Patella scores are similar both with gap balancing and measured resection after total knee arthroplasty: a randomized single-centre study

PurposeThe purpose of this prospective study was to compare femoral component rotation (FCR) values when adjusted with 'gap balancing' (GB) and 'measured resection' (MR) techniques following total knee arthroplasty (TKA). The study hypothesis was that the GB technique would be better on FCR than MR in TKA.MethodsFrom a total of 93 unilateral TKAs performed between August 2019 and November 2020, the FCR values were adjusted by GB in 46 cases and MR in 47. Post-TKA magnetic resonance imaging (MRI) was applied for FCR assessment. Orthoroentgenograms and lateral knee radiographs were taken to determine the mechanical axis and posterior condylar offset (PCO) ratio, respectively. Both groups were compared radiologically. The Western Ontario and Mcmaster Universities Osteoarthritis Index (WOMAC), Knee Society Score (KSS), and Hospital for Special Surgery (HSS) patella scores were calculated and compared between the groups preoperatively and at the end of 6 months, and 1 and 2 years postoperatively.ResultsThere was no difference between the groups in respect of the demographic data. The mean HSS patella score was 86.4 & PLUSMN; 4.1 in the GB group and 84.6 & PLUSMN; 3.8 in the MR group in the 2nd year (p = 0.047). A higher degree of external rotation in the FC was determined in the GB group [2.2 & DEG; (1.7 & DEG;-4.3 & DEG;)] compared to the MR group [1.7 & DEG; (0.8 & DEG;-3.0 & DEG;)] (p = 0.009). The postoperative increase in PCO ratio was higher in the GB group (p = 0.005). All other variables were similar in both groups.ConclusionThe results of this study showed that at the end of the 2nd year, the HSS patella scores were better, FCs were more externally rotated and PCO ratios were higher in TKAs using the GB technique. However, taking into account that the difference between the 2nd year HSS patella scores was too small to be considered clinically significant, it was shown that both the GB and MR techniques can be used for FCR in clinical practice without any hesitation.