Evaluation of Femoral–Tibial Flexion Gap in Total Knee Arthroplasty with Everted or Lateralized Patella
| Autor: | Silvio Mezzari, Alberto Residori, Michele Malavolta, Gianpietro Lista, Andrea Cochetti |
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| Rok vydání: | 2018 |
| Předmět: |
Male
musculoskeletal diseases Knee Joint Rotation medicine.medical_treatment Knee replacement Osteoarthritis Prosthesis 03 medical and health sciences 0302 clinical medicine Humans Medicine Orthopedics and Sports Medicine Femur Prospective Studies Range of Motion Articular Arthroplasty Replacement Knee Valgus deformity Orthodontics 030222 orthopedics Tourniquet Tibia business.industry Bone Malalignment Patella 030229 sport sciences Osteoarthritis Knee musculoskeletal system medicine.disease Arthroplasty Biomechanical Phenomena Female Surgery Knee Prosthesis business Range of motion human activities |
| Zdroj: | The Journal of Knee Surgery. 32:1028-1032 |
| ISSN: | 1938-2480 1538-8506 |
| DOI: | 10.1055/s-0038-1675422 |
| Popis: | Intraoperative patellar position (eversion, lateralization, or in situ) influences the ligamentous balancing in knee flexion and thereby the correct positioning of the femoral component during total knee arthroplasty. The correct ligament balancing is crucial when, as in our experience, prostheses with medial pivot design are used. It was shown that the flexion gap in the normal knee is not rectangular and that the lateral compartment is significantly slacker than the medial. Therefore, to obtain a correct kinematics of a medial pivot anatomical prosthesis, it is essential to recreate an anatomical flexion gap slacker in the lateral compartment. We conducted a prospective study on a consecutive series of 87 total knee prostheses. The objective of this study is to evaluate the femoral external rotation angle in each patient with everted patella as well as with pure subluxated patella. The purpose of this study is to offer guidance about the optimal femoral rotation angle to achieve best outcomes of a knee replacement. The evaluation was done using an instrument developed by Medacta International (Switzerland) with our direct collaboration (Tensor, Medacta, Switzerland) and standardizing the basic conditions of each patient (knee 90 degrees flexed, medial transquadricipital surgical access, lateral displacement of the patella, tourniquet inflated at 250 mm Hg, spinal anesthesia). Each group was subdivided into subgroups according to gender, preoperative varus or valgus deformity, and patellar height. Our study advises against evaluating the flexion gap with everted patella due to high risk of underestimation of the lateral compartment laxity (differences up to + 3 degrees with pure subluxated patella compared with everted patella). |
| Databáze: | OpenAIRE |
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