Gradual low riding of the patella during postoperative course after total knee arthroplasty in osteoarthritis and rheumatoid arthritis

Koshino, Tomihisa; Ejima, Masaharu; Okamoto, Ryo; Morii, Takamichi

doi:10.1016/s0883-5403(08)80091-5

Cited by 64 publications

(59 citation statements)

References 3 publications

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“…Several studies in the literature suggest TKA may be associated with a high incidence of patellar tendon shortening and resultant patella baja [11,18,19,26]. Moreover, two studies using a minimally invasive technique showed a decreased incidence of patella baja as compared with a standard TKA [11,26].…”

Section: Discussionmentioning

confidence: 99%

“…A change of 10% or more in the postoperative ISR was also calculated to compare our results with previously published studies [11,18,26]. Because the purpose of this study was to find the true postoperative patella baja resulting from shortening of the patellar tendon, no attempt was made to evaluate the joint line elevation and the resultant pseudo-baja [13].…”

Section: Methodsmentioning

confidence: 98%

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Does Patellar Eversion in Total Knee Arthroplasty Cause Patella Baja?

Sharma

Tsailas

Maheshwari

et al. 2008

Clinical Orthopaedics &Amp; Related Research

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Several proponents of minimally invasive surgery-total knee arthroplasty (MIS-TKA) have suggested patellar eversion during a standard exposure of the knee may cause shortening of the patellar tendon and poorer outcomes secondary to acquired patella baja. To explore this suggestion, we retrospectively reviewed 135 consecutive TKAs in 110 patients to ascertain the effect of TKA on the postoperative Insall-Salvati ratio. All surgeries were performed using standard TKA techniques with a midline incision, medial parapatellar arthrotomy, partial excision of the fat pad, and routine eversion of the patella. One patient developed a postoperative patella baja, defined as an InsallSalvati ratio of less than 0.8. The Knee Society score for knee and function in this patient was 75 and 70, respectively. Five additional patients had a decrease in InsallSalvati ratio by 10% or more but without patella baja.Mean Knee Society score for knee and function in these five patients was 94 (range, 73-99) and 96 (range, 90-100), respectively, as compared with 93 (range, 37-99) and 94 (range, 40-100) in the remaining 104 patients. Our data suggest the incidence of patella baja is low after TKA despite routine patellar eversion. Furthermore, a 10% or more decrease in the Insall-Salvati ratio without patella baja was not associated with a worse clinical outcome.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 98%

Does Patellar Eversion in Total Knee Arthroplasty Cause Patella Baja?

Sharma

Tsailas

Maheshwari

et al. 2008

Clinical Orthopaedics &Amp; Related Research

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“…Selective use of patellar replacement in cases with lowriding patella has been advocated (Fern et al 1992). However, low-riding patella also occurs postoperatively through shrinkage of the patellar ligament (Koshino et al 1990). Previous reports on patellar revision rates vary considerably.…”

Section: Discussionmentioning

confidence: 99%

Knee arthroplasty in rheumatoid arthritis: A report from the Swedish Knee Arthroplasty Register on 4, 381 primary operations 1985–1995

Robertsson

Knutson

Lewold

et al. 1997

Acta Orthopaedica Scandinavica

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“…2,3,12,22 The suggested reasons for patella baja were extensive surgical exposure and patellar eversion. Despite use of a standard TKA technique with routine eversion of the patella at our center, a high incidence of patella baja was not observed as mentioned in the literature.…”

Section: Discussionmentioning

confidence: 99%

“…2 Although lateral release was performed in all patients, the fat pad was not resected. However in our study lateral release was not done in any of the cases.…”

Section: Discussionmentioning

confidence: 99%

Incidence of patella baja following patellar eversion in total knee arthroplasty

et al. 2017

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Background: Patella baja is a rare complication of total knee arthroplasty (TKA) leading to decreased mechanical advantage of the extensor mechanism, decreased knee range of motion, anterior knee pain and increased wear of the tibial and patellar polyethylene. There exists a lack of evidence on whether patellar eversion leads to shortening of the patellar tendon. The present study aims to determine if eversion of patella during TKA leads to patella baja.Methods: Between August 2014 and August 2016, 55 knees undergoing primary TKA with a standard medial parapatellar arthrotomy and eversion of patella were included in this two point cross sectional study. Preoperative X-rays were taken to assess the length of the patellar tendon and Insall Salvati ratio (ISR). Postoperatively the Blackburne Peel Index (BPI), ISR and patellar tendon lengths were assessed on lateral X-rays to look for any incidence of patella baja.Results: The postoperative change in the length of the patellar tendon was unpredictable; though most of them decreased. The pre and post op difference in the length of patellar tendon was statistically significant in females (4.43±0.20 cm vs. 4.35±0.24 cm; p value-0.005). Significant decrease in length of patellar tendon was seen in patients aged 66-70 years (p= 0.024) and patients with BMI >30 kg/m2. No case of true patella baja was found postoperatively. No significant correlation could be established between ISR and age, sex or BMI of the patients.Conclusions: The different risk factors for post TKA shortening of patellar tendon include female gender and higher BMI (>30 Kg/m²). However eversion of patella during TKA may not lead to an increased incidence of true patella baja.

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Gradual low riding of the patella during postoperative course after total knee arthroplasty in osteoarthritis and rheumatoid arthritis

Cited by 64 publications

References 3 publications

Does Patellar Eversion in Total Knee Arthroplasty Cause Patella Baja?

Does Patellar Eversion in Total Knee Arthroplasty Cause Patella Baja?

Knee arthroplasty in rheumatoid arthritis: A report from the Swedish Knee Arthroplasty Register on 4, 381 primary operations 1985–1995

Incidence of patella baja following patellar eversion in total knee arthroplasty

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