Gap Balancing vs. Measured Resection Technique in Total Knee Arthroplasty

Creation of symmetric balanced flexion and extension gaps is a surgical goal of a total knee arthroplasty (TKA).1) Precise soft tissue balancing combined with accurate bone resections determine rotation of the femoral component.2) Improper femoral component rotation results in patel-lofemoral instability,3) anterior knee pain, arthrofibrosis,4) and flexion gap instability.5,6) Gap balancing and measured resection techniques have been used to determine femoral component rotation. This chapter will review gap balancing techniques, emphasizing key surgical techniques to achieve correct femoral component rotation and flexion stability as well as discuss measured resection methodologies. A goal of total knee arthroplasty is to obtain symmetric and balanced flexion and extension gaps. Controversy exists regarding the best surgical technique to utilize to obtain gap balance. Some favor the use of a measured resection technique in which bone landmarks, such as the transepicondylar, the anterior-posterior, or the posterior condylar axes are used to determine proper femo