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Saturday, October 9, 2010, 14:00-14:40Session A21: Knee ArthroplastyBalanced Gap Technology - Tibia and Extension First*Harald Dinges - Westpfalz-Klinikum - Kusel, GermanyKhalaf Moussa - Westpfalz Teaching Hospital -University Mainz-Germany - Kusel, Germany*Email: Hdinges@westpfalz-klinikum.deTotal knee arthroplasty belongs today to one of the standard operation in orthopaedic surgery.During the last years the number of the total knee arthroplasty has dramatically increased.Theprognosis for the future have shown also an increasing tendence. The Swedish Regiter Studyand others showed that the results after total knee replacement not almost dependant on thedesign of the prothesis . More important are patient selection ,operation technique and thepostoperative therapy.The goals of modern knee replacement surgery are restoring mechanical alignment ,preserving of the joint line , balancing ligament with a well balanced extension and flexiongap to reach maximum stability and movement. Bone resection is the simple part of atotal knee operation . Ligament balancing with equal extention and flextion gap representsa major chalange for the surgeon which may consequantly affect the stability both inextention and flextion. Stability of total knee arthroplasty is dependant on correct andpercise rotation of the femoral component. Femoral component malrotation has beenassociated with numerous adverse sequelae, including patellofemoral and tibiofemoralinstability ,knee pain, arthrofibrosis,and abnormal knee kinematics. A great number ofearly revision today are due to malrotation of the femoral component.Multiple differing surgical techniques are currently utilized to perform TKA.1-femur first (measured resection)2-tibia first ( gap balancing)In the classic femur first technique the excision of the bone done indepentaly after one anotherfollowed by ligament balancing in flextion and extension. There are 4 bony landmarks decidingthe rotational position of the femur. The epicondylar line ,whiteside line, the dorsal condylesand anetroir-posterior axis. All these landmarks are associated with problems and failure todefine exactly these bony landmarks intraoperatively.This may lead not seldom to malrotationof the femural component ,consequently instability,limitation of function and increased wear.In the tibia first technique excision of the femur especially for flexion done dependant on theexcision of the tibia. This carried out using a tensor. With using this technique the rotation ofthe femur will be oriented mainly at the ligament balancing espcialy in flexion . Flexioninstability and patellae maltacking will be avoided.We present our preferrd tibia first technique using a new tensor system . With this systemit is possible to reach a well balanced extension and flextion gap. A 3° release is onlyneeded in special cases. The rotation position of the femur depend primerly on thereleased soft tissue in extension. Also an exact reconstruction of the dorsal offset as well asan exact anterior or posterior referencing can be guaranteed with the instruments byinfinitely variable ap movement..The use of bony landmarks also possible.we think our new tensor present a step forwards in understanding the biomechanics of thefile:///E|/ISTA2010-Abstracts.htm[12/7/2011 3:15:47 PM]