La luxation de la rotule au cours d’une arthroplastie totale de genou est-elle déterminante sur l’ajustement de l’espace prothétique et l’équilibrage des parties molles ?

Summary Introduction Assessment of soft-tissue balance by the gap technique in Total Knee Arthroplasty (TKA) impacts femoral component rotation positioning. Proper femoral component rotation is a critical factor in TKA, both for adequate patellar tracking and in achieving a symmetrical flexion gap. Soft tissue balance assessment and gap measurements are performed at 90° flexion and with the patella everted in conventional TKA; during MIS-TKA, this step is performed with the patella in situ. We therefore investigated intra-operative joint gap parameters at 90° flexion with and without patellar eversion during conventional TKA, so as to better understand the influence of this intraoperative patellar position factor on final ligament balance. Hypothesis Conducting TKA without patellar eversion increases both gap size and gap inclination. Materials and methods Twenty-four osteoarthritic knees were included in the study. Joint gap size and inclination were measured intraoperatively on a knee in 90° flexion, with and without patellar eversion. Results The joint gap with patella in situ (17.0 ± 3.4 mm) was significantly greater than with patellar eversion (15.4 ± 3.0 mm), as was gap inclination at 90° flexion with the patella in situ (4.9 ± 3.1°) compared to with patellar eversion (4.0 ± 2.9°). Discussion The flexion gap inclination obtained without patellar eversion was steeper than with patellar eversion. This induced more externally rotated femoral positioning in absence of patellar eversion. These results ought to be taken into account by surgeons considering switching from conventional to MIS-TKA. Level of evidence Level II. Prospective randomized study.