Skip to main content
SpringerLink
Log in

Optimal patellar alignment with minimally invasive approaches in total knee arthroplasty after a minimum five year follow-up

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

Patellofemoral syndrome is still a common complication after total knee arthroplasty (TKA). However, the effects of specific surgical approaches on patellar tracking and alignment remain incompletely understood. In this study, we compared patellar alignment in patients who underwent TKA via three different techniques.

Methods

A total of 96 patients who completed a minimum follow-up of five years were involved in three groups: 30 patients were treated with the traditional medial parapatellar approach (MPP group), 35 patients were treated with the mini-medial parapatellar approach (MMP group) and 31 were treated with a quadriceps-sparing approach (QS group). Radiographic data for patellar alignment and clinical results were compared.

Results

Patellar tilt and patellar displacement at the final follow-up evaluation differed significantly among the three groups [P < 0.01, analysis of variance (ANOVA)]. The MMP and QS groups exhibited more proper patellar alignment than the MPP group. The clinical results did not differ significantly among the groups (P > 0.05, ANOVA). In addition, there were no correlations between postoperative patellar alignment and clinical scores.

Conclusions

The results of this study indicate that TKA performed using minimally invasive approaches yields superior patellar alignment compared to the traditional MPP approach.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Sharkey PF, Hozack WJ, Rothman RH, Shastri S, Jacoby SM (2002) Insall Award paper. Why are total knee arthroplasties failing today? Clin Orthop Relat Res 404:7–13. doi:10.1097/01.blo.0000036002.13841.32

    Article  PubMed  Google Scholar 

  2. Baldini A, Anderson JA, Cerulli-Mariani P, Kalyvas J, Pavlov H, Sculco TP (2007) Patellofemoral evaluation after total knee arthroplasty. Validation of a new weight-bearing axial radiographic view. J Bone Joint Surg Am 89:1810–1817. doi:10.2106/JBJS.E.00432

    Article  PubMed  Google Scholar 

  3. Fukagawa S, Matsuda S, Mizu-uchi H, Miura H, Okazaki K, Iwamoto Y (2011) Changes in patellar alignment after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 19:99–104. doi:10.1007/s00167-010-1164-7

    Article  PubMed  Google Scholar 

  4. Kong CG, Cho HM, Suhl KH, Kim MU, In Y (2012) Patellar tracking after total knee arthroplasty performed without lateral release. Knee 19:692–695. doi:10.1016/j.knee.2011.09.007

    Article  PubMed  Google Scholar 

  5. Meftah M, Jhurani A, Bhat JA, Ranawat AS, Ranawat CS (2012) The effect of patellar replacement technique on patellofemoral complications and anterior knee pain. J Arthroplasty 27:1075–1080. doi:10.1016/j.arth.2011.10.006

    Article  PubMed  Google Scholar 

  6. Kawano T, Miura H, Nagamine R, Urabe K, Matsuda S, Mawatari T, Moro-Oka T, Iwamoto Y (2002) Factors affecting patellar tracking after total knee arthroplasty. J Arthroplasty 17:942–947

    Article  PubMed  Google Scholar 

  7. Dhollander AAM, Bassens D, Victor J, Verdonk P (2013) Patellar tilt and thickness do not influence postoperative flexion in a high-flex design total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 21:2817–2822. doi:10.1007/s00167-012-2245-6

    Article  PubMed  Google Scholar 

  8. Lee GW, Lee SM, Jang SJ, Son JH (2013) The efficacy of patellar decompression for improving anterior knee pain following total knee arthroplasty without patellar resurfacing. Arch Orthop Trauma Surg 133:561–567. doi:10.1007/s00402-013-1702-0

    Article  PubMed  Google Scholar 

  9. Zha GC, Sun JY, Dong SJ (2014) Less anterior knee pain with a routine lateral release in total knee arthroplasty without patellar resurfacing: a prospective, randomized study. Knee Surg Sports Traumatol Arthrosc 22:517–525. doi:10.1007/s00167-013-2789-0

    Article  PubMed  Google Scholar 

  10. Chew JT, Stewart NJ, Hanssen AD, Luo ZP, Rand JA, An KN (1997) Differences in patellar tracking and knee kinematics among three different total knee designs. Clin Orthop Relat Res 345:87–98

    Article  PubMed  Google Scholar 

  11. Pongcharoen B, Yakampor T, Charoencholvanish K (2013) Patellar tracking and anterior knee pain are similar after medial parapatellar and midvastus approaches in minimally invasive TKA. Clin Orthop Relat Res 471:1654–1660. doi:10.1007/s11999-012-2778-5

    Article  PubMed Central  PubMed  Google Scholar 

  12. Curtin B, Yakkanti M, Malkani A (2014) Postoperative pain and contracture following total knee arthroplasty comparing parapatellar and subvastus approaches. J Arthroplasty 29:33–36. doi:10.1016/j.arth.2013.03.021

    Article  PubMed  Google Scholar 

  13. Bindelglass DF, Vince KG (1996) Patellar tilt and subluxation following subvastus and parapatellar approach in total knee arthroplasty. Implication for surgical technique. J Arthroplasty 11:507–511

    Article  CAS  PubMed  Google Scholar 

  14. Varela-Egocheaga JR, Suárez-Suárez MA, Fernández-Villán M, González-Sastre V, Varela-Gómez JR, Rodríguez-Merchán C (2010) Minimally invasive subvastus approach: improving the results of total knee arthroplasty: a prospective, randomized trial. Clin Orthop Relat Res 468:1200–1208. doi:10.1007/s11999-009-1160-8

    Article  PubMed Central  PubMed  Google Scholar 

  15. Heekin RD, Fokin AA (2013) Mini-midvastus versus mini-medial parapatellar approach for minimally invasive total knee arthroplasty: outcomes pendulum is at equilibrium. J Arthroplasty 29:339–342. doi:10.1016/j.arth.2013.05.016

    Article  PubMed  Google Scholar 

  16. Wülker N, Lambermont JP, Sacchetti L, Lazaró JG, Nardi J (2010) A prospective randomized study of minimally invasive total knee arthroplasty compared with conventional surgery. J Bone Joint Surg Am 92:1584–1590. doi:10.2106/JBJS.H.01070

    Article  PubMed  Google Scholar 

  17. Kim YH, Kim JS, Kim DY (2007) Clinical outcome and rate of complications after primary total knee replacement performed with quadriceps-sparing or standard arthrotomy. J Bone Joint Surg Br 89:467–470. doi:10.1302/0301-620x.89b4.18663

    Article  PubMed  Google Scholar 

  18. Lin SY, Chen CH, Fu YC, Huang PJ, Lu CC, Su JY, Chang JK, Huang HT (2013) Comparison of the clinical and radiological outcomes of three minimally invasive techniques for total knee replacement at two years. Bone Joint J 95-B:906–910. doi:10.1302/0301-620X.95B7.29694

    Article  PubMed  Google Scholar 

  19. Tria AJ Jr, Coon TM (2003) Minimal incision total knee arthroplasty: early experience. Clin Orthop Relat Res 416:185–190. doi:10.1097/01.blo.0000093030.56370.d9

    Article  PubMed  Google Scholar 

  20. Tenholder M, Clarke HD, Scuderi GR (2005) Minimal-incision total knee arthroplasty: the early clinical experience. Clin Orthop Relat Res 440:67–76

    Article  PubMed  Google Scholar 

  21. Insall J (1971) A midline approach to the knee. J Bone Joint Surg Am 53:1584–1586

    CAS  PubMed  Google Scholar 

  22. Aglietti P, Baldini A, Sensi L (2006) Quadriceps-sparing versus mini-subvastus approach in total knee arthroplasty. Clin Orthop Relat Res 452:106–111. doi:10.1097/01.blo.0000238789.51972.16

    Article  CAS  PubMed  Google Scholar 

  23. Grelsamer RP, Bazos AN, Proctor CS (1993) Radiographic analysis of patellar tilt. J Bone Joint Surg Br 75:822–824

    CAS  PubMed  Google Scholar 

  24. Laurin CA, Dussault R, Levesque HP (1979) The tangential x-ray investigation of the patellofemoral joint: x-ray technique, diagnostic criteria and their interpretation. Clin Orthop Relat Res 144:16–26

    PubMed  Google Scholar 

  25. Petersen W, Rembitzki IV, Brüggemann GP, Ellermann A, Best R, Koppenburg AG, Liebau C (2014) Anterior knee pain after total knee arthroplasty: a narrative review. Int Orthop 38:319–328. doi:10.1007/s00264-013-2081-4

    Article  PubMed Central  PubMed  Google Scholar 

  26. Schiavone Panni A, Cerciello S, Del Regno C, Felici A, Vasso M (2014) Patellar resurfacing complications in total knee arthroplasty. Int Orthop 38:313–317. doi:10.1007/s00264-013-2244-3

    Article  PubMed Central  PubMed  Google Scholar 

  27. Bracey DN, Brown ML, Beard HR, Mannava S, Nazir OF, Seyler TM, Lang JE (2015) Effects of patellofemoral overstuffing on knee flexion and patellar kinematics following total knee arthroplasty: a cadaveric study. Int Orthop. doi:10.1007/s00264-015-2715-9

    Google Scholar 

  28. Župan A, Snoj Ž, Antolič V, Pompe B (2014) Better results with patelloplasty compared to traditional total knee arthroplasty. Int Orthop 38:1621–1625. doi:10.1007/s00264-014-2366-2

    Article  PubMed Central  PubMed  Google Scholar 

  29. Matsueda M, Gustilo RB (2000) Subvastus and medial parapatellar approaches in total knee arthroplasty. Clin Orthop Relat Res 371:161–168

    Article  PubMed  Google Scholar 

  30. Ozkoc G, Hersekli MA, Akpinar S, Ozalay M, Uysal M, Cesur N, Tandogan RN (2005) Time dependent changes in patellar tracking with medial parapatellar and midvastus approaches. Knee Surg Sports Traumatol Arthrosc 13:654–657. doi:10.1007/s00167-004-0605-6

    Article  PubMed  Google Scholar 

  31. Scheurer P, Reininga IH, van Jonbergen HP, van Raay JJ (2015) Secondary patellar resurfacing following total knee arthroplasty: a cohort study in fifty eight knees with a mean follow-up of thirty one months. Int Orthop 39:1301–1306. doi:10.1007/s00264-015-2684-z

    Article  PubMed  Google Scholar 

  32. Bindelglass DF, Cohen JL, Dorr LD (1993) Patellar tilt and subluxation in total knee arthroplasty. Relationship to pain, fixation, and design. Clin Orthop Relat Res 286:103–109

    PubMed  Google Scholar 

  33. Bertin KC, Lloyd WW (2013) Effect of total knee prosthesis design on patellar tracking and need for lateral retinacular release. J Arthroplasty 28:772–777. doi:10.1016/j.arth.2012.12.012

    Article  PubMed  Google Scholar 

  34. Breeman S, Campbell M, Dakin H, Fiddian N, Fitzpatrick R, Grant A, Gray A, Johnston L, Maclennan G, Morris R, Murray D, KAT Trial Group (2011) Patellar resurfacing in total knee replacement: five-year clinical and economic results of a large randomized controlled trial. J Bone Joint Surg Am 93:1473–1481. doi:10.2106/JBJS.J.00725

    Article  PubMed  Google Scholar 

  35. Smith AJ, Wood DJ, Li MG (2008) Total knee replacement with and without patellar resurfacing: a prospective, randomised trial using the profix total knee system. J Bone Joint Surg Br 90:43–49. doi:10.1302/0301-620X.90B1.18986

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

This study was funded by the Beijing Science and Technology Planning Projects of Beijing Science and Technology Committee (No. Z131100005213004), Instrument Research Project of the National Natural Science Foundation (No. 81327001). We thank Medjaden Bioscience for their language editing which greatly improved the manuscript.

Conflict of interest

The authors declare that they have no conflict of interest. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

Author information

Author notes

    Authors and Affiliations

    1. Institute of Sports Medicine, Peking University Third Hospital, No. 49, North Garden Road, Haidian District, Beijing, 100191, China

      Ai-Bing Huang, Hai-Jun Wang, Jia-Kuo Yu, Bo Yang, Dong Ma & Ji-Ying Zhang

    Authors
    1. Ai-Bing Huang
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Hai-Jun Wang
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Jia-Kuo Yu
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Bo Yang
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Dong Ma
      View author publications

      You can also search for this author in PubMed Google Scholar

    6. Ji-Ying Zhang
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to Jia-Kuo Yu.

    Additional information

    Ai-Bing Huang and Hai-Jun Wang contributed equally to this work.

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Huang, AB., Wang, HJ., Yu, JK. et al. Optimal patellar alignment with minimally invasive approaches in total knee arthroplasty after a minimum five year follow-up. International Orthopaedics (SICOT) 40, 487–492 (2016). https://doi.org/10.1007/s00264-015-2896-2

    Download citation

    • Received:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s00264-015-2896-2

    Keywords

    Search

    Navigation