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Zhu K, Wang J, Dai H, Xi Y, Wang Q, Zhang X, Wang Q. Effect of Posterior Cruciate Ligament Resection on Gap Balancing in Robot-assisted Total Knee Arthroplasty. Orthop Surg 2024; 16:1929-1938. [PMID: 38859720 PMCID: PMC11293922 DOI: 10.1111/os.14135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 05/19/2024] [Accepted: 05/23/2024] [Indexed: 06/12/2024] Open
Abstract
OBJECTIVE Retention or sacrifice of the posterior cruciate ligament (PCL) is one of the most controversial issues while performing total knee arthroplasty (TKA). This study aimed to evaluate the impact of PCL resection on flexion-extension gaps, femoral component rotation, and bone resection amounts during robot-assisted TKA. METHODS This prospective study included 40 patients with knee osteoarthritis who underwent robot-assisted posterior-stabilized (PS) TKA between September 2021 and February 2022. Of the patients, 75% were women (30/40) with a mean age and BMI of 72.6 years and 27.4 kg/m2, respectively. The guidance module and camera stand assembly were used to capture gaps before and after PCL resection. Measurements of femoral component rotation and bone resection amounts were made in cruciate-retaining (CR) TKA mode and PS-TKA mode. RESULTS After PCL resection, the mean change in the medial and lateral compartments of flexion gaps increased by 2.0 and 0.6 mm, respectively (p < 0.001). Compared with the CR-TKA mode group, the bone resection amounts of the medial posterior condyle and the lateral posterior condyle in the PS-TKA mode group decreased by 2.0 ± 1.1 and 1.1 ± 1.1 mm, respectively, and the external rotation of the femoral prosthesis relative to the posterior condylar axis and trans-epicondylar line was reduced by 1.0° ± 1.3° and 1.2° ± 1.6°, respectively (p < 0.001). CONCLUSION The release of the PCL did not affect the extension gap, but significantly increased the flexion gap. Moreover, the increases in the medial flexion gap were greater than those of the lateral flexion gap. After PCL resection, less external rotation of the femoral prosthesis and fewer bone cuts of the posterior femur were needed in PS-TKA.
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Affiliation(s)
- Kechao Zhu
- Department of OrthopedicsShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Jiaxing Wang
- Department of OrthopedicsShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Huiyong Dai
- Department of OrthopedicsShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yan Xi
- Shanghai First‐Imaging Information Technology Co., LtdShanghaiChina
| | - Qiaojie Wang
- Department of OrthopedicsShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Xianlong Zhang
- Department of OrthopedicsShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Qi Wang
- Department of OrthopedicsShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
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Liu K, Fan Z, Liu W, Li L, Guan Y, Fu D. The Clinical Outcomes of Measured Resection and Gap Balancing Techniques in Primary Total Knee Arthroplasty: A Meta-analysis. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2024; 162:391-402. [PMID: 37220795 DOI: 10.1055/a-2050-7621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND At present, the clinical efficacy of measured resection (MR) and gap balancing (GB) techniques in total knee arthroplasty (TKA) is still controversial. The objective of this study was to evaluate the clinical outcome indexes of the two surgical methods through a meta-analysis. METHODS The literature was systematically searched on PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure (CNKI), WANFANG, Weipu (VIP), and China Biomedical Literature (CBM) electronic databases inception until June 12, 2022. RevMan 5.3 software (the Nordic Cochrane Center, the Cochrane Collaboration, Copenhagen, Denmark) was used to analyze all data of this study. The Cochrane risk bias assessment tool is a risk bias evaluation criterion recommended by the Cochrane Handbook for systematic reviews. RESULTS Eleven studies involving 1268 knees in total were included. The main outcome indexes showed that the Knee Society Score (KSS) knee score (MD: -1.40; 95% CI: -2.57 to -0.22; p = 0.02) and KSS knee function score (MD: -3.11; 95% CI: -3.72 to -2.50; p < 0.001) in the GB group were higher 1 year after operation, while femoral component rotation angle (FCRA; MD: -0.75; 95% CI: -1.34 to -0.07; p = 0.03) and the osteotomy volume of the posterior medial femoral condyle (MD: -0.76; 95% CI; -1.13 to -0.38; p < 0.001) were greater in the GB group. In addition, there was no significant difference in the joint line change (MD: -0.03; 95% CI: -0.07 to 0.01; p = 0.16) between the two groups. Secondary outcome results showed that the knee joint range of motion (ROM) in 3 months, and the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score after 1 year were better in the GB group. However, the operation time of the MR group was shorter. In addition, this study revealed no significant differences in post-complications between these two groups. CONCLUSION Although the GB technique may not provide better radiographic results or reduce the complication rate, the recovery of joint function showed earlier improvement.
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Affiliation(s)
- Kun Liu
- Orthopedics, Fuyang People's Hospital Affiliated to Anhui Medical University, Fuyang, China
| | - Zongqing Fan
- Orthopedics, Fuyang People's Hospital Affiliated to Anhui Medical University, Fuyang, China
| | - Weina Liu
- School of Foreign Languages, Qilu University of Technology, Qilu University of Technology, Jinan, China
| | - Li Li
- Orthopedics, Fuyang People's Hospital Affiliated to Anhui Medical University, Fuyang, China
| | - YuJun Guan
- Orthopedics, Fuyang People's Hospital Affiliated to Anhui Medical University, Fuyang, China
| | - Donglin Fu
- Orthopedics, Fuyang People's Hospital Affiliated to Anhui Medical University, Fuyang, China
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Hao K, Wei M, Ji G, Jia Y, Wang F. Comparison of the Imaging and Clinical Outcomes among the Measured Resection, Gap Balancing, and Hybrid Techniques in Primary Total Knee Arthroplasty. Orthop Surg 2022; 15:93-102. [PMID: 36377906 PMCID: PMC9837215 DOI: 10.1111/os.13525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Although many studies have compared the measured resection (MR) technique to the gap balancing (GB) technique, few studies have investigated the hybrid technique. In this study, we compared imaging and clinical outcomes of the MR, GB, and hybrid techniques in primary total knee arthroplasty (TKA). METHODS From January 2016 to January 2019, we conducted a retrospective study on 90 patients who underwent unilateral primary TKA; 30 received the MR technique, 30 received the GB technique, and 30 received the hybrid technique. Radiological outcomes, including joint line level, mechanical alignment of the lower limb, positions of the femoral and tibial components, and rotation of the femoral component, and clinical outcomes, including the visual analog scale score for pain, the Knee Society Score, and the range of motion, were assessed among the three groups. One-way analysis of variance and Dunnett's test were performed for normally distributed data. Kruskal-Wallis H test and Dunn-Bonferroni test were conducted for non-normally distributed data. RESULTS No significant difference in the mechanical alignment (p = 0.151) and the positions of the tibial and femoral components (p = 0.230 for α angle, p = 0.517 for β angle, p = 0.686 for femoral flexion angle, and p = 0.918 for tibial slope angle) was found among the three groups. No significant difference in the elevation of the joint line between the MR and the hybrid groups was found (2.1 ± 0.3 mm vs 2.1 ± 0.1 mm, p = 0.627), but the GB group (2.8 ± 0.2 mm) differed significantly from the other two groups (p < 0.001). Although rotation of the femoral component in the GB group was larger than that of the MR and hybrid groups, the difference was not significant (1.8° ± 0.2° vs 1.7° ± 0.3° vs. 1.7° ± 0.2°, p = 0.101). The clinical outcomes were not significantly different (p > 0.05), although the results in the hybrid group were slightly higher. CONCLUSION The hybrid technique helped to restore the mechanical alignment of the lower limb and realize optimal positions of the femoral and tibial components without significant differences relative to the MR and GB techniques. The hybrid technique was more helpful for maintaining the original height of the joint line, which was similar to the MR technique. Additionally, although the improvement in the clinical outcomes in the hybrid group was slightly higher, it was not significantly different among the three groups.
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Affiliation(s)
- Kuo Hao
- Department of Joint SurgeryThird Hospital of Hebei Medical UniversityShijiazhuangPeople's Republic of China
| | - Maozheng Wei
- Department of Joint SurgeryThird Hospital of Hebei Medical UniversityShijiazhuangPeople's Republic of China
| | - Gang Ji
- Department of Joint SurgeryThird Hospital of Hebei Medical UniversityShijiazhuangPeople's Republic of China
| | - Yanfeng Jia
- Department of Joint SurgeryThird Hospital of Hebei Medical UniversityShijiazhuangPeople's Republic of China
| | - Fei Wang
- Department of Joint SurgeryThird Hospital of Hebei Medical UniversityShijiazhuangPeople's Republic of China
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Xuequan Z, Bin Z, Shuzhang Y, Kanduo C, Chongxi R. Measurement for gap balancing technique in patients undergoing total knee arthroplasty: a large retrospective observational study. J Orthop Surg Res 2022; 17:209. [PMID: 35392951 PMCID: PMC8991780 DOI: 10.1186/s13018-022-03104-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/29/2022] [Indexed: 11/24/2022] Open
Abstract
Background Many traditional methods are available to prevent unbalance of extension and flexion gap during total knee arthroplasty (TKA), but there are no reports on the use of measurement and positioning method before tibial osteotomy with self-made tools. We designed a self-made tool measuring the location before tibial osteotomy and determined the clinical effect. Methods The retrospective study included patients who received TKA at our hospital, between January 1, 2012 and December 31, 2015. A new method, named as the measurement and localization before osteotomy with self-made tools, was developed to measure the osteotomy position of the posterior femoral condyle during TKA. They were divided into two groups, one that received the new method (Group I), and the other that received the traditional method as a control (Group I I). HSS score, Oxford score, VAS score and knee joint activity were evaluated in two groups. Results One hundred and eighty-seven of 210 eligible patients were included. The function of knee joint in all patients was improved and the pain was obviously relieved. Significant differences were found in the HSS score, Oxford score, VAS score, knee joint activity between two groups at 5-year follow-up (p < 0.05). Conclusions The biomet knee prosthesis was selected for all intraoperative implants. All operations were completed by the same senior surgeon. The use of self-made tools may contribute to improve the balance between flexion and extension gaps as well as the balance between internal and external gaps during TKA, and overcome knee flexion instability.
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Affiliation(s)
- Zhao Xuequan
- Department of Orthopaedics, Cangzhou Clinical College of Integrated Traditional Chinese and Western Medicine of Hebei Medical University, Qian Tong North Street No. 17, Cangzhou City, 061000, Hebei Province, China.
| | - Zhao Bin
- Department of Orthopaedics, Cangzhou Clinical College of Integrated Traditional Chinese and Western Medicine of Hebei Medical University, Qian Tong North Street No. 17, Cangzhou City, 061000, Hebei Province, China
| | - Yao Shuzhang
- Department of Orthopaedics, Cangzhou Clinical College of Integrated Traditional Chinese and Western Medicine of Hebei Medical University, Qian Tong North Street No. 17, Cangzhou City, 061000, Hebei Province, China
| | - Cao Kanduo
- Department of Orthopaedics, Cangzhou Clinical College of Integrated Traditional Chinese and Western Medicine of Hebei Medical University, Qian Tong North Street No. 17, Cangzhou City, 061000, Hebei Province, China
| | - Ren Chongxi
- Department of Oncology Surgery, Cangzhou Clinical College of Integrated Traditional Chinese and Western Medicine of Hebei Medical University, Cangzhou, 061000, China
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Intra- and postoperative assessment of femoral component rotation in total knee arthroplasty: an EKA knee expert group clinical review. Knee Surg Sports Traumatol Arthrosc 2021; 29:772-782. [PMID: 32350578 DOI: 10.1007/s00167-020-06006-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 04/16/2020] [Indexed: 01/16/2023]
Abstract
PURPOSE Malrotation of the femoral component after primary total knee arthroplasty (TKA) is one of the most important problems leading to painful TKA requiring revision surgery. METHODS A comprehensive systematic review of the literature was performed to present current evidence on how to optimally place the femoral component in TKA. Several landmarks and techniques for intraoperative determination of femoral component placement and examination of their reliability were analyzed. RESULTS 2806 articles were identified and 21 met the inclusion criteria. As there is no unquestioned gold standard, numerous approaches are possible which come along with specific advantages and disadvantages. In addition, imaging modalities and measurements regarding postoperative femoral component rotation were also investigated. Femoral component rotation measurements on three-dimensional (3D) reconstructed computerised tomography (CT) images displayed intraclass correlation coefficients (ICC) above 0.85, significantly better than those performed in radiographics or two-dimensional (2D) CT images. Thus, 3D CT images to accurately evaluate the femoral prosthetic component rotation are recommended, especially in unsatisfied patients after TKA. CONCLUSION The EKA Femoral Rotation Focus Group has not identified a single best reference method to determine femoral component rotation, but surgeons mostly prefer the measured resection technique using at least two landmarks for cross-checking the rotation. LEVEL OF EVIDENCE III.
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De Wachter E, Vanlauwe J, Krause R, Bayer-Helms H, Ganzer D, Scheerlinck T. Clinical and Radiographic Outcome of Gap Balancing Versus Measured Resection Techniques in Total Knee Arthroplasty. Arthroplast Today 2020; 6:835-844. [PMID: 33083508 PMCID: PMC7551640 DOI: 10.1016/j.artd.2020.07.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/29/2020] [Accepted: 07/30/2020] [Indexed: 11/26/2022] Open
Abstract
Background There is no consensus regarding superiority between gap balancing (GB) and measured resection (MR) techniques to implant total knee arthroplasties. In a multicenter setup, we compared both techniques using the same prosthesis. Methods We included 262 balanSys posterior-stabilized total knee arthroplasties from 4 centers: 3 using the MR (n = 162) and one using the GB technique (n = 100), without navigation. Results There was no significant difference in the Knee Society Score or visual analog scale pain at 2- and 7-year follow-up. The visual analog scale for satisfaction was significantly better in the MR group at 2 but not at 7 years. We found a significantly higher average valgus in the GB group, but the overall alignment was within 2° of neutral on the full-leg radiographs. There were no significant differences concerning radiolucency and survival. Conclusions We found no significant differences in the functional outcome, pain, alignment, or survival, but a tendency toward better function using MR and better survival with GB.
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Affiliation(s)
- Eva De Wachter
- Department of Orthopedic Surgery and Traumatology, UZ Brussel, Brussels, Belgium
| | - Johan Vanlauwe
- Department of Orthopedic Surgery and Traumatology, UZ Brussel, Brussels, Belgium
| | - Robert Krause
- Department of Orthopedic Surgery and Traumatology, Oberlinklinik, Potsdam, Germany
| | - Hans Bayer-Helms
- Department of Orthopedic Surgery and Traumatology, Hilden, Germany
| | - Dirk Ganzer
- Department of Orthopedic Surgery and Traumatology, Dietrich-Bonhoeffer-Klinikum, Altentreptow, Germany
| | - Thierry Scheerlinck
- Department of Orthopedic Surgery and Traumatology, UZ Brussel, Brussels, Belgium
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Migliorini F, Eschweiler J, Mansy YE, Quack V, Schenker H, Tingart M, Driessen A. Gap balancing versus measured resection for primary total knee arthroplasty: a meta-analysis study. Arch Orthop Trauma Surg 2020; 140:1245-1253. [PMID: 32409905 DOI: 10.1007/s00402-020-03478-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION To achieve the most desirable post-operative results, operation techniques and procedures for total knee arthroplasty (TKA) are highly standardized. However, debates persist whether patients having undergone a gap balancing technique (GB) perform better than those having undergone measured resection (MR) technique. Therefore, a meta-analysis study was conducted to investigate advantages of GB compared to the MR. The focus of the present study was on clinical and functional scores, radiological measurements and further complications. MATERIALS AND METHODS The present meta-analysis was conducted according to the PRISMA checklist. In November 2019, literature search was performed. All clinical studies comparing measured resection technique versus gap balancing technique for primary total knee arthroplasty were considered for inclusion. Only articles reporting quantitative data under the outcomes of interest were eligible for inclusion. The methodological quality assessment and statistical analyses were performed through the Review Manager Software version 5.3 (The Cochrane Collaboration, Copenhagen). RESULTS Data from 25 clinical trials (2971 procedures) were collected. Patient baseline demonstrated a good comparability. No difference among the two cohorts was found in terms of SF-12 Mental and Physical, ROM, KSS, KSS Function, OKS, WOMAC. No difference was found in the alignment of mechanical axis and femoral rotation. During the knee motion, no difference was found between the medial and lateral gaps among the two techniques. The GB showed a significant elevated joint line (P < 0.0001), along with a longer duration of the operating time (P = 0.001). No differences were found in terms of revision surgery, aseptic loosening or prosthetic infections. CONCLUSION GB and MR achieve similar outcomes for TKA. In the GB group, a proximalisation of the joint line and extended operating time was detected. Regarding the additional outcomes of interest, the present analysis showed comparability between both groups, MR and GB.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Pauwelsstraße, 30, 52074, Aachen, Germany.
| | - Jörg Eschweiler
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Pauwelsstraße, 30, 52074, Aachen, Germany
| | - Yasser El Mansy
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Pauwelsstraße, 30, 52074, Aachen, Germany
- Department of Orthopaedics, University of Alexandria, Alexandria, Egypt
| | - Valentin Quack
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Pauwelsstraße, 30, 52074, Aachen, Germany
| | - Hanno Schenker
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Pauwelsstraße, 30, 52074, Aachen, Germany
| | - Markus Tingart
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Pauwelsstraße, 30, 52074, Aachen, Germany
| | - Arne Driessen
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Pauwelsstraße, 30, 52074, Aachen, Germany
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Cumulative Incidence of Revision for a Balanced Knee System at a Mean 8-Year Follow-Up: A Retrospective Review of 500 Consecutive Total Knee Arthroplasties. Adv Orthop 2019; 2019:9580586. [PMID: 31275661 PMCID: PMC6582882 DOI: 10.1155/2019/9580586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 05/08/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose The primary purpose of this study was to evaluate mid-term survival of a Balanced Knee System in the first 500 total knee arthroplasty (TKA) cases using a fully cemented, posterior stabilized TKA at a high-volume private practice. Patients and Methods In this IRB approved retrospective cohort study, data were extracted from a surgical registry at a high-volume orthopaedic practice for the first 500 total knee arthroplasty (TKA) cases performed using the Balanced Knee® System (BKS, Ortho Development®, Draper, Utah, USA). Procedures were performed between June 2000 and September 2003 by one of two orthopaedic surgeons. Follow-up was performed at 6 weeks, 6 months, 1 year, 5 years, and 10 years. 48 patients (9.6%) were considered lost to follow-up. A competing risk analysis was performed to evaluate the cumulative incidence of revision while accounting for the competing risk of death. In the model, failure was defined as revision of any BKS component. Those who failed prior to two years remained in the analysis. Results The mean age of the population was 69 years (range: 40–94) and 73% were female. The cumulative incidence of revision of any component was approximately 1% at a mean 8-year follow-up (range: 0.11–14.1 years) when accounting for the competing risk of death. When considering all those lost to follow-up as failures, the cumulative incidence of failure at 8 years was approximately 10%. Conclusion Based on the results of the current study, a posterior stabilized primary TKA, implanted using a flexion and extension gap balancing technique, had excellent survivorship and outcomes at a mean 8-year follow-up.
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Clinical Outcomes of Gap Balancing vs Measured Resection in Total Knee Arthroplasty: A Systematic Review and Meta-Analysis Involving 2259 Subjects. J Arthroplasty 2018; 33:2684-2693. [PMID: 29656972 DOI: 10.1016/j.arth.2018.03.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 02/26/2018] [Accepted: 03/02/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The argument on the clinical effects between gap balancing (GB) and measured resection (MR) in total knee arthroplasty remains to be resolved. A systematic review and meta-analysis was performed to investigate which technique in total knee arthroplasty has better clinical effect. METHODS A total of 20 studies involving 2259 cases were included in the meta-analysis. The primary outcome measure was Knee Society Score (KSS), whereas the secondary outcomes included other function assessment systems (eg, range of motion, Western Ontario and McMaster University Osteoarthritis Index), radiological outcomes (eg, femoral component rotation, total outliers), revision rate, complications (eg, infection, loosening, instability), and surgical time. RESULTS The GB technique was associated with statistically significant increases in the primary outcomes of KSS-function in 1 year. However, a mean difference of 2.12 points was below the minimal clinically important difference of 6 points. No differences were found in the analyses of KSS-knee and KSS-function in any other follow-up periods. Secondary outcome assessments showed significant decreased surgical time (mean difference, 16.18; P < .00001) for MR. Although statistically significant difference in favor of GB was identified in total outliers (risk ratio, 1.72, P = .0004), the 2 techniques were comparable in range of motion, Western Ontario and McMaster University Osteoarthritis Index, femoral component rotation, complications, and revision rate. CONCLUSION We conclude that both techniques can result in equivalent results when done properly, and each surgeon must understand the strengths and weaknesses of each technique.
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