Clinical Outcomes Of Gap Balancing Versus Measured In Total Knee Arthroplasty:A Meta-analysis Involving 2259 Subjects

1.Objective:The argument on the clinical effects between gap balancing(GB)and measured resection(MR)in total knee arthroplasty(TKA)remains to be resolved.A systematic review and meta-analysis was performed to investigate which technique in TKA performs better clinical effect.2.Methods:A total of 20 studies involving 2259 cases were included in the meta-analysis.The primary outcome measure was Knee Society Score(KSS),whereas the secondary outcomes included other function assessment systems(eg,range of motion[ROM],Western Ontario and McMaster University[WOMAC]Osteoarthritis Index),radiological outcomes(eg,femoral component rotation,total outliers),revision rate,complications(eg,infection,loosening,instability),and surgical time.3.Results:The GB technique was associated with statistically significant increases in the primary outcomes of KSS-function in 1 year.However,a mean difference(MD)of 2.12 points was below the minimal clinically important difference of 6 points.No differences were found in the analyses of KSS-knee and KSS-function in any other follow up periods.Secondary outcome assessments showed significant decreased surgical time(MD 16.18,P<.00001)for MR.Although statistically significant difference in favor of GB was identified in total outliers(RR 1.72,P=.0004),the 2 techniques were comparable in ROM,WOMAC,femoral component rotation,complications,and revision rate.4.Conclusion:We conclude that both techniques can result in equivalent results when done properly,and each surgeon must understand the strengths and weaknesses of each technique.