title: Is patella eversion during total knee arthroplasty crucial for gap adjustment and soft-tissue balancing?
abstract: BACKGROUND
  Assessment of soft-tissue balance by the gap technique in Total Knee Arthroplasty (TKA) impacts femoral component rotation positioning. Proper femoral component rotation is a critical factor in TKA, both for adequate patellar tracking and in achieving a symmetrical flexion gap. Soft tissue balance assessment and gap measurements are performed at 90° flexion and with the patella everted in conventional TKA; during MIS-TKA, this step is performed with the patella in situ. We therefore investigated intraoperative joint gap parameters at 90° flexion with and without patellar eversion during conventional TKA, so as to better understand the influence of this intraoperative patellar position factor on final ligament balance.
  
  
  OBJECTIVE
  Conducting TKA without patellar eversion increases both gap size and gap inclination.
  
  
  METHODS
  Twenty-four osteoarthritic knees were included in the study. Joint gap size and inclination were measured intraoperatively on a knee in 90° flexion, with and without patellar eversion.
  
  
  RESULTS
  The joint gap with patella in situ (17.0±3.4 mm) was significantly greater than with patellar eversion (15.4±3.0 mm), as was gap inclination at 90° flexion with the patella in situ (4.9±3.1°) compared to with patellar eversion (4.0±2.9°).
  
  
  CONCLUSIONS
  The flexion gap inclination obtained without patellar eversion was steeper than with patellar eversion. This induced more externally rotated femoral positioning in absence of patellar eversion. These results ought to be taken into account by surgeons considering switching from conventional to MIS-TKA.
authors: Department of Orthopaedic Surgery, Division of Clinical Medical Science, Graduated School of Biomedical Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, Japan. go_k_0127@yahoo.co.jp
authors: G
authors: G
authors: Kamei
authors: Y
authors: Y
authors: Murakami
authors: H
authors: H
authors: Kazusa
authors: S
authors: S
authors: Hachisuka
authors: H
authors: H
authors: Inoue
authors: H
authors: H
authors: Nobutou
authors: K
authors: K
authors: Nishida
authors: Y
authors: Y
authors: Mochizuki
authors: M
authors: M
authors: Ochi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D001696:Biomechanical Phenomena; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology / Q000517:prevention & control*; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods*; D020370:Osteoarthritis, Knee / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D010329:Patella / Q000000981:diagnostic imaging / Q000601:surgery*; D011446:Prospective Studies; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology*; D012399:Rotation