• Kanto Nagai, Hirotsugu Muratsu, Yutaro Kanda, Masanori Tsubosaka, Tomoyuki Kamenaga, Hidetoshi Miya, Takehiko Matsushita, Takahiro Niikura, Ryosuke Kuroda, and Tomoyuki Matsumoto.
• Department of Orthopaedic Surgery, Steel Memorial Hirohata Hospital, 3-1, Yumesaki-cho, Hirohata-ku, Himeji, 671-1122, Japan.
• Knee Surg Sports Traumatol Arthrosc. 2018 Nov 1; 26 (11): 3474-3481.

PurposeTo investigate intraoperative soft tissue balance with femoral component trial in place using a novel medial preserving gap technique, focusing on medial compartment stability and allowing lateral physiological laxity, with compared with using a measured resection technique in posterior-stabilized (PS) total knee arthroplasty (TKA).MethodsPrimary PS TKA, using either medial preserving gap technique (n = 127) or measured resection technique (n = 148), was performed in 275 subjects with varus knee osteoarthritis. Intraoperative soft tissue balance with femoral component in place was assessed using Offset Repo-Tensor with 40 lbs. of joint distraction force throughout the range of motion, and medial and lateral compartment gaps (mm) were calculated. Medial and lateral joint gap changes (mm) were calculated by subtracting the medial/lateral compartment gap at 0° from the medial/lateral compartment gap at each knee flexion angle, respectively.ResultsMedial and lateral joint gap changes in medial preserving gap technique were significantly smaller than measured resection technique respectively (mean difference between two procedures: medial; 0.9 ± 0.2 mm, lateral; 1.0 ± 0.3 mm). Medial and lateral joint gaps were significantly changed during knee flexion in measured resection technique, whereas medial and lateral joint gaps were not significantly changed during mid-to-deep knee flexion (30°-90° in medial, 30°-120° in lateral) in medial preserving gap technique.ConclusionsMedial preserving gap technique provided more consistent intraoperative soft tissue balance during knee flexion than the measured resection technique, suggesting that this novel technique can be utilized to obtain a more stable joint gap in PS TKA.Level Of EvidenceIII.

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