Balancing is important whether or not you are doing a primary or a revision. Restoring the joint line is key. From that point you need to balance your extension and flexion gaps. Although a primary TKA the main variables are soft tissue releases or bone cuts, in a revision you have those options but more commonly you will use implant size, augments and offset to restore balancing. Rotation is another important factor, especially in fixed bearing knees. I balance initially with a CR to get a "feel" of the knee. I then balance with a stabilized insert to identify the appropriate rotation of the tibia while the post is engaged with the femoral component.
