Elsevier

The Journal of Arthroplasty

Volume 20, Issue 6, September 2005, Pages 694-697
The Journal of Arthroplasty

Original Article
Influence of the Pneumatic Tourniquet on Patella Tracking in Total Knee Arthroplasty: A Prospective Randomized Study in 100 Patients

https://doi.org/10.1016/j.arth.2004.11.016Get rights and content

Abstract

One hundred consecutive patients with osteoarthritis of the knee joint and scheduled for primary total knee arthroplasty performed in a bloodless field were prospectively randomized to have the tourniquet inflated on either straight leg or maximally flexed knee. There was no difference in the number of lateral releases between the groups, and position of the knee in maximal flexion during inflation of the tourniquet did not decrease the number of lateral releases. There was no difference in clinical or radiological patella tracking between groups. If the patella was maltracking, tourniquet deflation led to better patella tracking and saved 5 (31%) of 16 releases with no difference between groups. We recommend tourniquet deflation and reevaluation of patella tracking before performing lateral release in patellar maltracking.

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

References (13)

There are more references available in the full text version of this article.

Cited by (39)

  • How to optimize patellar tracking in knee arthroplasty?

    2023, Orthopaedics and Traumatology: Surgery and Research
    Citation 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 Traumatologique
  • Soft-tissue damage during total knee arthroplasty: Focus on tourniquet-induced metabolic and ionic muscle impairment

    2017, Journal of Orthopaedics
    Citation 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.

View all citing articles on Scopus

No benefits or funds were received in support of the study.

View full text