• T Huang, Y Long, D George, and W Wang.
• The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
• Bone Joint J. 2017 Feb 1; 99-B (2): 151-158.

AimsThere are two techniques widely used to determine the rotational alignment of the components in total knee arthroplasty (TKA); gap balancing (GB) and measured resection (MR). Which technique is the best remains controversial. We aimed to investigate this in a systematic review and meta-analysis.Materials And MethodsIn accordance with the methods of Cochrane, databases were searched for all randomised controlled trials in the literature between January 1986 and June 2015 comparing radiographic and clinical outcomes between the use of these two tecniques. Meta-analysis involved the use of the Revman5.3 software provided by Cochrane collaboration.ResultsA total of 1464 papers were initially identified, and after the application of rigourous inclusion and exclusion critera, eight were included in the study. In total they inolved 980 TKAs. The meta-analysis showed that GB techniques resulted in statistically significant improvements in the restoration of mechanical and rotational alignment and mean Knee Society Scores and Knee Society Function scores two years post-operatively, but resulted in greater elevation of the position of the joint line. There is no significant difference in the other radiographic data.ConclusionThis study suggests that GB may provide better radiographic and clinical outcomes than MR when used to determine mechanical rotation in TKAs. Cite this article: Bone Joint J 2017;99-B:151-8.©2017 The British Editorial Society of Bone & Joint Surgery.

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