Extension and Flexion Gap Balancing and Its Correlation With Alignment in Navigated Total Knee Arthroplasty

Computer-assisted surgery was developed to improve the results of conventional total knee arthroplasty (TKA). The authors investigated the preoperative varus/valgus deformity influence on the production of balanced extension and flexion gaps using computer-assisted surgery. This study evaluated data from a prospective case series. A total of 132 patients (107 women and 25 men) underwent navigated TKA. Patients were divided into the following 3 groups according to the degree of the initial varus/valgus deformity: group 1, 0 degrees to 3 degrees; group 2, 3 degrees to 9 degrees; and group 3, greater than 9 degrees. The final lower limb mechanical axis (LLMA) and the final flexion and extension gaps were measured. Knees exhibiting up to 3 degrees of deviation on the frontal plane and a difference of up to 3 mm between the lateral and medial gaps were considered to be aligned and balanced, respectively. Average LLMA deviation decreased from 5.58 degrees (+/- 4.80 degrees) to 1.87 degrees (+/- 1.66 degrees). For knees with varus deviation, the percentage of balancing relative to the flexion gaps was 97.8% and that relative to the extension gap was 100% (P>.05). For knees with valgus deviation, the percentage of balancing relative to the flexion gaps was 95.1% and that relative to the extension gap was 97.6% (P>.05). Approximately 92% of the LLMA alignment was achieved in the group with varus deformity, whereas 71.4% was observed in the group with valgus deformity (P<.05). Computer-assisted TKA could attain proper flexion and extension balance regardless of coronal plane malalignment magnitude. Severe valgus and varus knees are more difficult to align using navigation. No difference was found in the balance of flexion or extension gaps in valgus or varus knees, independent of the severity.