Abstract
We hypothesized that patella eversion during total knee arthroplasty (TKA) reduces early return of active knee extension and flexion, quadriceps muscle strength, and postoperative pain. In 100 conventional TKA knees and 100 minimally invasive TKA (MIS TKA) knees, we compared knee range of motion (ROM), postoperative pain, and quadriceps muscle strength at 1 day, 4 days, 1 week, 2 weeks, 3 weeks, 4 weeks, 12 weeks, 1 year, and 5 years after surgery. The differences of surgical approach between MIS TKA and conventional TKA of this study are length of skin incision with subcutaneal flap and patella eversion. In MIS TKA, skin incision is shorter than conventional TKA. Furthermore, patella is not everted in MIS TKA procedure. There were no significant differences in preoperative factors. Postoperative improvement of ROM, postoperative muscle strength recovery, and postoperative improvement of visual analog scale were faster in patients with MIS TKA when compared to that in patients with conventional TKA. On the other hand, no significant difference was observed in complication, 5-year clinical results of subjective knee function score, and the postoperative component angle and lower leg alignment. These results indicate that patella eversion may affect muscle strength recovery and postoperative pain.
Highlights
Total knee arthroplasty (TKA) is an established treatment for advanced arthritis of the knee [1, 2]
We hypothesized that patella eversion will deteriorate early return of knee range of extension and flexion, quadriceps strength, and postoperative pain
This paper showed that postoperative improvement of range of motion (ROM), postoperative muscle strength recovery, and postoperative improvement of pain were greater in patients with minimally invasive TKA (MIS TKA) when compared to patients with conventional TKA
Summary
Total knee arthroplasty (TKA) is an established treatment for advanced arthritis of the knee [1, 2]. The most popular approach of TKA is a medial parapatellar approach that splits quadriceps tendon with eversion of the patella [3]. It has been reported that subvastus approach in TKA could regain quadriceps muscle strength faster than the medial parapatellar approach [4,5,6]. Some surgeons use the midvastus muscle-splitting approach. With the use of this approach, complete eversion and lateral displacement of the patella are not inhibited, allowing for adequate exposure to the joint [8]. In these three approaches, surgeons need an approximately 20 cm length incision of the skin and patella eversion. That may affect length of hospitalization, medical cost, postoperative pain, and length of rehabilitation
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