The meta‐ analysis showed that GB techniques result ed in statistically significant improvements in the restoration of mechanical and rotational alignment and mean Knee Society Scores and Knee Society Function scores two years post‐operatively , but result ed in greater elevation of the position of the joint line .
There is no significant difference in the other radiographic data .
Conclusion This study suggests that GB may provide better radiographic and clinical outcomes than MR when used to determine mechanical rotation in TKAs
Aims There are two techniques widely used to determine the rotational alignment of the components in total knee arthroplasty ( TKA ) ;  gap balancing ( GB ) and measured resection ( MR ) .
Which technique is the best remains controversial .
We aim ed to investigate this in a systematic review and meta‐ analysis .
Joint line restoration after revision total knee arthroplasty.
In 99 patients , 107 knee replacements were revised in two centers by two surgeons using a single revision total knee arthroplasty system . A retrospective radiographic review of joint line position before and after revision total knee arthroplasty was made , and compared with the joint line position before primary knee arthroplasty . Prospect ively collected Knee Society Clinical Rating Scores were correlated with radiographic findings . The joint line position in unreplaced knee replacements averaged 16 mm , and the joint line position in knee replacements before revision surgery averaged 17 mm . The joint line was elevated by the revision total knee arthroplasty in 85 of 107 knees ( 79 % ) . After the revision total knee replacement , the joint line elevation averaged 24 mm . The Knee Society Clinical Rating Score after revision surgery averaged 131 points . If the joint line position was elevated more than 8 mm , the Knee Society Clinical Rating Score averaged 125 points , if the joint line was elevated less than 8 mm , the score averaged 141 points . Joint line elevation after revision total knee replacement is a problem . Excessive elevation may result in worse clinical outcomes . Distal femoral augments should be used more often and with greater thicknesses . St and ard implants used for revision surgery should have increased distal dimensions
The meta‐ analysis showed that GB techniques result ed in statistically significant improvements in the restoration of mechanical and rotational alignment and mean Knee Society Scores and Knee Society Function scores two years post‐operatively , but result ed in greater elevation of the position of the joint line .
There is no significant difference in the other radiographic data .
Conclusion This study suggests that GB may provide better radiographic and clinical outcomes than MR when used to determine mechanical rotation in TKAs
Aims There are two techniques widely used to determine the rotational alignment of the components in total knee arthroplasty ( TKA ) ;  gap balancing ( GB ) and measured resection ( MR ) .
Which technique is the best remains controversial .
We aim ed to investigate this in a systematic review and meta‐ analysis .