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Patellar eversion during total knee replacement: a prospective, randomized trial


, : Patellar eversion during total knee replacement: a prospective, randomized trial. Journal of Bone and Joint Surgery. American Volume 96(3): 207-213

Proponents of minimally invasive total knee arthroplasty argue that retracting rather than everting the patella results in quicker postoperative recovery and improved function. We aimed to investigate this in patients undergoing knee arthroplasty through a standard medial parapatellar approach. In a prospective randomized double-blinded study, sixty-eight patients undergoing total knee arthroplasty through a standard medial parapatellar approach were assigned to either retraction or eversion of the patella. Postoperatively, at three months, and at one year after surgery, an independent observer assessed the primary outcome measure (i.e., knee flexion) and secondary outcome measures (i.e., Oxford knee score, Short Form-12 [SF-12] score, visual analog scale pain score, knee motion, and alignment and patellar height as measured on radiographs with use of the Insall-Salvati ratio). Early (three-month) follow-up showed no significant difference between patellar eversion and subluxation in flexion (mean and 95% confidence interval [CI], 101° ± 5.37° versus 102° ± 4.14°, respectively), Oxford knee scores (25 ± 3 versus 27 ± 2.69, respectively), SF-12, or visual analog scale pain scores (1.9 ± 0.54 versus 1.1 ± 0.44, respectively). A significant improvement in extension was found (-3.9° ± 1.12° versus -2.0° ± 0.91°, respectively [p = 0.034]), but this was not clinically significant. There was no significant difference in any of the outcomes at one year. There was a significant difference in implant malpositioning between the eversion group and the subluxation group, with an increased percentage of lateral tibial overhang in the subluxation group (0.45 ± 0.39 versus 1.84 ± 0.82, respectively [p = 0.005]), but this did not correlate with functional outcome. There was no significant difference in alignment between the two groups (178.29° ± 0.84° versus 178.18° ± 0.78°). At one year after surgery, there was no difference between the two groups in Insall-Salvati ratio (1.15 ± 0.06 versus 1.12 ± 0.06) although there was a correlation between the percentage reduction in the ratio and functional outcome. There were two partial divisions of the patella tendon in the subluxation group, but no patella-related complications in the eversion group. The results of this trial showed that retracting rather than everting the patella during total knee arthroplasty resulted in no significant clinical benefit in the early to medium term. We observed no increase in patellar tendon shortening as a result of eversion rather than subluxation. Our findings did suggest that, with subluxation, there may be an increased risk of damage to the patellar tendon and reduced visualization of the lateral compartment, leading to an increase in implant malpositioning with lateral tibial overhang.

US$19.90

PMID: 24500582

DOI: 10.2106/JBJS.J.00947


Other references

Lindgren, K., 1981: Unemployment occurs in nursing threatened by personnel with basic education. Vardfacket 5(5): 10-11

Umedera Makoto; Fujiwara A.; Hyodo Masayuki; Murata Hidekazu; Yasufuku Noriyuki, 1996: Effect of suction on the mechanical behavior of bentonite-sand mixtures. Pages 169-172 1996

Horvathne, L.I.; Kardos, I.; Maurer, E., 1970: Results of trials with the. Describes and illustrates a tractor-mounted grab, a modified version of one already described . It is hydraulically driven to give the jaws better gripping force. Test results, given for different species and stump diameters, are extremely satisfa...

Tsuki K., 1971: Development and present state of surgery involving heart blood vessels. Nagasaki Igakkai Zasshi 46(10-11-12): 355

Kojima, Y.; Komatsu, A., 1975: Effect of feeding high-barley and cooked barley on the amount of starch escaping into the abomasum. Two Japanese Corriedale wethers of bodyweight about 39 kg were prepared with fistulae of the rumen and abomasum. They were fed on crushed barley and lucerne hay cubes or cooked crushed barley and lucerne cubes at different ratios. Rumen contents w...

Matsunaga, K.; Minakata, Y.; Yukawa, S., 1998: Primary pulmonary cryptococcosis with pleural effusion. A 32-year woman presented at our hospital with left chest pain. Chest X-ray films revealed multiple nodular shadows (accompanied by a fusing tendency) and pleural effusion in the left lower lung field. Transbronchial lung biopsy specimens containe...

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Pekkanen, J.; Brunner, E.J.; Anderson, H.R.; Tiittanen, P.; Atkinson, R.W., 2000: Daily concentrations of air pollution and plasma fibrinogen in London. Objectives: The reason for the association between air pollution and risk of cardiovascular diseases is unknown. The hypothesis was examined that daily concentrations of air pollution are associated with daily concentrations of fibrinogen, a risk...

Seregi A.; Noe B.; Hertting G., 1991: Astroglial cells as sources of eicosanoids role of receptor mediated phosphatidylinositol breakdown. Racagni, G , N Brunello And T Fukuda (Ed ) International Congress Series, No 968 Biological Psychiatry, Vols 1 And 2; Proceedings Of The 5th World Congress Of Biological Psychiatry, Florence, Italy, June 9-14, Xxviii+886p (Vol 1); Xxxi+949p (Vol 2) Elsevier Science Publishers B V : Amsterdam, Netherlands; (Dist in The Usa And Canada By Elsevier Science Publishing Co , Inc : New York, New York, Usa) Illus 784-786

Bielka, F.; Szigat, G., 1993: Description of the characters of powdery mildew (Erysiphe graminis DC) on an amphidiploid Hordeum bulbosum x H. vulgare-hybrid. Controlled environment experiments were conducted to establish whether a new race of E. graminis was the cause of powdery mildew on an F1 amphidiploid hybrid (BS10) of a resistant tetraploid genotype and a susceptible tetraploid genotype (H. bulbo...