The Debate Over Measured Resection vs. Gap Balancing in TKA

    If proponents of measured resection in total knee arthroplasty (TKA) and proponents of gap balancing have the same goal – a well-aligned knee, appropriate rotation, and balanced flexion and extension gaps – then why are we debating which is better? Isn’t it essentially a circular argument?

    Gwo-Chin Lee, MD, thinks so. And, more important, he believes surgeons who do TKA are neither pure measured resecters or pure gap balancers – they do a little of each. He favors measured resection for TKA, for example, but he says he does some gap balancing during the procedure to ensure his flexion gaps are balanced. Surgeons who favor gap balancing also pay attention to the epicondylar axis to get the proper femoral rotation, as in the measured resection technique, Dr. Lee says.

    At ICJR’s annual Winter Hip & Knee Course, Dr. Lee debated Yogesh Mittal, MD, on the issue of measured resection vs. gap balancing when doing a TKA.

    Dr. Mittal agreed that the goals are the same, but he is firmly in the gap balancing camp, arguing that measured resection can result in unpredictable rotation of the femoral component, cause asymmetric flexion gaps, and predispose the patient to lateral laxity and condylar lift off.

    Gap balancing, Dr. Mittal says, creates more predictable flexion gap stability while minimizing condylar lift off.

    Not so, says Dr. Lee. He contends there is no evidence suggesting that the gap balancing technique leads to better rotation compared with the measured resection technique. In fact, the claim that rotation of the femoral component is more accurate with gap balancing is, simply put, not true, he said.

    Dr. Lee’s presentation can be found here.

    Dr. Mittal’s presentation can be found here.