Comparison of Three Surgical Techniques to Achieve Patella Symmetry During Resection
| Status: | Completed |
|---|---|
| Conditions: | Orthopedic |
| Therapuetic Areas: | Orthopedics / Podiatry |
| Healthy: | No |
| Age Range: | 18 - 99 |
| Updated: | 4/21/2016 |
| Start Date: | March 2013 |
| End Date: | December 2015 |
Effect of Surgical Technique on Resection Symmetry of the Patella in Total Knee Arthroplasty
This research was performed to determine which of the three techniques used by knee surgeons
at the Mayo Clinic was the most accurate at the surgical removal (resection) of the knee-cap
(patella) in a symmetric fashion during total knee replacement (arthroplasty). Although all
three techniques are known to be effective, the three techniques had never been compared to
one another to determine if one was more effective than the others at resecting the patella.
at the Mayo Clinic was the most accurate at the surgical removal (resection) of the knee-cap
(patella) in a symmetric fashion during total knee replacement (arthroplasty). Although all
three techniques are known to be effective, the three techniques had never been compared to
one another to determine if one was more effective than the others at resecting the patella.
Resection of the patella to prepare it for placement of a patellar prosthesis is a procedure
that is performed routinely in the vast majority of total knee arthroplasties (TKA) in the
United States and at the Mayo Clinic. This procedure is performed by a number of different
techniques that have been proved to be safe and effective. Despite this, patellar
instability, tilt, obliquity, and maltracking are all possible complications of improperly
resected patellae during TKA. The goals of resection are to create a patella that is
symmetrical, absent of obliquity (slanting), and thick enough to receive a patellar
prosthesis. Although outcomes are generally good for most described methods, to date, little
had been published regarding direct comparison of these methods.
Patients undergoing TKA with planned patellar resection were randomized to have their
patella resected by one of three methods during primary TKA: 1) use of a cutting guide, 2)
haptic feedback, or 3) free-hand resection guided by four quadrant measurements. There were
three experienced fellowship-trained arthroplasty surgeons (hip and knee) performing the
procedures who were all familiar and experienced with each of the three techniques being
investigated. Each surgeon, within a group of 30 of their patients, performed a total 10
resections using each of the three methods listed above (30 resections per surgeon for a
total of 90 resections).
Before and after resection measurements of knee-cap thickness were taken and used to
determine patellar symmetry. The resulting symmetry of each of the three techniques was then
be compared between and within each of the three techniques and surgeons. Each procedure was
also be timed from first measurement by the staff surgeon to the final measurement by that
surgeon.
that is performed routinely in the vast majority of total knee arthroplasties (TKA) in the
United States and at the Mayo Clinic. This procedure is performed by a number of different
techniques that have been proved to be safe and effective. Despite this, patellar
instability, tilt, obliquity, and maltracking are all possible complications of improperly
resected patellae during TKA. The goals of resection are to create a patella that is
symmetrical, absent of obliquity (slanting), and thick enough to receive a patellar
prosthesis. Although outcomes are generally good for most described methods, to date, little
had been published regarding direct comparison of these methods.
Patients undergoing TKA with planned patellar resection were randomized to have their
patella resected by one of three methods during primary TKA: 1) use of a cutting guide, 2)
haptic feedback, or 3) free-hand resection guided by four quadrant measurements. There were
three experienced fellowship-trained arthroplasty surgeons (hip and knee) performing the
procedures who were all familiar and experienced with each of the three techniques being
investigated. Each surgeon, within a group of 30 of their patients, performed a total 10
resections using each of the three methods listed above (30 resections per surgeon for a
total of 90 resections).
Before and after resection measurements of knee-cap thickness were taken and used to
determine patellar symmetry. The resulting symmetry of each of the three techniques was then
be compared between and within each of the three techniques and surgeons. Each procedure was
also be timed from first measurement by the staff surgeon to the final measurement by that
surgeon.
Inclusion Criteria:
- Patients scheduled for primary total knee arthroplasty with planned patellar
resection by one of the three staff surgeons included in the study.
- Patient must be able and willing to provide consent for study participation
Exclusion Criteria:
- Patient in need of revision total knee arthroplasty or having already undergone prior
total knee arthroplasty
- Patient not in need of patellar resection during their primary total knee
arthroplasty
- Unwilling or unable to provide consent for participation
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