Original ArticlesThe effect of surgical approaches and tourniquet application on patellofemoral tracking in total knee arthroplasty*,**,*
Section snippets
Materials and methods
From January to December 1999, 95 TKAs were performed in our department. Of these, single-setting bilateral TKAs were performed in 12 patients by the senior author (H.O.). Selection criteria for this study included patients single-setting bilateral TKA, almost the same grade arthrosis in both knees, and ability to flex the knee more than 120° and extend the knee less than −15°. Exclusion criteria were previous knee surgery and severe varus or valgus knee deformity. Ten patients met the
Results
After tourniquet inflation and before beginning each surgical approach, LPFL stress increased with knee flexion, with the maximum at 120° flexion. In the parapatellar approach group, the average values from the transducer at each knee flexion angle before surgery were 0 ± 0 MPa at full extension, 0.49 ± 0.13 MPa at 30°, 1.07 ± 0.22 MPa at 60°, 1.65 ± 0.31 MPa at 90°, and 1.98 ± 0.4 MPa at 120° of knee flexion. In the midvastus approach group, the average values were 0 ± 0 MPa at full extension,
Discussion
The etiology of patellar maltracking after TKA is multifactorial and commonly results from imbalance in the extensor mechanism characterized by excessive tightness of the lateral retinaculum and associated weakness of the vastus medialis muscle [6, 21, 22]. Placement of prosthetic components in an excessively valgus position results in an increased lateral force vector on the patella and may also result in the maltracking of the patella [21]. Asymmetrical patellar resection and malpositioning
Acknowledgements
The authors gratefully thank Seiko Harata, MD, for his helpful comments and suggestions. The authors also acknowledge Kan-ichiro Wada, MD, for data analysis.
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2020, Journal of ArthroplastyCitation Excerpt :The lateral approach was introduced by Keblish in 1991 in response to patellar maltracking and complications seen in the medial approach for valgus TKA patients [4]. Since then, a number of studies have compared different arthrotomy approaches in TKA [2,9–11,15]. Among these, few studies assess preoperative and postoperative patellar tilt.
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2020, Arthroplasty TodayTourniquet time in total knee arthroplasty
2018, KneeCitation Excerpt :The unwanted side effects of the tourniquet occur from the ischemia itself and the reperfusion injury upon the release of the tourniquet [1,2]. These consist of muscle injury, postoperative stiffness (reducing the range of motion (ROM)), pain, limb swelling, nerve palsy, deep venous thrombosis (DVT), direct vascular injury, and an increased risk of lateral release [1,3–7]. Currently no consensus regarding the use of an arterial tourniquet in TKA has been reached.
Comparing the mid-vastus and medial parapatellar approaches in total knee arthroplasty: A meta-analysis of short term outcomes
2012, KneeCitation Excerpt :This was further reduced to 18 studies after critical appraisal of the full papers; Table 2 shows the included studies and data extracted [1,2,7–11,13–23]. Reasons for further exclusion included irrelevant outcomes measured in individual studies such as postoperative symptomatic transient patellar ischaemia [24], lateral retinacular tension [25] and alteration of patellar tracking by measuring patellar tilt [26]. Parentis et al. [27] published a longer term follow-up of the same patients (Kelly et al.) [1] and therefore, their earlier study was also excluded.
Incorrect Use of the Student t Test in Randomized Trials of Bilateral Hip and Knee Arthroplasty Patients
2011, Journal of ArthroplastyCitation Excerpt :We eliminated 95 studies based on abstract or title, 8 did not use the t test, and 4 did not provide any details of their method of analysis. One additional study was identified through a review of the bibliographies of relevant publications, for a total of 40 randomized trials for systematic review [8-47]. All studies were published in English and represented a broad spectrum of orthopedic journals (Table 1).
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No benefits or funds were received in support of this study.
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Reprint requests: Yasuyuki Ishibashi, MD, Department of Orthopaedic Surgery, Hirosaki University, School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan.
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