Influence of the infrapatellar fat pad resection in a synovectomy during total knee arthroplasty in patients with rheumatoid arthritis☆
Section snippets
Patients and methods
The study was approved by the institutional ethics committee, and informed consent was obtained from each patient. One hundred and twenty consecutive patients (29 men and 91 women) with RA who underwent TKA (total, 160 knees) with a posterior stabilized prosthesis (Nex-gen; Zimmer, Warsaw, IN) were enrolled in the study. All of the patients fulfilled the American Rheumatism Association 1987 revised criteria for the diagnosis of RA [9]. Patient age at surgery operation ranged from 45 to 71
Results
Preoperative intergroup comparisons of age, gender, duration of disease and knee symptoms, radiographic grade, follow-up periods, range of motion, quadriceps peak torque, and radiographic assessment of patella position are shown in Table 1. No significant differences were found among 53 knees in the IPS group, 54 knees in the IPS + fat group, and 53 knees in the non-IPS group.
The 1 to 2 months follow-up results are shown in Table 2. Three knees (6%) and 12 knees (27%) had anterior aching
Discussion
The major factors that cause a low-lying patella after TKA are believed to be injury and scarring of infrapatellar tissues such as the fat pad and tendon, a postoperative raised joint line (more than 8 mm of the preoperative joint line), eccentric loading of the domed patella surface, limited knee motion, and quadriceps weakness 2, 6, 12, 16 weakness. In 2 reports 12, 15, lowering of the patella was significantly pronounced when both the infrapatellar fat pad and synovium were completely
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No benefits or funds were received in support of this study.