The reversed gap technique produces anatomical alignment with less midflexion instability in total knee arthroplasty: a prospective randomized trial.

PURPOSE: No surgical technique is capable of controlling the stability of the joint in midflexion. The purpose of the present study was to present and evaluate a surgical technique that aims to reduce the need for soft-tissue release and optimize stability in midflexion.
METHODS: Sixty knee joints were included in this prospective randomized study. Surgery was performed either according to a classical gap (GT) technique or using the reversed gap (RG) technique. In the RG, the femoral component was positioned parallel to the surgical transepicondylar axis using a preoperative MRI and a navigation system. The frontal alignment of the tibia was then selected to produce a symmetric flexion gap. Then, the frontal alignment of the femoral component was adjusted to produce a symmetric extension gap. Soft-tissue release was defined to be extensive if more than two steps or stabilizing structures were involved. Joint stability was measured at different flexion angles (-5° to 120°) using a gap tensioning device and the trial femoral implant.
RESULTS: In the GT group, 16 knee joints (53 %) showed an instability of more than 2 mm at 5°, 30° or 60°, compared with 8 knee joints (27 %) in the RG group (p = 0.035). The RG did not lead to a reduction in the number of soft-tissue releases, but they were less extensive.
CONCLUSION: RG reduced midflexion instability and the number of extensive soft-tissue releases. It may simplify the operation by reducing the extent of soft-tissue releases and avoid instability-related problems of knee arthroplasty. Nevertheless, it should only be performed under controlled conditions until long-term clinical data are available. LEVEL OF EVIDENCE: I.

RCT Entities:   Population Interventions Outcomes