# A comparison on the clinical outcomes of using intraoperative load sensors versus manual balancing in total knee arthroplasty: a systematic review and meta-analysis

## TL;DR

This study compares sensor-guided and manual balancing techniques in knee replacement surgery and finds no significant differences in outcomes.

## Contribution

The study provides a meta-analysis showing no significant clinical benefit of sensor-guided over manual balancing in total knee arthroplasty.

## Key findings

- Sensor-guided balancing did not improve functional scores compared to manual techniques.
- No significant differences in complication rates or range of motion were observed.
- Sensors may still be useful for training in soft tissue balancing.

## Abstract

To compare clinical outcomes and complications between sensor-assisted and manual balancing techniques in total knee arthroplasty, focusing on randomized controlled trials (RCTs).

A systematic search of the Cochrane Library, Medline, Embase, Scopus, and Web of Science databases was conducted through February 22, 2024. RCTs comparing sensor-guided and manual balancing methods in primary TKA were included. Outcomes assessed include patient reported outcome measures, range of motion, and total complications.

Data from four RCTs (667 knees: 334 sensor-guided, 333 manual) were extracted and analyzed using RevMan V.5.4 with random- and fixed-effects models. The meta-analysis revealed no significant improvement in functional scores for sensor-guided balancing compared to manual techniques (SMD 0.10; 95% CI − 0.15–0.34; I2 = 57%). No significant differences were observed in complication rates (OR 0.84; 95% CI 0.46–1.54; I2 = 0%) or postoperative range of motion (MD 1.20; 95% CI − 0.26–2.65; I2 = 0%).

Sensor-guided balancing did not significantly enhance functional outcomes, reduce complication rates, or improve range of motion compared to manual techniques. While the clinical impact of intraoperative sensors remains limited, they hold promise as training tools to standardize soft tissue balancing. Further high-quality, long-term studies are required to explore their potential benefits and establish definitive guidelines for TKA procedures.

The online version contains supplementary material available at 10.1186/s13018-025-06394-8.