MacDessi SJ, Cohen DA, Wood JA, et al. - This study was intended to correlate clinical outcomes of sensor balance (SB) to manual balance (MB) total knee arthroplasty (TKA) with a minimum two-year follow-up. Researchers compared a consecutive series of 207 MB TKAs to 222 SB TKAs between April 2014 and April 2017. The primary outcome included the aggregated mean change in four subscales of the Knee injury and Osteoarthritis Outcome Score (KOOS 4) between preoperative and two-year time points. The mean differences between groups in all five KOOS subscales, proportions of knee balancing procedures, and rates of reoperations including revisions and manipulations for stiffness were considered secondary endpoints. Despite significantly increasing the number of surgical interventions required to achieve a balanced knee, the use of sensors in TKA to achieve knee balance did not result in improved clinical outcomes. For manipulation, sensors did not alter the rates of revision surgery or requirements. It remains to be ascertained whether precise soft tissue balancing improves prosthetic survivorship and joint biomechanics.