The influence of patellar position on soft tissue balance in minimal incision total knee arthroplasty

• Published in: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Vol. 20; no. 6; pp. 1064 - 1068
• Main Authors: Oka, Shinya, Muratsu, Hirotsugu, Matsumoto, Tomoyuki, Kubo, Seiji, Maruo, Akihiro, Miya, Hidetoshi, Kuroda, Ryosuke, Kurosaka, Masahiro
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01-06-2012; Springer Nature B.V
• Subjects: Aged; Aged, 80 and over; Arthroplasty, Replacement, Knee - instrumentation; Arthroplasty, Replacement, Knee - methods; Balance; Bone Anteversion - complications; Bone Anteversion - surgery; Female; Humans; Joint replacement surgery; Joints; Knee; Knee Joint - physiology; Knee Joint - surgery; Knees; Ligaments; Ligaments, Articular - physiology; Ligaments, Articular - surgery; Male; Measurement; Medicine; Medicine & Public Health; Middle Aged; Objectives; Orthopedics; Osteoarthritis, Knee - complications; Osteoarthritis, Knee - surgery; Patella - physiology; Patella - surgery; Patients; Range of Motion, Articular; Sports; Surgeons; Surgery; Minimal invasive surgery; Total knee arthroplasty; Patellar position; Soft tissue balancing; Quadriceps sparing
• ISSN: 0942-2056; 1433-7347
• DOI: 10.1007/s00167-011-1642-6

Purpose
This study aims to clarify the influence of surgical exposure on intra-operative soft tissue balance measurements using a new tensor in minimal incision total knee arthroplasty (TKA).
Methods
Sixty patients with osteoarthritis of the knee received minimal incision TKAs. Twenty patients received a posterior-stabilized TKA using a quadriceps sparing approach, and the other forty patients, using a limited medial parapatellar (mini) approach. After femoral trial placement, soft tissue balance was measured using an offset type tensor at full extension and 90° of knee flexion, with the patella both laterally retracted and reduced. The joint component gap and varus imbalance were used to assess the difference in patellar position and surgical exposure.
Results
At extension, the joint component gap and varus imbalance showed no statistical difference regardless of patellar position in either TKA. However, the joint component gaps decreased at 90° of flexion when the patella was laterally retracted in both TKAs. Additionally, a significantly smaller joint gap was observed in the quadriceps sparing TKA than the mini-TKA with a retracted patella at 90° of flexion. Varus ligament imbalances decreased with the patella laterally retracted at 90° of flexion in the quadriceps sparing TKA, not in the mini-TKA.
Conclusion
Surgeons should be aware of the influence in surgical exposure of the joint gap and ligament balance during patella shift in minimal incision TKA.
Level of evidence
III.