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Patella scores are similar both with gap balancing and measured resection after total knee arthroplasty: a randomized single-centre study

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this prospective study was to compare femoral component rotation (FCR) values when adjusted with ‘gap balancing’ (GB) and ‘measured resection’ (MR) techniques following total knee arthroplasty (TKA). The study hypothesis was that the GB technique would be better on FCR than MR in TKA.

Methods

From a total of 93 unilateral TKAs performed between August 2019 and November 2020, the FCR values were adjusted by GB in 46 cases and MR in 47. Post-TKA magnetic resonance imaging (MRI) was applied for FCR assessment. Orthoroentgenograms and lateral knee radiographs were taken to determine the mechanical axis and posterior condylar offset (PCO) ratio, respectively. Both groups were compared radiologically. The Western Ontario and Mcmaster Universities Osteoarthritis Index (WOMAC), Knee Society Score (KSS), and Hospital for Special Surgery (HSS) patella scores were calculated and compared between the groups preoperatively and at the end of 6 months, and 1 and 2 years postoperatively.

Results

There was no difference between the groups in respect of the demographic data. The mean HSS patella score was 86.4 ± 4.1 in the GB group and 84.6 ± 3.8 in the MR group in the 2nd year (p = 0.047). A higher degree of external rotation in the FC was determined in the GB group [2.2° (1.7°–4.3°)] compared to the MR group [1.7° (0.8°–3.0°)] (p = 0.009). The postoperative increase in PCO ratio was higher in the GB group (p = 0.005). All other variables were similar in both groups.

Conclusion

The results of this study showed that at the end of the 2nd year, the HSS patella scores were better, FCs were more externally rotated and PCO ratios were higher in TKAs using the GB technique. However, taking into account that the difference between the 2nd year HSS patella scores was too small to be considered clinically significant, it was shown that both the GB and MR techniques can be used for FCR in clinical practice without any hesitation.

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Abbreviations

FC:

Femoral component

GB:

Gap balancing

MR:

Measured resection

TKA:

Total knee arthroplasty

PCO:

Posterior condylar offset

WOMAC:

Western Ontario and McMaster Universities Osteoarthritis Index

KSS:

Knee Society Score

HSS:

Hospital for Special Surgery

MCL:

Medial collateral ligament

MRI:

Magnetic resonance imaging

MAVRIC:

Multi-Acquisition Variable Resonance Image Combination

PCA:

Posterior condylar angle

sTEA:

Surgical transepicondylar axis

ROM:

Range of motion

CR:

Cruciate retaining

PS:

Posterior stabilized

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Funding

No funding was received for this study.

Author information

Authors and Affiliations

  1. Department of Orthopedics and Traumatology, Heath Sciences University, Bursa Yüksek İhtisas Research and Training Hospital, 16300, Yıldırım, Bursa, Turkey

    Alpaslan Öztürk, Yavuz Akalın, Nazan Çevik & Fatih Türkmensoy

  2. Department of Orthopedics and Traumatology, Tavsanli State Hospital, Kütahya, Turkey

    Özgür Avci

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  1. Alpaslan Öztürk
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  2. Özgür Avci
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Contributions

All listed authors have contributed substantially to this work (AÖ and ÖA for the study conception and design; ÖA, YA, NÇ, and FT for the data collection, NÇ and FT for the data analysis; YA, AÖ, and ÖA for the data interpretation; AÖ, ÖA, FT, and NÇ for the drafting of the manuscript, the figures, and the literature research) and have approved the submission to KSSTA.

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Correspondence to Alpaslan Öztürk.

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Conflict of interest

No benefits in any form have been received or will be received from a commercial party related directly or indirectly, financially or otherwise, to the subject of this article.

Ethical approval

Approval for this research project was received from the local ethics committee of our hospital on 2019/02-08.

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Öztürk, A., Avci, Ö., Akalın, Y. et al. Patella scores are similar both with gap balancing and measured resection after total knee arthroplasty: a randomized single-centre study. Knee Surg Sports Traumatol Arthrosc 31, 4942–4950 (2023). https://doi.org/10.1007/s00167-023-07540-7

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