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General Orthopaedics

MEASURED RESECTION TRUMPS GAP BALANCING IN TKA – AFFIRMS

Current Concepts in Joint Replacement (CCJR) – Spring 2015



Abstract

Measured resection approach (anatomic) is based on the patients' unique anatomy adjusting for worn cartilage or bone loss. The femoral component is aligned around the primary transverse distal femoral axis around which the tibia follows a multi-radius of curvature. The tibia cut is made according to the patient's native anatomy adjusting for worn cartilage and bone loss, and applying an anatomic amount of tibial slope. This technique minimises the need for partial ligamentous releases to a large degree preserving the competence of the patient's soft tissue, though ligament and capsular releases can be used in difficult cases. Adjustments for the varus/valgus (up to 3 degrees) or slope of the tibial bone cut (3–10 degrees) further aids in knee balancing. The final alignment may not agree with a neutral hip-knee-ankle mechanical alignment on full length standing x-rays, leaving varus knees in slight varus, and valgus legs in neutral. Since little balance is required this operation can be performed in less than 40 minutes.