Sagittal plane balancing in the total knee arthroplasty.

Theodore T. Manson, Harpal S. Khanuja, Michael A. Jacobs, Marc W. Hungerford

Research output: Contribution to journalReview articlepeer-review

10 Scopus citations


Postoperative stiffness or instability may result from a total knee arthroplasty imbalanced in the sagittal plane. Total knee arthroplasty instrumentation systems differ in the basic strategies used to assure this balance. In an anterior referencing system, changes in femoral size affect flexion gap tightness, and femoral size selection is paramount to assure sagittal plane balance. Conversely, in posterior referencing systems, femoral size changes do not affect the flexion gap but, rather, influence femoral component-patella articulation. Flexion/extension gap systems use calibrated spacer blocks to ensure gap balance but do not guarantee midrange stability; if used incorrectly, they may cause component malposition and joint line elevation. The authors reviewed the strengths and weaknesses of system types and provided system-specific troubleshooting guidelines for clinicians addressing intraoperative sagittal plane imbalance.

Original languageEnglish (US)
Pages (from-to)83-92
Number of pages10
JournalJournal of surgical orthopaedic advances
Issue number2
StatePublished - Jan 1 2009

ASJC Scopus subject areas

  • General Medicine


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