were randomly allocated to one of two groups: The GP group, TKA with GB technique (19 male, 31 female; mean age = 55.9 ±16.5)and the MR group, TKA with MR technique (19 male, 30 female; mean age = 54.2 ± 18.7). Patients in both groups werecomparable in terms of the demographic and clinical data. The angle of cutting block to PCA and Cutting Thickness of theMedial and Lateral Condyle (CTMC, CTLC) were intraoperatively measured. In radiographic analysis, Preoperative MechanicalFemorotibial Angle (Pre-mFTA), Postoperative Mechanical Femorotibial Angle (Post-mFTA), and joint line changes wereexamined. Femoral component Rotation Angle (FCRA) was also measured by computed tomography. In gait analysis, thespatiotemporal parameters (walking speed, step length, and single support time) and kinematics parameters (flexion angle,extension angle, and transversal rotation) were collected at 12 months postoperatively. Furthermore, Western Ontario andMcMaster Universities Arthritis Index (WOMAC) were performed at 12 months after surgery.Results: CTMC and CTLC were both significantly higher in GB group than in the MR group (9.8±2.0 mm vs 8.5 ± 1.2 mm; 7.9 ±1.8mm vs 6.8 ± 1.4mm; P = 0.001, P = 0.002, respectively). Angle of cutting block to PCA was statistically lower in GB group than inthe MR group (1.7 ± 1.5° vs 3.1 ± 0.5 °; P 0.05). Although post-mFTA significantly improved comparedwith pre-mFTA in both groups, no significant difference was observed in the changes of post-mFTA between the two groups (0.9± 1.7° vs 0.3 ± 1.8°, P > 0.05). No significant differences were determined between the two groups in spatiotemporal gaitparameters including walking speed, step length, and single support time. The sagittal max knee flexion range was significantlylarger in the GB group than in the MR group (49.27 ± 5.24 ° vs 45.99 ± 8.21 °, P 0.05).Conclusion: Evidence from this study has revealed GB and MR techniques have both little effect on early clinical results of TKA.Nonetheless, GB technique can provide better knee flexion in the early postoperative gait status compared with MR technique. Level of Evidence: Level I, Therapeutic Study