title: Patellar non-eversion in primary TKA reduces the complication rate.
abstract: OBJECTIVE
  This study was designed to evaluate the isolated benefits of patellar non-eversion in total knee arthroplasty (TKA).
  
  
  METHODS
  This systematic review and meta-analysis was conducted following the PRISMA statement. A comprehensive search of the MEDLINE/PubMed, Cochrane Library, and Embase databases was performed in August 2014. Randomized controlled trials (RCTs) that considered the handling of the patella as the only variable were included in our review. Quality assessment of RCTs was performed according to the CONSORT statement. The meta-analysis was performed to pool the available data for some parameters.
  
  
  RESULTS
  The searches of the MEDLINE/PubMed, Cochrane Library, and Embase databases yielded 10 RCTs, and five RCTs were selected for inclusion in the review. This results suggested that tourniquet time [mean difference (MD) = -5.69; 95% confidence interval (CI) -9.77 to -1.60], length of hospitalization (MD = 1.24; 95% CI 0.54-1.94) and the incidence of complications [odds ratio (OR) = 2.23; 95% CI 1.12-4.44] differed significantly between the eversion group and non-eversion group. No differences in postoperative pain, alignment, and the Insall-Salvati ratio were observed between the groups.
  
  
  CONCLUSIONS
  The patellar non-eversion approach offers a shorter length of hospitalization and lower incidence of postoperative complications, but requires more operative time. The merits of patellar non-eversion for recovery of knee function remain controversial, and more high-quality RCTs are needed to draw clear conclusions. In general, avoidance of patellar eversion is recommended when exposing the knee joint for TKA.
authors: Department of Orthopaedics, Zhujiang Hospital, Southern Medical University, 253 Industrial Avenue, Haizhu, Guangzhou, 510282, Guangdong, China. yanggp522@163.com.
authors: Guangpu
authors: G
authors: Yang
authors: Department of Orthopaedics, Zhujiang Hospital, Southern Medical University, 253 Industrial Avenue, Haizhu, Guangzhou, 510282, Guangdong, China.
authors: Wenfa
authors: W
authors: Huang
authors: Department of Orthopaedics, Zhujiang Hospital, Southern Medical University, 253 Industrial Avenue, Haizhu, Guangzhou, 510282, Guangdong, China.
authors: Weixin
authors: W
authors: Xie
authors: Department of Orthopaedics, Zhujiang Hospital, Southern Medical University, 253 Industrial Avenue, Haizhu, Guangzhou, 510282, Guangdong, China.
authors: Zhipeng
authors: Z
authors: Liu
authors: Department of Orthopaedics, Zhujiang Hospital, Southern Medical University, 253 Industrial Avenue, Haizhu, Guangzhou, 510282, Guangdong, China.
authors: Meimei
authors: M
authors: Zheng
authors: Department of Orthopaedics, Zhujiang Hospital, Southern Medical University, 253 Industrial Avenue, Haizhu, Guangzhou, 510282, Guangdong, China.
authors: Yuxing
authors: Y
authors: Hu
authors: Department of Orthopaedics, Zhujiang Hospital, Southern Medical University, 253 Industrial Avenue, Haizhu, Guangzhou, 510282, Guangdong, China. tianjing_ortho@163.com.
authors: Jing
authors: J
authors: Tian
mesh_terms: D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007719:Knee Joint / Q000601:surgery; D010329:Patella / Q000601:surgery*; D016032:Randomized Controlled Trials as Topic
keywords: Minimally invasive surgery; Patellar eversion; Patellar non-eversion; Total knee arthroplasty