No difference between tibia-first and femur-first techniques in TKA using computer-assisted surgery

The measured resection technique and the gap-balancing technique are two philosophies used in total knee surgery. It is still unknown whether one or the other technique provides superior results when computer-assisted surgery is performed. We hypothesized that the gap-balancing technique improves joint stability because the technique relies primarily on the soft tissue.

A prospective controlled study was performed in 116 patients using the tibia-first or femur-first technique. The Columbus^TM total knee system and the Orthopilot^® (Aesculap^® AG, Tuttlingen, Germany) navigation system were used in all cases. Sixty-three patients were allocated to the femur-first technique (group F) and 53 patients to the tibial first technique (group T). The mean follow-up time was 11.4 ± 1.1 months. The KSS, KOOS and SF-36 were taken prior to surgery and at the time of follow-up for clinical assessment. Long-leg weight-bearing radiographs were performed to assess ligament alignment. Radiographs in varus and valgus stress were performed using the Telos^®-Instrument (Telos^® GmbH, Greisheim, Germany) under a force of 15 N at the time of follow-up for the assessment of medial–lateral stability. The nonparametric t test (Mann–Whitney U-test) was used in order to compare the ligament stability and the scores between group F and group T.

The surgeon should use his/her preferred surgical technique providing the implantation is performed with computer assistance. It remains unclear whether the same findings will occur after conventional surgery.

II.