Original ArticleInfluence of the Pneumatic Tourniquet on Patella Tracking in Total Knee Arthroplasty: A Prospective Randomized Study in 100 Patients
Section snippets
Materials and Methods
One hundred consecutive patients having osteoarthritis, who were scheduled for primary total knee arthroplasty in a bloodless field, were randomized into 2 groups: to have the tourniquet inflated on either straight leg or maximally flexed knee. Randomization took place in the operating theater, was performed by equal/unequal numbers from a machined randomization list, and was not blinded from the surgeon (as he puts the tourniquet on).
Before operation, all patients had biplanar digitalized
Results
Sixteen patellas were found to be maltracking with the tourniquet inflated at the end of operation. Eleven patellas had major maltracking, whereas 5 had minor maltracking. After deflation of the tourniquet, all patellas tracked better; the 11 major maltrackings were now considered minor, the 5 minor maltrackings were corrected, and the patellas were found to track normally. Eleven lateral releases were performed owing to persistent minor maltracking.
There was no difference between patients who
Discussion
Patellar maltracking and subsequent lateral release should be avoided if possible. Although some find the procedure rather harmless with few complications [7], others regard it as a procedure with potential risk of devastating complications [8]. But lateral release is a potent and necessary tool to address patellar maltracking, provided the components are positioned properly. Rates of lateral release as high as 40% to 50% are reported 9, 10.
In the present study, 2 surgeons using the same
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Cited by (39)
How to optimize patellar tracking in knee arthroplasty?
2023, Orthopaedics and Traumatology: Surgery and ResearchCitation Excerpt :However, its impact on patellar tracking is negligible. A tourniquet, inflated in extension or in flexion, had no impact on final tracking after deflation [27,28]. Even so, we recommend assessing tracking after the tourniquet, if any, has been deflated, and releasing the lateral retinaculum in case of maltracking [29,30].
How to optimize patellar tracking in knee arthroplasty?
2022, Revue de Chirurgie Orthopedique et TraumatologiqueSoft-tissue damage during total knee arthroplasty: Focus on tourniquet-induced metabolic and ionic muscle impairment
2017, Journal of OrthopaedicsCitation Excerpt :Independent from the surgical approach and the type of implant, most TKA includes the use of a tourniquet to provide a relatively bloodless operative field.9 However, the use of a pneumatic tourniquet during TKA surgery is associated with an increased risk for soft-tissue damage, postoperative complications as well as intraoperative challenges, e.g. by impaired patella mobility/tracking.10 Based on the additional possibility of thrombosis or missed arterial bleeding,11 surgeons are reevaluating the necessity and benefits of tourniquet application.
Effect of removing the ischaemia tourniquet on the transfusion needs of the patient undergoing primary knee arthroplasty
2015, Revista Espanola de Cirugia Ortopedica y Traumatologia
No benefits or funds were received in support of the study.