Can We Really "Feel" a Balanced Total Knee Arthroplasty?

BACKGROUND: Balancing techniques in total knee arthroplasty are often based on surgeons' subjective judgment. However, newer technologies have allowed for objective measurements of soft tissue balancing. This study compared the use of sensor technology to the 30-year surgeon experience regarding (1) compartment loads, (2) soft tissue releases, and (3) component rotational alignments.
METHODS: Patients received either sensor-guided soft tissue balancing (n = 10) or manual gap balancing (n = 12). Wireless, intraoperative sensor tibial inserts were used to measure intracompartmental loads. The surgeon was blinded to values in the manual gap-balancing cohort. In the sensor cohort, the surgeon was unblinded, and implant trials were placed after normal releases were performed to guide further ligament releases after femoral and tibial resections, as needed. Load measurements were taken at 10°, 45°, and 90°.
RESULTS: The sensor cohort had lower medial and lateral compartment loading at 10°, 45°, and 90°. The sensor group had lower mean differences in intercompartment loading at 10° (-5.6 vs -51.7 lbs), 45° (-9.8 vs -45.9 lbs), and 90° (-4.3 vs -27 lbs) compared to manually balanced patients. There were 10 additional soft tissue releases in the sensor cohort (2 initial ones before sensor use), compared to 2 releases in the gap-balanced cohort. In the gap-balanced cohort, tibial trays were positioned at a mean 9° external rotation, compared to a mean 1° internal rotation in the sensor-guided cohort.
CONCLUSION: Sensor-balanced total knee arthroplasties provide objective feedback to perform releases and potentially improve knee balancing and rotational alignment. Future work may clarify whether these changes are beneficial for our patients.