Similar postoperative outcomes after total knee arthroplasty with measured resection and gap balancing techniques using a contemporary knee system: a randomized controlled trial

Abstract

Purpose

The Attune® Knee System provides new instrumentation to achieve symmetric flexion/extension gaps in total knee arthroplasty (TKA). However, there is limited information on the optimal TKA technique using this system. The aim of this randomised controlled trial was to determine which surgical technique results in better postoperative clinical outcomes after TKA using the contemporary Attune® Knee System: the measured resection or gap balancing technique.

Methods

A prospective randomized controlled trial was conducted with 100 patients undergoing TKA using measured resection (n = 50) or gap balancing (n = 50) technique. The measured femoral sizer was used in the measured resection group, while the balanced femoral sizer was used in the gap balancing group. Functional outcomes and quality of life were assessed preoperatively and at 6 months and 2 years post-surgery, using the Knee Society Function Score (KSFS), Knee Society Knee Score (KSKS), Oxford Knee Score (OKS), the Physical Component Score (PCS) and Mental Component Score (MCS) of Short-Form 36 (SF-36). Using weight-bearing coronal radiographs, the hip-knee-ankle angle (HKA), coronal femoral component angle (CFA), coronal tibial component angle (CTA) and joint line height were also evaluated for each patient.

Results

There were no significant differences in the functional scores or the proportion of patients from each group who were satisfied or had their expectations fulfilled at 6 months or 2 years post-surgery. There was also no significant difference in the number of patients who attained minimum clinically important difference (MCID) postoperatively between the groups. Postoperatively, there was no significant difference in the number of HKA outliers between the groups (p = 0.202). The postoperative CFA (p = 0.265) and CTA (p = 0.479) were similar between the groups. There was also no significant difference in the absolute change (p = 0.447) or proportion of outliers (p = 0.611) for joint line height between the groups.

Conclusion

Both measured resection and gap balancing techniques resulted in comparable functional and quality of life outcomes up to 2 years post-surgery. Both techniques appear to be equally effective in achieving excellent outcomes with the Attune® Knee System.

Level of evidence

I.

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Fig. 1

Abbreviations

KSFS:

Knee Society Function Score

KSKS:

Knee Society Knee Score

OKS:

Oxford Knee Score

PCS:

Physical Component Score

MCS:

Mental Component Score

SF-36:

Short-Form 36

MCID:

Minimum clinically important difference

TKA:

Total knee arthroplasty

BMI:

Body mass index

HKA:

Hip-knee-ankle angle

CFA:

Coronal femoral component angle

CTA:

Coronal tibial component angle

ATJL:

Adductor tubercle and joint line

ROM:

Range of motion

WOMAC:

Western Ontario and McMaster Universities Osteoarthritis Index

PROMs:

Patient-reported outcome measures

CT:

Computed tomography

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Funding

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Authors

Contributions

VM, MCL, MHLL and JYC helped in data collection, statistical analysis and drafting the manuscript. HNP, SLC, NNL and SJY conceived the study, study design and carried out the study. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Vikaesh Moorthy.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Approval from the institutional ethics committee (SingHealth CIRB Ref: 2014/2070) was obtained.

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Written consent from each patient was obtained.

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Moorthy, V., Lai, M.C., Liow, M.H.L. 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. Knee Surg Sports Traumatol Arthrosc (2020). https://doi.org/10.1007/s00167-020-06103-4

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Keyword

  • Total knee arthroplasty
  • Knee replacement
  • Knee
  • Randomized controlled trial
  • Quality of life