Document Detail

Is patella eversion during total knee arthroplasty crucial for gap adjustment and soft-tissue balancing?
MedLine Citation:
PMID:  21458400     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: Assessment of soft-tissue balance by the gap technique in Total Knee Arthroplasty (TKA) impacts femoral component rotation positioning. Proper femoral component rotation is a critical factor in TKA, both for adequate patellar tracking and in achieving a symmetrical flexion gap. Soft tissue balance assessment and gap measurements are performed at 90° flexion and with the patella everted in conventional TKA; during MIS-TKA, this step is performed with the patella in situ. We therefore investigated intraoperative joint gap parameters at 90° flexion with and without patellar eversion during conventional TKA, so as to better understand the influence of this intraoperative patellar position factor on final ligament balance.
HYPOTHESIS: Conducting TKA without patellar eversion increases both gap size and gap inclination.
PATIENTS AND METHODS: Twenty-four osteoarthritic knees were included in the study. Joint gap size and inclination were measured intraoperatively on a knee in 90° flexion, with and without patellar eversion.
RESULTS: The joint gap with patella in situ (17.0±3.4 mm) was significantly greater than with patellar eversion (15.4±3.0 mm), as was gap inclination at 90° flexion with the patella in situ (4.9±3.1°) compared to with patellar eversion (4.0±2.9°).
DISCUSSION: The flexion gap inclination obtained without patellar eversion was steeper than with patellar eversion. This induced more externally rotated femoral positioning in absence of patellar eversion. These results ought to be taken into account by surgeons considering switching from conventional to MIS-TKA.
G Kamei; Y Murakami; H Kazusa; S Hachisuka; H Inoue; H Nobutou; K Nishida; Y Mochizuki; M Ochi
Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2011-03-31
Journal Detail:
Title:  Orthopaedics & traumatology, surgery & research : OTSR     Volume:  97     ISSN:  1877-0568     ISO Abbreviation:  Orthop Traumatol Surg Res     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-05-04     Completed Date:  2011-11-15     Revised Date:  2013-10-31    
Medline Journal Info:
Nlm Unique ID:  101494830     Medline TA:  Orthop Traumatol Surg Res     Country:  France    
Other Details:
Languages:  eng     Pagination:  287-91     Citation Subset:  IM    
Copyright Information:
Copyright © 2011. Published by Elsevier Masson SAS.
Department of Orthopaedic Surgery, Division of Clinical Medical Science, Graduated School of Biomedical Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, Japan.
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MeSH Terms
Aged, 80 and over
Arthroplasty, Replacement, Knee / methods*
Femur / physiopathology,  radiography,  surgery*
Follow-Up Studies
Joint Instability / physiopathology,  prevention & control*
Monitoring, Intraoperative / methods*
Osteoarthritis, Knee / physiopathology,  radiography,  surgery*
Patella / radiography,  surgery*
Prospective Studies
Range of Motion, Articular / physiology*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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