title: Contact Kinematic Differences Between Gap Balanced vs Measured Resection Techniques for Single Radius Posterior-Stabilized Total Knee Arthroplasty.
abstract: Measured resection (MR) and gap balancing (GB) are common surgical techniques for total knee arthroplasty (TKA). Controversy has arisen as each conceptually differs in how the knee is balanced through bone and soft tissue management. The objective of the present study was to compare both the frequency of condylar liftoff and the location of femorotibial contact from extension through midflexion between patients undergoing GB or MR TKA.
  
  
  
  A total of 24 knees (23 patients) were randomly assigned at referral to either a surgeon performing MR or GB TKA with the same single radius, posterior-stabilized implant (12 per cohort). At 1-year postoperation, patients underwent biplanar radiographic imaging at 0°, 20°, 40°, and 60° of flexion. Condylar liftoff, contact location, and magnitude of excursion on each condyle were measured. Preoperative and postoperative clinical outcome scores were also collected.
  
  
  
  There was no difference (P = .41) in the frequency of liftoff between cohorts. The MR cohort had more posterior contact on the medial condyle (P < .01) and more anterior contact on the lateral condyle (P < .01) throughout flexion. Motion patterns were similar between cohorts, with similar medial (P = .48) and lateral (P = .44) excursion, which was equal in magnitude between condyles for both MR (P = .48) and GB (P = .73). There was no difference in clinical outcome scores between groups.
  
  
  
  For this particular implant system, GB and MR appear to produce similar kinematic and patient-reported outcome results.
authors.affiliation: Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, ON, Canada; Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada; Surgical Innovation Program, Lawson Health Research Institute, London, ON, Canada; Imaging Research Laboratories, Robarts Research Institute, London, ON, Canada. Electronic address: matthew.teeter@lhsc.on.ca.
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Teeter
authors.affiliation: Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, ON, Canada; Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Kevin I
authors.initials: KI
authors.lastname: Perry
authors.affiliation: Imaging Research Laboratories, Robarts Research Institute, London, ON, Canada.
authors.forename: Xunhua
authors.initials: X
authors.lastname: Yuan
authors.affiliation: Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, ON, Canada.
authors.forename: James L
authors.initials: JL
authors.lastname: Howard
authors.affiliation: Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, ON, Canada.
authors.forename: Brent A
authors.initials: BA
authors.lastname: Lanting
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D001696:Biomechanical Phenomena; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007717:Knee / Q000601:surgery; D007719:Knee Joint / Q000601:surgery; D007720:Knee Prosthesis; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000601:surgery; D011184:Postoperative Period; D016059:Range of Motion, Articular
keywords: gap balancing; kinematics; measured resection; radiostereometric analysis; single radius femoral component; total knee arthroplasty