Early Recovery After Total Knee Arthroplasty Performed with and without Patellar Eversion and Tibial Translation A Prospective Randomized Study

Background: Proponents of minimally invasive total knee arthroplasty claim that patellar eversion and anterior tibial translation during total knee arthroplasty have a deleterious effect on early patient rehabilitation and the early clinical outcome. Our purposewas to identify differences in knee preference and clinical outcomemeasures in a series of patients who had undergone bilateral total knee arthroplasty with each knee randomized to one of two different surgical approaches: patellar eversion and anterior tibial translation, or patellar subluxation and no tibial translation. Methods: The knees of forty patients were prospectively randomized to one of two treatment groups, patellar eversion or patellar subluxation, with each patient having one knee treatedwith each type of approach. Three patientswerewithdrawn, leaving a final study group of thirty-seven patients. The patients and physical therapists were blinded to the type of treatment. Clinical outcomes, including the Knee Society scores, range of motion, quadriceps strength as tested with a dynamometer, and the patient’s preferred knee on the basis of pain, motion, and strength, were collected preoperatively and at six weeks, twelve weeks, and six months postoperatively and were analyzed. Results: At six weeks after the surgery, there were no significant differences between the two groups with regard to the range of motion, quadriceps strength, or Knee Society scores. With regard to the patient’s knee preference at six weeks, the two knees were rated as being the same in terms of pain, whereas a higher percentage preferred the knee treated with eversion in terms of motion (43 % compared with 35 % who preferred the knee treated with subluxation) and strength (43