28 April 2026
The Quest for the "Natural Feel": A Conversation with Prof. A. Niemeier
Soft Tissue Balancing in Total Knee Arthroplasty is often described as the bridge between a technically successful surgery and a truly satisfied patient. As part of the Enovis campaign “Soft Tissue Balancing – the
sense of stability,” we spoke with Prof. A. Niemeier, Reinbek, Germany, to explore how this approach addresses the most elusive goal in orthopedics: the "natural feel."
For Prof. A. Niemeier, soft tissue balancing is not just a procedural step, but an implantation technique that translates directly into the patient's subjective experience. “It is about allowing for a ‘natural feel’ of
the replaced knee,” he explains. According to him, the objective proof of a well-balanced knee is found in the final range of motion. “At the end of the operation, there should be no relevant gapping, medially
or laterally, from full extension to deep flexion. Furthermore, the patella must track well without tilt or any tendency for lateralization throughout the entire range of motion.”
Achieving this level of stability requires a rigorous, iterative process. Prof. A. Niemeier emphasizes that balance is not a single moment in time, but a continuous assessment of both the individual soft tissue
constitution and the unique bony anatomy. “Technically, this requires a continuous assessment and re-assessment from planning to each bone cut,” he says. This is not a "one-size-fits-all" approach; rather, it is
a surgical discipline where every move is measured against a specific goal. “We re-assess after each bone cut with the respective, individually predetermined alignment goal in all three planes in mind.”
When asked why he remains a firm believer in this specific surgical philosophy, his answer is direct: “Because it works! It results in very few unhappy knees.”
Clinical Advantages: Early and Late Success
The benefits of Soft Tissue Balancing are felt by the patient almost immediately. Prof. A. Niemeier notes that the main clinical advantages appear in two distinct phases:
Early Post-Op: Patients experience less pain, less swelling, and benefit from faster mobilization.
Longer Term: The ultimate reward is a knee that feels inherently more natural, increasing patient confidence in their daily activities.
Looking toward the horizon, Prof. A. Niemeier sees a clear role for enabling technologies like robotics, AR, and VR—provided they are used to enhance the surgeon’s understanding of the patient's unique
biology.
“In the long run, if integrated intelligently, I expect these technologies to provide a way of objectively measuring individual soft tissue tension over the entire range of motion—both before the first bone cut
and throughout the entire procedure,” he notes. He believes the real breakthrough will come from the intersection of technology and experience. “Once this data can be correlated with subjective and
objective outcomes on the basis of Big Data, we will significantly reduce the percentage of dissatisfaction after TKA.”
This third interview in our series reinforces that Soft Tissue Balancing is not merely a technical choice, but a commitment to long-term clinical excellence. By prioritizing the "natural feel" through constant
re-assessment, surgeons like Prof. A. Niemeier are ensuring that Soft Tissue Balancing – the sense of stability remains the gold standard for patient satisfaction.
