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Does intraoperative patellar eversion affect clinical and functional outcomes in patients undergoing primary total knee arthroplasty? An evidence-based meta-analysis

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A Correction to this article was published on 22 May 2023

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Abstract

Purpose

This meta-analysis aims to compare the early postoperative recovery, complications encountered, length of hospital stay, and initial functional scores between patellar eversion and non-eversion manoeuvres in patients undergoing during primary total knee arthroplasty (TKA) based on clinical studies available in the literature.

Methods

A systematic literature search was conducted using PubMed, Embase, Web of Science, and the Cochrane Library databases between January 1, 2000 and August 12, 2022. Prospective trials comparing clinical, radiological, and functional outcomes in patients undergoing TKA with and without patellar eversion manoeuvre were included. The meta-analysis was performed using Rev-Man version 5.41 (Cochrane Collaboration). Pooled-odds ratios (for categorical data) and mean differences with 95% confidence intervals (for continuous data) were calculated (p < 0.05 was regarded as statistically significant).

Results

Ten (out of the 298 publications identified in this subject) were included for the meta-analysis. The patellar eversion group (PEG) had a significantly shorter tourniquet time [mean difference (MD) − 8.91 min; p = 0.002], although the overall intraoperative blood loss was higher (IOBL; MD 93.02 ml; p = 0.0003). The patellar retraction group (PRG), on the other hand, revealed statistically better early clinical outcomes in terms of shorter time necessary to perform active straight leg raising (MD 0.66, p = 0.0001), shorter time to achieve 90° knee-flexion (MD 0.29, p = 0.03), higher degree of knee flexion achieved at 90 days (MD − 1.90, p = 0.03), and reduced length of hospital stay (MD 0.65, p = 0.03). There was no statistically significant difference in the early complication rates, 36-item short-form health survey (1 year), visual analogue scores (1 year), and Insall-Salvati index at follow-up between the groups.

Conclusion

The implications from the evaluated studies suggest that in comparison with patellar eversion, patellar retraction manoeuvre during surgery provides significantly faster recovery of quadriceps function, earlier attainment of functional knee range of motion (ROM), and shorter length of hospital stay in patients undergoing TKA.

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Authors and Affiliations

  1. Department of Orthopedics, University of Calgary, Calgary, AB, Canada

    Vibhu Krishnan Viswanathan

  2. Central Institute of Orthopaedics, Safdarjung Hospital, New Delhi, India

    Mohit Kumar Patralekh

  3. Ganga Medical Centre and Hospital, Coimbatore, Tamil Nadu, India

    Guna Pratheep Kalanjiyam

  4. Southport and Ormskirk NHS Trust, Southport, PR8 6PN, UK

    Karthikeyan P. Iyengar

  5. Department Orthopaedics, Parul Institute of Medical Sciences and Research, Parul University, Vadodara, Gujarat, India

    Karthik Vishwanathan

  6. AtalBihari Vajpayee Institute of Medical Sciences, Dr Ram ManoharLohia Hospital, New Delhi, 110001, India

    Vijay Kumar Jain

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Contributions

Vibhu Krishnan Viswanathan: methodology, formal analysis and investigation, and writing (original draft preparation). Mohit Kumar Patralekh: conceptualisation, methodology, formal analysis and investigation, and resources. Guna Pratheep Kalanjiyam: methodology and formal analysis and investigation. Karthikeyan P. Iyengar: conceptualisation, methodology, and writing (review and editing). Karthik Vishwanathan: conceptualisation, methodology, and writing (review and editing). Vijay Kumar Jain: conceptualisation, methodology, writing (review and editing), resources, and supervision.

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Correspondence to Vijay Kumar Jain.

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The original version of this article was revised. The correct affiliation of Karthik Vishwanathan is Department Orthopaedics, Parul Institute of Medical Sciences and Research, Parul University, Vadodara, Gujarat, India

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Viswanathan, V.K., Patralekh, M.K., Kalanjiyam, G.P. et al. Does intraoperative patellar eversion affect clinical and functional outcomes in patients undergoing primary total knee arthroplasty? An evidence-based meta-analysis. International Orthopaedics (SICOT) 47, 1947–1961 (2023). https://doi.org/10.1007/s00264-023-05797-8

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