The influence of retropatellar fat preservation on the positioning of the tibial component of total knee arthroplasty
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20232179Keywords:
Total knee arthoplasty, Tibial component, Hoffa's fat padAbstract
Background: The good clinical-functional outcomes of total knee arthroplasty (TKA) depend on several factors, such as the surgical time and the adequate positioning of the prosthesis components. The present study aims to evaluate whether the preservation of retropatellar fat pad during the surgical act influences the rotational alignment of the tibial component and the surgical time of the procedure.
Methods: The study was carried out with 50 patients operated on by the main author, who were randomly divided into two groups, experimental and control. For the evaluation of the positioning of the tibial component, the patients underwent computed tomography (CT) four weeks after the surgery, on average. Casuistry was determined by pilot study with the first five patients of each group. For the sample calculation, the t-student test was used for two independent samples.
Results: All patients presented internal rotation of the tibial component, with no statistical difference in mean rotation between the experimental and control groups. When there was complete detachment of the fat in the experimental group, the tibial component showed greater external rotation, with a statistical difference. Surgical time was shorter in the experimental group, varying in this group according to the degree of osteoarthrosis.
Conclusions: Maintenance of retropatellar fat pad did not influence the rotational alignment of the tibial component; however, in patients with advanced osteoarthrosis, such maintenance increases the surgical time.
References
Nakahara H, Okazaki K, Hamai S, Kawahara S, Higaki H, Mizu-uchi H, et al. Rotational alignment of the tibial component affects the kinematic rotation of a weight-bearing knee after total knee arthroplasty. Knee. 2015;22(3):201-5.
Scigliano NM, Carender CN, Glass NA, Deberg J, Bedard NA. Operative Time and Risk of Surgical Site Infection and Periprosthetic Joint Infection: A Systematic Review and Meta-Analysis. Iowa Orthop J. 2022;42(1):155-61.
White L, Holyoak R, Sant J, Hartnell N, Mullan J. The effect of infrapatellar fat pad resection on outcomes post-total knee arthroplasty: a systematic review. Arch Orthop Trauma Surg. 2016;136(5):701-8.
Bohnsack M, Wilharm A, Hurschler C, Rühmann O, Stukenborg-Colsman C, Joachim Wirth C. Biomechanical and Kinematic Influences of a Total Infrapatellar Fat Pad Resection on the Knee. Am J Sports Med. 2004;32(8):1873-80.
Moverley R, Williams D, Bardakos N, Field R. Removal of the infrapatella fat pad during total knee arthroplasty: does it affect patient outcomes? Int Orthop. 2014;38(12):2483-7.
Berger RA, Crossett LS, Jacobs JJ, Rubash HE. Malrotation Causing Patellofemoral Complications After Total Knee Arthroplasty. Clin OrthopRelat Res. 1998;356:144-53.
Duan G, Liu C, Lin W, Shao J, Fu K, Niu Y, et al. Different Factors Conduct Anterior Knee Pain Following Primary Total Knee Arthroplasty: A Systematic Review and Meta-Analysis. J Arthroplasty. 2018;33(6):1962-71.
Nisar S, Lamb JN, Somashekar N, Pandit H, van Duren BH. Preservation vs. resection of the infrapatellar fat pad during total knee arthroplasty part II: A systematic review of published evidence. Knee. 2019;26(2):422-6.
Gwyn R, Kotwal RS, Holt MD, Davies AP. Complete excision of the infrapatellar fat pad is associated with patellar tendon shortening after primary total knee arthroplasty. Eur J Orthop Surg Traumatol. 2016;26(5):545-9.
van Duren BH, Lamb JN, Nisar S, Ashraf Y, Somashekar N, Pandit H. Preservation vs. resection of the infrapatellar fat pad during total knee arthroplasty Part I: A survey of current practice in the UK. Knee. 2019 26(2):416-21.
Maculé F, Sastre S, Lasurt S, Sala P, Segur JM, Mallofré C. Hoffa’s fat pad resection in total knee arthroplasty. Acta Orthop Belg. 2005;71(6):714-7.
Abdelnasser MK, Adi MM, Elnaggar AA, Tarabichi S. Internal rotation of the tibial component in total knee arthroplasty can lead to extension deficit. Knee Surgery, Sports Traumatology, Arthroscopy. 2020;28(9):2948-52.
Kuriyama S, Ishikawa M, Furu M, Ito H, Matsuda S. Malrotated tibial component increases medial collateral ligament tension in total knee arthroplasty. J Orthop Res. 2014;32(12):1658-66.
Osano K, Nagamine R, Todo M, Kawasaki M. The Effect of Malrotation of Tibial Component of Total Knee Arthroplasty on Tibial Insert during High Flexion Using a Finite Element Analysis. Scientific World J. 2014;2014:1-7.
Steinbrück A, Schröder C, Woiczinski M, Müller T, Müller PE, Jansson V, et al. Influence of tibial rotation in total knee arthroplasty on knee kinematics and retropatellar pressure: an in vitro study. Knee Surgery, Sports Traumatology, Arthroscopy. 2016;24(8):2395-401.
Kim YH, Park JW, Kim JS, Park SD. The relationship between the survival of total knee arthroplasty and postoperative coronal, sagittal and rotational alignment of knee prosthesis. Int Orthop. 2014;38(2):379-85.
Panni AS, Ascione F, Rossini M, Braile A, Corona K, Vasso M, et al. Tibial internal rotation negatively affects clinical outcomes in total knee arthroplasty: a systematic review. Knee Surgery, Sports Traumatology, Arthroscopy. 2018;26(6):1636-44.
Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KDJ. Patient Satisfaction after Total Knee Arthroplasty: Who is Satisfied and Who is Not? Clin Orthop Relat Res. 2010;468(1):57-63.
Akagi M, Mori S, Nishimura S, Nishimura A, Asano T, Hamanishi C. Variability of Extraarticular Tibial Rotation References for Total Knee Arthroplasty. Clin Orthop Relat Res. 2005;436:172-6.
Gromov K, Korchi M, Thomsen MG, Husted H, Troelsen A. What is the optimal alignment of the tibial and femoral components in knee arthroplasty? Acta Orthop. 2014;85(5):480-7.
Insall JN, Scott WN. Insall & Scott Surgery of the Knee. New York: Elsevier/Churchill Livingstone. 2012.
Stephen JM, Sopher R, Tullie S, Amis AA, Ball S, Williams A. The infrapatellar fat pad is a dynamic and mobile structure, which deforms during knee motion, and has proximal extensions which wrap around the patella. Knee Surgery, Sports Traumatology, Arthroscopy. 2018;26(11):3515-24.
Kramers-de Quervain IA, Engel-Bicik I, Miehlke W, Drobny T, Munzinger U. Fat-pad impingement after total knee arthroplasty with the LCS A/P-Glide system. Knee Surgery, Sports Traumatology, Arthroscopy. 2005;13(3):174-8.
Dragoo JL, Johnson C, McConnell J. Evaluation and Treatment of Disorders of the Infrapatellar Fat Pad. Sports Medicine. 2012;42(1):51-67.
Sekiya H. Painful Knee is not Uncommon after total Knee Arthroplasty and can be Treated by Arthroscopic Debridement. Open Orthop J. 2017;11(1):1147-53.
Hatayama K, Terauchi M, Saito K, Hagiwara K, Higuchi H. Tibial Tubercle in Valgus Osteoarthritic Knees Is More Laterally Positioned Than in Varus Knees. J Arthroplasty. 2016;31(10):2303-7.
Kosashvili Y, Mayne IP, Trajkovski T, Lackstein D, Safir O, Backstein D. Influence of sex on surgical time in primary total knee arthroplasty. Can J Surg. 2010;53(4):256-60.
Harato K, Maeno S, Tanikawa H, Kaneda K, Morishige Y, Nomoto S, et al. What are the important manoeuvres for beginners to minimize surgical time in primary total knee arthroplasty? Knee Surgery, Sports Traumatology, Arthroscopy. 2016;24(8):2704-9.