Spacer-Based Gap Balancing in Total Knee Arthroplasty: Clinical Success with a Reproducible Technique
Bibliographic record
Abstract
Abstract Proper coronal and transverse ligament balancing is an important aspect of total knee arthroplasty (TKA) and has an impact on postoperative outcome. Many variations of the gap balancing technique were described to address this challenge, most of them using various tensioning devices, but none for which the use is widespread. The aim of this paper is to describe a gap technique variant for TKA using spacer blocks and report the clinical results for a cohort of patients on which it was used. A total of 114 TKAs were performed in 101 patients using a standardized surgical technique that integrates ligament balancing with sizing and positioning of the femoral component. Clinical variables were assessed preoperatively and after a mean follow-up of 43 months using the Knee Society score, the Knee injury and Osteoarthritis Outcome Score (KOOS), and the International Knee Documentation Committee (IKDC) score. A significant improvement in every clinical function score was noted at the latest follow-up compared with preoperative values. All the knees except four (96%) were well-balanced at the last follow-up examination; a firm but delayed end-point was noted in the remaining four knees but did not seem to affect patient outcome. The patellar button was centered in the prosthetic trochlear groove for all knees on the postoperative radiographs. Similar improvements in the scores and in range of motion were noted for knees with a preoperative coronal misalignment of 10 degrees or more (n = 26) compared with knees with less than 10 degrees of varus or valgus (n = 77). The described surgical technique appears to be reliable to obtain well-balanced knees and good patellar tracking when performing a primary TKA, even in knees with important coronal misalignment.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".