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Ford M. C., Woodard E., Mihalko W. M.
Campbell Clinic, Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee, Memphis, TN, USA
The increasing number of total knee arthroplasty (TKA) procedures expected to be needed in the coming decades underscores the need for surgical techniques that avoid malalignment and instability, which can lead to costly early revision. Soft-tissue or gap balancing has long been recognized as an important part of TKA surgery, especially in osteoarthritic knees with varus or valgus deformities. Biomechanical studies have helped delineate the roles of various structures and their effects on rotational and coronal stability. Clinical algorithms have been developed to relate surgical procedures to positive patient outcomes and to outline steps to properly balance flexion and extension gaps during TKA surgery. Several approaches can be used to correct deformities during TKA surgery, but all should attempt to create an equal medial and lateral joint gap in flexion and extension, while carefully considering the role of all ligaments and soft tissue structures to maintain postoperative stability. This review discusses the biomechanical validation for balancing the varus or valgus knee during TKA surgery and presents technique pearls and pitfalls for correcting different deformities.