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Distal femur resection only
2%
63/3425
Distal femur augmentation and use of the same size polyethylene
88%
3018/3425
Downsize femoral component and use a thinner polyethylene insert
52/3425
Proximal tibia resection only
1%
42/3425
Distal femur augmentation and thicker polyethylene insert
7%
224/3425
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The goal in sagittal balancing of TKA is to obtain a gap that is equal in flexion and extension. General principles to remember: 1. Changing the distal femur only affects extension, 2. Changing the femoral component size only affects flexion, and 3. Changing the proximal tibia/polyethylene insert affects both extension and flexion. In the above scenario, distal femoral augmentation will correct the "looseness in extension" without changing the "balanced flexion". The above principles are reviewed by Ries et al along with soft tissue balancing principles for stability in the coronal plane.
4.1
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