Techniques for Consistent Knee Arthroplasty

All operations were performed by two surgeons in a standard fashion under general anesthesia with tourniquet inflation to 300 mmHg. A PS knee system with the subvastus approach was used in all cases. A measured resection technique was used for bone cutting. Proper gap balancing was applied after bone cutting. Extension and 90° flexion gaps were measured using a tensor device (B.Braun-Aesculap, Tuttlingen, Germany) and scaled forceps (B.Braun-Aesculap) with the application of a 200-N distraction force. In the case of a tight medial gap, multiple needling puncturing was performed with a standard 18-gauge needle based on digital palpation of taut medial collateral ligament (MCL) fibers [12 (link)]. All components were fixed using bone cement. Two PE insert insertion methods were used; the knee dislocation method and the sliding method (Figure 2). The PE insert insertion method was determined according to the design of the locking mechanism of the knee system or the status of soft tissue balance. Some knee systems required knee dislocation for secure PE insert insertion, and some allowed sliding insertion of PE insert without knee dislocation.