Meta analysis of the effect of gap balance and measurement osteotomy in total knee arthroplasty

doi:10.3877/cma.j.issn.2095-8757.2022.04.007

Abstract

Abstract:

Objective

To evaluate the effect of gap balance (GB) and measured resection (MR) in total knee arthroplasty (TKA).

Methods

Searches for randomized controlled clinical trials on the comparison of GB and MR effects during TKA published from May 2009 to May 2021 were performed in PubMed, Embase, CNKI, Vip, Wanfang, China Biomedical Literature Database, etc. And the magazine catalogue and references were searched manually. Cochrane risk of bias tool was used to assess the underling risk of bias of the included literature, and the quality of included literature was assessed with Jadad score. Meta analysis was performed in postoperative knee society function score (KSFS), postoperative knee society score (KSS), postoperative range of motion, postoperative angle between lower limb force line and leg anatomical axis, postoperative mechanical axis angle, postoperative joint space, intraoperative osteotomy and operation time using Review Manager 5.3.

Results

A total of 16 articles were included for meta analysis, including 12 in foreign languages and 4 in Chinese. MR was better in the overall KSFS and KSS than GB (MD=2.12, 95%CI: 0.74~3.50, P < 0.01), while GB was better in the angle between the lower limb force line and the leg anatomical axis (MD=-1.00, 95%CI: -1.86~0.13, P < 0.05), and the angle between the mechanical axis than MR (MD=-0.39, 95%CI: -0.65~-0.13, P < 0.01).

Conclusion

In the treatment of moderate and severe knee osteoarthritis with TKA, MR has a better functional score, while GB has more advantages in imaging results.

Key words: Gap balance, Measuring resection, Total knee arthroplasty, Effect, Meta analysis

Yuepeng Wang, Su Yang, Shilei Qin, Pengfei Han, Yunfeng Xu. Meta analysis of the effect of gap balance and measurement osteotomy in total knee arthroplasty[J]. Chinese Journal of Geriatrics Research(Electronic Edition), 2022, 09(04): 30-39.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhlnbyjdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-8757.2022.04.007

https://zhlnbyjdzzz.cma-cmc.com.cn/EN/Y2022/V09/I04/30

Figures/Tables 10

References 36

[1]	Vogel N, Kaelin R, Rychen T, et al. The German version of the High-Activity Arthroplasty Score is valid and reliable for patients after total knee arthroplasty[J]. Knee Surg Sports Traumatol Arthrosc, 2022, 30(4):1204-1211.
[2]	Wang Z, Cheng X, Zhang Y, et al. Restoration of constitutional alignment in tka with a novel osteotomy technique[J]. J Knee Surg, 2020, 33(2):190-199.
[3]	Miyasaka T, Saito M, Kurosaka D, et al. Impact of posterior femoral condylar cartilage and posterior intercondylar distance on rotation of femoral component in total knee arthroplasty[J]. BMC Musculoskelet Disord, 2020, 21(1):498-451.
[4]	Yulou S, Yanqin X, Yongjun X, et al. Method and effect of total knee arthroplasty osteotomy and soft tissue release for serious knee joint space narrowing[J].Open Med (Wars), 2015, 10(1):457-461.
[5]	Arnholdt J, Boelch SP, Dogan F, et al. Revision arthroplasty with rotating hinge systems for total knee arthroplasty instability[J]. Oper Orthop Traumatol, 2020, 32(4): 298-308.
[6]	Parker DA, Dunbar MJ, Rorabeck CH, et al. Extensor mechanism failure associated with total knee arthroplasty: Prevention and management[J]. J Am Acad Orthop Surg, 2003, 11(4):238-247.
[7]	De Wachter E, Vanlauwe J, Krause R, et al. Clinical and radiographic outcome of gap balancing versus measured resection techniques in total knee arthroplasty[J]. Arthroplast Today, 2020, 6(4):835-844.
[8]	Migliorini F, Eschweiler J, Mansy YE, et al. Gap balancing versus measured resection for primary total knee arthroplasty: A meta-analysis study[J]. Arch Orthop Trauma Surg, 2020, 140(9):1245-1253.
[9]	Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: Is blinding necessary[J]? Control Clin Trials, 1996, 17(1):1-12.
[10]	Babazadeh S, Dowsey MM, Stoney JD, et al. Gap balancing sacrifices joint-line maintenance to improve gap symmetry: A randomized controlled trial comparing gap balancing and measured resection[J]. J Arthroplasty, 2014, 29(5):950-954.
[11]	Baier C, Fitz W, Craiovan B, et al.Improved kinematics of total knee replacement following partially navigated modified gap-balancing technique[J]. Int Orthop, 2014, 38(2):243-249.
[12]	Cidambi KR, Robertson N, Borges C, et al. Intraoperative comparison of measured resection and gap balancing using a force sensor: A prospective, randomized controlled trial[J]. J Arthroplasty, 2018, 33(7):126-130.
[13]	Hommel H, Kunze D, Hommel P, et al. Small improvements in postoperative outcome with gap balancing technique compared with measured resection in total knee arthroplasty[J]. Open Orthop J, 2017, 11(1):1236-1244.
[14]	Hernández-Hermoso JA, Nescolarde-Selva L, Rodríguez-Montserrat D, et al. Different femoral rotation with navigated flexion-gap balanced or measured resection in total knee arthroplasty does not lead to different clinical outcomes[J]. Knee Surg Sports Traumatol Arthrosc, 2019, 28(6):1805-1813.
[15]	Lee DH, Park JH, Song DI, et al. Accuracy of soft tissue balancing in TKA: Comparison between navigation-assisted gap balancing and conventional measured resection[J]. Knee Surg Sports Traumatol Arthrosc, 2010, 18(3):381-387.
[16]	Lee HJ, Lee JS, Jung HJ, et al. Comparison of joint line position changes after primary bilateral total knee arthroplasty performed using the navigation-assisted measured gap resection or gap balancing techniques[J]. Knee Surg Sports Traumatol Arthrosc, 2011, 19(12):2027-2032.
[17]	袁兴期，冯瑛琦，许飞.TKA术中间隙平衡与测量截骨技术行股骨外旋截骨效果分析[J].中国现代手术学杂志，2020，24（5）：347-352.
[18]	Moorthy V, Lai MC, Liow MHL, et al. Similar postoperative outcomes after total knee arthroplasty with measured resection and gap balancing techniques using a contemporary knee system: A randomized controlled trial[J]. Knee Surg Sports Traumatol Arthrosc, 2020, 29(10):3178-3185.
[19]	Pang HN, Yeo SJ, Chong HC, et al. Computer-assisted gap balancing technique improves outcome in total knee arthroplasty, compared with conventional measured resection technique[J]. Knee Surg Sports Traumatol Arthrosc, 2011, 19(9):1496-1503.
[20]	Tapasvi SR, Shekhar A, Patil SS, et al. Comparison of gap balancing vs measured resection technique in patients undergoing simultaneous bilateral total knee arthroplasty: One technique per knee[J]. J Arthroplasty, 2020, 35(3):732-740.
[21]	Teeter MG, Perry KI, Yuan X, et al. Contact kinematic differences between gap balanced vs measured resection techniques for single radius posterior-stabilized total knee arthroplasty[J]. J Arthroplasty, 2017, 32(6):1834-1838.
[22]	Tigani D, Sabbioni G, Ben Ayad R, et al. Comparison between two computer-assisted total knee arthroplasty: Gap-balancing versus measured resection technique[J]. Knee Surg Sports Traumatol Arthrosc, 2010, 18(10):1304-1310.
[23]	吴建明，胡伟，刘向阳，等.全膝关节置换中采用测量截骨与间隙平衡技术的对比分析[J].中国组织工程研究，2019，23（18）：2817-2821.
[24]	柴瑞宝，刘瑞，张子安.间隙平衡与测量截骨技术在全膝关节置换的比较[J].中国矫形外科杂志，2020，28（9）：804-808.
[25]	王帝，韩立业，张爱民，等.不同截骨技术在老年全膝关节置换术中的效果对比研究[J].中国临床医生杂志，2020，48（11）：1343-1346.
[26]	Huijbregts HJ, Khan RJ, Fick DP, et al. Component alignment and clinical outcome following total knee arthroplasty: A randomised controlled trial comparing an intramedullary alignment system with patient-specific instrumentation[J]. Bone Joint J, 2016, 98(8):1043-1049 .
[27]	Laskin RS. Flexion space configuration in total knee arthroplasty[J]. J Arthroplasty, 1995, 10(5):657-660.
[28]	Scuderi GR, Komistek RD, Dennis DA, et al. The impact of femo-ral component rotational alignment on condylar lift-off[J]. Clin Orthop Relat Res, 2003, 4(10):148-154.
[29]	文鹏飞，郝林杰，王军，等.间隙平衡和测量截骨技术在分期双侧全膝关节置换术中的对比研究[J].中华医学杂志，2022，102（37）：2926-2932.
[30]	Kakuta A, Ikeda R, Takeshita B, et al. Intraoperative changes in medial joint gap after posterior femoral condylar resection, posterior osteophyte removal, and femoral component placement during primary total knee arthroplasty[J]. Knee, 2022, 39:1-9.
[31]	Zheng K, Zhu F, Zhang W, et al. Total knee arthroplasty using adjusted restricted kinematic alignment for the treatment of severe varus deformity: Technical note[J]. Orthop Surg, 2022, 14(8):1892-1901.
[32]	Okazaki K. Adopting the joint line theory for bone resection in cruciate-retaining total knee arthroplasty to prevent flexion gap tightness[J]. Orthop Surg, 2022, 14(5):984-989.
[33]	Supreeth S, Yukata K, Suetomi Y, et al. Optimal intraoperative medial joint gap in extension to prevent flexion contracture following total knee arthroplasty using modified gap balancing technique[J]. J Clin Orthop Trauma, 2022, 33:101992.
[34]	Sameshima S, Inui H, Taketomi S, et al. The intraoperative gap differences due to joint distraction force differences in total knee arthroplasty are affected by preoperative lower limb alignment and body mass index[J]. Clin Biomech (Bristol, Avon), 2022, 99:105765.
[35]	Winnock de Grave P, Kellens J, Luyckx T, et al. Inverse kinematic alignment for total knee arthroplasty[J]. Orthop Traumatol Surg Res, 2022, 108(5):103305.
[36]	Kamei G, Ishibashi S, Yoshioka K, et al. Accuracy of total knee arthroplasty using the modified gap technique based on the bone gap: An evaluation of the bone gap with a distal femoral trial component[J]. Arthroplasty, 2021, 3(1):17.

作者	国家	发表年份	分组（GB组/MR组，例）	平均年龄（GB组/MR组，岁）	男性（GB组/MR组，例）	随访时间（月）	结局指标	改良Jadad质量评价
Babazadeh等^[10]	澳大利亚	2014	51/52	69.9/70.2	14/22	24	①⑤⑥	6
Baier等^[11]	德国	2014	19/21	70.0/72.4	15*	6	①②	5
Cidambi等^[12]	美国	2018	48/43	62.3*	41*	—	⑤	4
Hommel等^[13]	德国	2017	100/100	67.1/66.9	38/37	120	①②④⑦	7
Hernández-Hermoso等^[14]	西班牙	2019	39/33	70.2±6.7/69.9±7.4	8/4	24	①	4
Lee等^[15]	韩国	2010	60/56	68.7/69.2	3/2	24	④⑤	5
Lee等^[16]	韩国	2011	30/30	68.9/68.9	2/2	24	⑤⑦	4
袁兴期等^[17]	中国	2020	45/45	69.71±5.25/69.38±5.04	19/17	12	①②③⑥⑦	6
Moorthy等^[18]	新加坡	2020	50/50	68.4±7.0/66.1±7.2	10/12	24	①②	4
Pang等^[19]	新加坡	2011	70/70	68/70	10/12	24	①②④	5
Tapasvi等^[20]	印度	2020	50/50	66±7.4*	10*	24	②④⑥	5
Teeter等^[21]	加拿大	2017	12/12	67.2±7.0/70.0±7.9	7/3	12	①	4
Tigani等^[22]	意大利	2010	57/66	67/69	15/20	—	④	4
吴建明等^[23]	中国	2019	38/38	60.1±6.3/58.8±6.4	16/13	12	①③⑥⑦	6
柴瑞宝等^[24]	中国	2020	39/39	71.46±4.97/70.30±4.11	20/21	24	③⑦	4
王帝等^[25]	中国	2020	44/44	65.19±3.19/65.35±3.28	24/28	12		4

作者	国家	发表年份	分组（GB组/MR组，例）	平均年龄（GB组/MR组，岁）	男性（GB组/MR组，例）	随访时间（月）	结局指标	改良Jadad质量评价
Babazadeh等^[10]	澳大利亚	2014	51/52	69.9/70.2	14/22	24	①⑤⑥	6
Baier等^[11]	德国	2014	19/21	70.0/72.4	15*	6	①②	5
Cidambi等^[12]	美国	2018	48/43	62.3*	41*	—	⑤	4
Hommel等^[13]	德国	2017	100/100	67.1/66.9	38/37	120	①②④⑦	7
Hernández-Hermoso等^[14]	西班牙	2019	39/33	70.2±6.7/69.9±7.4	8/4	24	①	4
Lee等^[15]	韩国	2010	60/56	68.7/69.2	3/2	24	④⑤	5
Lee等^[16]	韩国	2011	30/30	68.9/68.9	2/2	24	⑤⑦	4
袁兴期等^[17]	中国	2020	45/45	69.71±5.25/69.38±5.04	19/17	12	①②③⑥⑦	6
Moorthy等^[18]	新加坡	2020	50/50	68.4±7.0/66.1±7.2	10/12	24	①②	4
Pang等^[19]	新加坡	2011	70/70	68/70	10/12	24	①②④	5
Tapasvi等^[20]	印度	2020	50/50	66±7.4*	10*	24	②④⑥	5
Teeter等^[21]	加拿大	2017	12/12	67.2±7.0/70.0±7.9	7/3	12	①	4
Tigani等^[22]	意大利	2010	57/66	67/69	15/20	—	④	4
吴建明等^[23]	中国	2019	38/38	60.1±6.3/58.8±6.4	16/13	12	①③⑥⑦	6
柴瑞宝等^[24]	中国	2020	39/39	71.46±4.97/70.30±4.11	20/21	24	③⑦	4
王帝等^[25]	中国	2020	44/44	65.19±3.19/65.35±3.28	24/28	12		4

Please choose a citation manager

Content to export