Patellar Eversion During Total Knee Replacement

Reid, Michael; Booth, Grant; Khan, Riaz J.K.; Janes, Gregory C.

doi:10.2106/jbjs.j.00947

Cited by 23 publications

(67 citation statements)

References 30 publications

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“…Umrani et al [52] in 2013, found that patellar eversion did not significantly affect quadriceps recovery after TKA up to 1 year after surgery. In the most recent study, Reid et al [53] in 2014 found that patients who underwent TKR with patella eversion had similar clinical outcome 3 mo and 1 year postoperatively with patients who had TKR with patellar subluxation. They also noted that patellar subluxation may lead to an increased risk of damage to the patella tendon and increase in tibial component malpositioning.…”

Section: Patellar Eversion or Not?mentioning

confidence: 99%

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Common controversies in total knee replacement surgery: Current evidence

Nikolaou¹

2014

WJO

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Total knee replacement (TKR) is a widely used operation that has radically improved the quality of life of millions of people during the last few decades. However, some technical details, concerning the surgical procedure and the rehabilitation following total knee arthroplasty, are still a matter of a strong debate. In this review of the literature, we have included the best evidence available of the last decade, in an effort to shed light on some of the most controversial subjects related to TKR surgery. Posterior-stabilized or cruciate-retaining prosthesis? To use a tourniquet during operation or not? Do patients need continuous passive motion for their post-surgery rehabilitation? To resurface patella or not? These are some of the most controversial topics that until now have been persistent dilemmas for the orthopedic surgeon. Results of this systematic review of the literature are highly controversial. These conflicting results are an indication that larger and more well conducted high quality trials are needed in order to gain more secure answers. At the same time, it is becoming apparent that a meticulous operative technique, respecting the soft tissue envelope and knowing the principles of alignment and soft tissue balancing, are some of the parameters that might contribute more to achieving the optimal results for the patients. Key words: Total knee replacement; Controversy; Literature review; Patella resurfacing; Patella eversion; Posterior stabilized; Cruciate retaining; Tourniquet; Continuous passive motion Core tip: A literature review has been conducted in an effort to present the best available evidence of the last decade and to shed light on some of the most controversial subjects related to total knee replacement surgery. Patella resurfacing or not? Posterior cruciate retaining or sacrificing? Continuous passive motion or not? Tourniquet or not? These are some of the most debatable topics that until now have been persistent dilemmas for the orthopedic surgeon. Results of this systematic review of the literature are highly controversial. These conflicting results are an indication that larger and better conducted high quality trials are needed in order to gain more secure answers.Nikolaou VS, Chytas D, Babis GC. Common controversies in total knee replacement surgery: Current evidence. World J Orthop 2014; 5(4

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Section: Patellar Eversion or Not?mentioning

confidence: 99%

“…Reid et al [53] Prospective randomized double-blinded study. Patients undergoing TKA through a standard medial parapatellar approach assigned to either retraction or eversion of the patella groups…”

Section: Ref Type Of Study Outcomementioning

confidence: 99%

Common controversies in total knee replacement surgery: Current evidence

Nikolaou¹

2014

WJO

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“…Several randomized controlled trials (RCTs) have been conducted with the aim of comparing the relative effect of patellar eversion with patellar noneversion during TKA, and the results have been included in numerous meta-analyses with the aim of summarizing the outcomes of this approach and delineating the clear guidelines based on the available evidences. [7][8][9][10][11][12][13][14][15] However, a 2016 review by Jia et al concluded that "patellar eversion and patellar non-eversion could achieve similar results," 9 whereas Yang et al analyzed the same RCTs concluded that "patellar non-eversion offers a shorter hospital stay and a lower incidence of postoperative complications." 8 Despite this scenario could appear paradoxical, it could represent an important source of confusion when clinicians aim to implement evidence-based approach in daily clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Should the patella be everted during primary total knee arthroplasty? A systematic review of overlapping meta-analyses

Grassi

Compagnoni

Ferrua

et al. 2019

J Orthop Surg (Hong Kong)

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Patellar eversion during total knee arthroplasty (TKA) is a debated issue. The aim of this study is to perform a review of overlapping meta-analyses analyzing clinical outcomes of patellar eversion compared to noneversion. A search was performed in PubMed\MEDLINE, Scopus, and Cochrane Library. Inclusion criteria were meta-analysis of randomized controlled trials (RCTs) or quasi-RCTs;l comparison between TKAs with or without patellar eversion; and at least one outcome, such as reoperation rate, pain, and functional scores. Meta-analyses were evaluated with the A Measurement Tool to Assess Systematic Review (AMSTAR) score, addressing the most relevant one with the Jadad algorithm. Three meta-analyses were identified and included in this review. No significant differences were found regarding complications, quadriceps strength, functional, and radiological outcomes. The meta-analysis by Zan et al. was selected as the best available one. Patellar eversion group showed a shorter tourniquet time but a longer skin incision. In conclusion, eversion and noneversion techniques did not demonstrate any significant or clinically relevant difference.

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“…This checklist was produced with surgical interventions, among others, in mind, and raises the issues of surgeons' relevant experience in procedures, as well as differences between procedures in terms of their difficulty. Consequently, it recommends reporting, “Details of how the interventions were standardized.” None of the trials included in this sample actually reference this statement (only eight of the 44 papers published in 2009 or later make any reference to CONSORT at all), and then just in relation to the provision of a flowchart of participants, but there might be a general, tacit influence of improved reporting standards at play. Finally, there are significant associations between good or poor reporting of the surgeon's experience domain and good or poor reporting of allocation concealment and attrition within this set of RCTs, but there are no other significant associations between the surgeon domain and others.…”

Section: Discussionmentioning

confidence: 99%

Risk of bias and the reporting of surgeons' experience in randomized controlled trials of total hip and total knee arthroplasty: A systematic review

Mahmood

2018

Evaluation Clinical Practice

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Rationale, aims, and objectives: The potential bias introduced by surgeons' lack of comparable, relevant experience when performing the procedures in different arms of randomized controlled trials (RCTs) is arguably not well-managed or reported.The aim of this work was to review the frequency and nature with which surgeons' relevant experience is reported in RCTs of total hip (THA) and total knee arthroplasty (TKA), and to relate this to other risk of bias domains for this study design. Methods:A systematic review of RCTs comparing different minimally invasive procedures for TKA and comparisons of THA and hemiarthroplasty (HA). We searched MEDLINE, EMBASE, Science Citation Index, The Cochrane Library, Conference Proceedings Citation Index-Science (CPCI-S), Current Controlled Trials, and Clinical Trials.gov. Results: Seventy-five relevant RCTs were identified, 65 RCTs comparing minimally invasive with standard or other minimally invasive approaches to TKA, and 10 for THA compared with HA. Risk of bias based on the reported details of surgeons' relevant experience was categorized as low, high, or unclear. There was a clear distinction before and after 2009, with a substantial decrease in trials at high or unclear risk of bias after this date. There were no strong associations between this domain and other, standard risk of bias domains for RCTs. Conclusion: The surgeons' relevant experience in an evaluated procedure is often poorly reported but has improved since 2009. The variable is not adequately captured by any other risk of bias domain. Future work should concentrate on conducting research on a much larger sample of studies and in procedures other than knee and hip arthroplasty.

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Patellar Eversion During Total Knee Replacement

Cited by 23 publications

References 30 publications

Common controversies in total knee replacement surgery: Current evidence

Common controversies in total knee replacement surgery: Current evidence

Should the patella be everted during primary total knee arthroplasty? A systematic review of overlapping meta-analyses

Risk of bias and the reporting of surgeons' experience in randomized controlled trials of total hip and total knee arthroplasty: A systematic review

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