Component gap measurement reflects the planned gap balance during total knee arthroplasty more accurately and reliably than bone surface gap measurement

• Published in: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Vol. 30; no. 2; pp. 584 - 592
• Main Authors: Shin, Kyun-Ho, Jang, Ki-Mo, Han, Seung-Beom
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.02.2022; Springer Nature B.V
• Subjects: Ankle; Arthritis; Arthroplasty (knee); Arthroplasty, Replacement, Knee - methods; Biomedical materials; Component reliability; Correlation coefficient; Correlation coefficients; Femur; Humans; Joint replacement surgery; Joint surgery; Knee; Knee Joint - surgery; Leg; Ligaments; Mathematical analysis; Measurement methods; Medical records; Medicine; Medicine & Public Health; Navigation systems; Orthopaedic implants; Orthopedics; Osteoarthritis; Osteoarthritis, Knee - surgery; Range of motion; Range of Motion, Articular; Regression analysis; Reliability analysis; Reproducibility of Results; Sports Medicine; Surgical techniques; Computer-assisted surgeries; Total knee arthroplasty; Gap balancing; Laxity; Gap measurement; Total knee replacement
• ISSN: 0942-2056; 1433-7347
• DOI: 10.1007/s00167-020-06324-7

Purpose This study aimed to compare the reliability of two gap assessment methods (component and bone surface gap measurement vs. planned gap balance) and identify the contributors to component gaps other than planned gaps. Methods The prospectively collected data for 122 consecutive primary total knee arthroplasties (TKAs; 114 patients). After femoral planning for gap balancing, the medial and lateral planned gaps were calculated (planned gap). The established medial extension and flexion gaps (MEG and MFG, respectively) and lateral extension and flexion gaps (LEG and LFG, respectively) were measured with and without the TKA components (bone surface and component gaps) at 0° and 90° flexion. The intraclass and Pearson correlation coefficients for each gap measurement method were assessed using planned gap values, and multiple linear regression analyses were performed to identify the contributors to component gaps. Results Compared with the bone surface gap measurement, the component gap measurement showed higher reliability and stronger correlation with the planned gap balance for each gap. The changes in the medial posterior femoral offset contributed to the MEG and LEG, whereas those in the joint line height contributed to the LEG. The changes in the hip–knee–ankle angle and lateral posterior femoral offset contributed to the LFG. Conclusion Component gap measurements of the established gap more accurately and reliably reflect the planned gap balance than do bone surface gap measurements. The established gaps are affected by several factors other than femoral planning.