Abstract
Standard surgical exposure reduces blood flow to the patella during total knee arthroplasty (TKA). Reduction of patellar blood flow has resulted in patellofemoral complications including osteonecrosis and patellar fracture, necessitating revision surgery. In TKA, avoiding patellar eversion is one type of minimally invasive surgery (MIS) technique. This study is the first to measure patellar blood flow during MIS TKA with the knee in both extension and 90° of flexion followed by lateral retraction and then eversion of the patella. Patellar blood flow was measured using laser Doppler flowmetry in 40 patients during MIS TKA. A significant reduction in flow was noted when the leg was flexed from full extension to 90°. Eversion of the patella reduced patellar blood flow. MIS TKA without patellar eversion may be useful for preventing a reduction in patellar blood flow.
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Başarir K, Erdemli B, Tuccar E, Esmer AF (2006) Safe zone for the descending genicular artery in the midvastus approach to the knee. Clin Orthop Relat Res 451:96–100. doi:10.1097/01.blo.0000223995.79894.5e
Bonutti PM, Miller BG, Cremens MJ (1998) Intraosseous patellar blood supply after medial parapatellar arthrotomy. Clin Orthop Relat Res 352:202–214. doi:10.1097/00003086-199807000-00024
Bonutti PM, Mont MA, McMahon M, Ragland PS, Kester M (2004) Minimally invasive total knee arthroplasty. J Bone Joint Surg Am 86-A(Suppl 2):26–32
Brick GW, Scott RD (1989) Blood supply to the patella. Significance in total knee arthroplasty. J Arthroplasty 4(Suppl):S75–S79. doi:10.1016/S0883-5403(89)80011-7
Gelfer Y, Pinkas L, Horne T, Halperin N, Alk D, Robinson D (2003) Symptomatic transient patellar ischemia following total knee replacement as detected by scintigraphy. A prospective, randomized, double-blind study comparing the mid-vastus to the medial para-patellar approach. Knee 10:341–345. doi:10.1016/S0968-0160(03)00026-7
Haas SB, Cook S, Beksac B (2004) Minimally invasive total knee replacement through a mini midvastus approach: a comparative study. Clin Orthop Relat Res 428:68–73. doi:10.1097/01.blo.0000147649.82883.ca
Hempfing A, Schoeniger R, Koch PP, Bischel O, Thomsen M (2007) Patellar blood flow during knee arthroplasty surgical exposure: Intraoperative monitoring by laser doppler flowmetry. J Orthop Res 25:1389–1394. doi:10.1002/jor.20416
Holtby RM, Grosso P (1996) Osteonecrosis and resorption of the patella after total knee replacement: a case report. Clin Orthop Relat Res 328:155–158. doi:10.1097/00003086-199607000-00024
Jensen LK (2005) Knee-straining work activities, self-reported knee disorders and radiographically determined knee osteoarthritis. Scand J Work Environ Health 31(Suppl 2):68–74
Jensen LK, Mikkelsen S, Loft IP, Eenberg W, Bergmann I, Løgager V (2000) Radiographic knee osteoarthritis in floorlayers and carpenters. Scand J Work Environ Health 26:257–262
Karachalios T, Giotikas D, Roidis N, Poultsides L, Bargiotas K, Malizos KN (2008) Total knee replacement performed with either a mini-midvastus or a standard approach: a prospective randomised clinical and radiological trial. J Bone Joint Surg Br 90-B:584–591. doi:10.1302/0301-620X.90B5.20122
Kayler DE, Lyttle D (1988) Surgical interruption of patellar blood supply by total knee arthroplasty. Clin Orthop Relat Res 229:221–227
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-B:467–470. doi:10.1302/0301-620X.89B4.18663
King J, Stamper DL, Schaad DC, Leopold SS (2007) Minimally invasive total knee arthroplasty compared with traditional total knee arthroplasty. Assessment of the learning curve and the postoperative recuperative period. J Bone Joint Surg Am 89:1497–1503. doi:10.2106/JBJS.F.00867
Kolisek FR, Bonutti PM, Hozack WJ, Purtill J, Sharkey PF, Zelicof SB et al (2007) Clinical experience using a minimally invasive surgical approach for total knee arthroplasty: early results of a prospective randomized study compared to a standard approach. J Arthroplasty 22:8–13. doi:10.1016/j.arth.2006.06.004
Laskin RS, Beksac B, Phongjunakorn A, Pittors K, Davis J, Shim JC et al (2004) Minimally invasive total knee replacement through a mini-midvastus incision: an outcome study. Clin Orthop Relat Res 428:74–81. doi:10.1097/01.blo.0000148582.86102.47
Näslund J, Waldén M, Lindberg LG (2007) Decreased pulsatile blood flow in the patella in patellofemoral pain syndrome. Am J Sports Med 35:1668–1673. doi:10.1177/0363546507303115
Nicholls RL, Green D, Kuster MS (2006) Patella intraosseous blood flow disturbance during a medial or lateral arthrotomy in total knee arthroplasty: a laser Doppler flowmetry study. Knee Surg Sports Traumatol Arthrosc 14:411–416. doi:10.1007/s00167-005-0703-0
Ogata K, Shively RA, Shoenecker PL, Chang SL (1987) Effects of standard surgical procedures on the patellar blood flow in monkeys. Clin Orthop Relat Res 215:254–259
Pagnano MW, Meneghini RM (2006) Minimally invasive total knee arthroplasty with an optimized subvastus approach. J Arthroplasty 21(Suppl 1):22–26. doi:10.1016/j.arth.2006.02.081
Ritter MA, Herbst SA, Keating EM, Faris PM, Meding JB (1996) Patellofemoral complications following total knee arthroplasty. Effect of a lateral release and sacrifice of the superior lateral geniculate artery. J Arthroplasty 11:368–372. doi:10.1016/S0883-5403(96)80024-6
Stoffel KK, Flivik G, Yates PJ, Nicholls RL (2007) Intraosseous blood flow of the everted or laterally-retracted patella during total knee arthroplasty. Knee 14:434–438. doi:10.1016/j.knee.2007.07.005
Swiontkowski MF, Schlehr F, Collins JC, Sanders R, Pou A (1988) Comparison of two laser Doppler flowmetry systems for bone blood flow analysis. Calcif Tissue Int 43:103–107. doi:10.1007/BF02555155
Walter F, Haynes MB, Markel DC (2007) A randomized prospective study evaluating the effect of patellar eversion on the early functional outcomes in primary total knee arthroplasty. J Arthroplasty 22:509–514. doi:10.1016/j.arth.2006.06.015
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M. Hasegawa and G. Kawamura contributed equally to this work.
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Hasegawa, M., Kawamura, G., Wakabayashi, H. et al. Changes to patellar blood flow after minimally invasive total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 17, 1195–1198 (2009). https://doi.org/10.1007/s00167-009-0834-9
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DOI: https://doi.org/10.1007/s00167-009-0834-9