الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 71 |  |  |
| | | from | 71 | | |
Abstract
Total knee replacement is one of the most common elective surgeries worldwide. Mobilization of the extensor mechanism is an important step of the exposure in total knee replacement. There has been ongoing debate about the optimal method of handling the extensor mechanism during TKR. Some authors are in favor of patellar eversion, while others are in favor of patellar retraction.
The aim of this study was to compare the early functional outcomes as well as the complications in patients treated by total knee replacement through patellar retraction versus eversion.
This prospective, randomized controlled study was conducted on 40 patients with end stage knee osteoarthritis and varus or valgus deformity <20 degrees, admitted to Elhadra University Hospital for elective TKR. Patients with ipsilateral knee surgery, those planned for revision TKR and those unfit for surgery were excluded from the study.
The patients were divided into two groups of 20 patients each according to the patellar mobilization technique during TKR. The two groups were matching in terms of age, sex, BMI, side affected and associated comorbidities. The medial parapatellar approach was used for all patients. However, patellar retraction was used for exposure in one group and patellar eversion was used for the other group.
The patients were examined 6 months after surgery to compare the functional outcomes between the two groups. We evaluated the function and strength of the extensor mechanism by assessing SLR and extension lag. We evaluated the postoperative active ROM and the presence of flexion contracture. And we used the OKS and VAS score to assess the overall functional outcomes of TKR in the two groups.
The results showed that patellar retraction lead to statistically significant better outcomes in ROM (p=0.001), OKS (p=0.001) and VAS score for anterior knee pain (p<0.001). Four patients in the patellar eversion group and one patient in the retraction group had extension lag but the results were statistically insignificant (p=0.342). Three patients in the patellar eversion group had varying degrees of flexion contracture and no patients in the retraction group had flexion contracture, but the difference was statistically insignificant (p=0.231).
No patients in the study had intra-operative or post-operative complications aside from the three patients in the eversion group who had flexion contracture.