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Freehand method compared with a specific guide device for the osteotomy to the patellar resurfacing in a Total Knee Arthroplasty. Does it Influence Radiological Outcomes?
Author(s):
Gil Gonzalez S. (Spain)
,
Gil Gonzalez S. (Spain)
Affiliations:
Gonzalez Sanchez Sara
,
Gonzalez Sanchez Sara
Affiliations:
Pelfort López X.
,
Pelfort López X.
Affiliations:
Garrucho Vicente M.
,
Garrucho Vicente M.
Affiliations:
Collado F.
,
Collado F.
Affiliations:
Cruz E.
Cruz E.
Affiliations:
ESSKA Academy. Gil Gonzalez S. 05/09/18; 209601; P10-511 Topic: Joint Replacement
Mr. Sergi Gil Gonzalez
Mr. Sergi Gil Gonzalez
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Abstract
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Objectives: Patellar resurfacing is a common practice in total knee arthroplasty (TKA) to treat anterior knee pain. Different techniques or devices are used to perform the osteotomy, to remove the patellar articular surface and to implant the patellar bottom in the correct position and orientation. The objective of our study was compare intraoperative implantation and radiological outcomes in two different techniques for the patellar resurfacing in TKA.

Methods: In a randomized study of 104 patients who underwent a TKA, we compared two different techniques for the patellar osteotomy: freehand method versus specific guide device. Exclusion criteria were previous patellar surgery or fractures. We performed a radiological study which included patellar height (Insall-Salvati), tilt, lateral displacement, arthropathy (Iwano) and thickness, preoperatively and at 3 months follow-up. Intraoperatively we measured patellar thickness pre-osteotomy, post-osteotomy and with the patellar bottom fixed. We report additional surgical action to improve patellar tracking, and the postoperative complications.

Results: 51 patients were included in the freehand method group and 53 in the specific guide group. We did not find any statistical differences when comparing radiological outcomes, except for patellar tilt, which was increased in the freehand method, but without clinical relevance. The mean patellar thickness pre-osteotomy was 22.47mm (SD 2.38) in the freehand group and 22.62mm (SD 1.89) in the specific guide group (p = 0.36). Post-osteotomy it was 14.36mm (SD 2.24) in the freehand group and 14.35mm (SD 1.06) in the specific guide group (p = 0.10). With the patellar bottom fixed it was 21.49mm (SD 2.23) in the freehand group and 21.53mm (SD 1.29) in the guide group (p = 0.13). Intraoperative post-osteotomy measures were more accurate and precise in the guide device group compared to the freehand group. Lateral patellar release was required in 7 patients in the freehand group and 2 in the other group. We did not see any complications in patellofemoral joint or knee prosthesis.

Conclusions: In our study we can conclude that patellar osteotomy with the specific guide device is more accurate and precise than the freehand method. However, we did not find any statistical difference in radiological outcomes.

Keywords:
TKA, patellar resurfacing, patellar osteotomy, freehand method, guide device
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