Changes to patellar blood flow after minimally invasive total knee arthroplasty

Standard surgical exposure reduces blood flow to the patella during total knee arthroplasty (TKA). Reduction of patellar blood flow has resulted in patellofemoral complications including osteonecrosis and patellar fracture, necessitating revision surgery. In TKA, avoiding patellar eversion is one type of minimally invasive surgery (MIS) technique. This study is the first to measure patellar blood flow during MIS TKA with the knee in both extension and 90° of flexion followed by lateral retraction and then eversion of the patella. Patellar blood flow was measured using laser Doppler flowmetry in 40 patients during MIS TKA. A significant reduction in flow was noted when the leg was flexed from full extension to 90°. Eversion of the patella reduced patellar blood flow. MIS TKA without patellar eversion may be useful for preventing a reduction in patellar blood flow.