Métodos de medición de la altura patelar y definiciones de patela baja en la artroplastia total de rodilla: una revisión sistemática de la literatura

Antecedentes: La artroplastia total de rodilla (ATR) es crucial para tratar la artrosis avanzada de rodilla, pero el éxito del procedimiento depende en gran medida de la correcta medición de la altura patelar. La patela baja (PB) postoperatoria está asociada con dolor, limitación de movimiento y des...

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2024
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Universidad del Rosario
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https://repository.urosario.edu.co/handle/10336/43308
Palabra clave:
Altura patelar
Artroplastia total de rodilla
Evaluación de la altura patelar
Patellar height
Total knee arthroplasty
Evaluation of patellar height
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id EDOCUR2_83d35de0dc63a23f28573054f5f28c8b
oai_identifier_str oai:repository.urosario.edu.co:10336/43308
network_acronym_str EDOCUR2
network_name_str Repositorio EdocUR - U. Rosario
repository_id_str
dc.title.none.fl_str_mv Métodos de medición de la altura patelar y definiciones de patela baja en la artroplastia total de rodilla: una revisión sistemática de la literatura
dc.title.TranslatedTitle.none.fl_str_mv Measuring methods of patellar height and definitions of patella baja in total knee arthroplasty: a systematic review of the literature
title Métodos de medición de la altura patelar y definiciones de patela baja en la artroplastia total de rodilla: una revisión sistemática de la literatura
spellingShingle Métodos de medición de la altura patelar y definiciones de patela baja en la artroplastia total de rodilla: una revisión sistemática de la literatura
Altura patelar
Artroplastia total de rodilla
Evaluación de la altura patelar
Patellar height
Total knee arthroplasty
Evaluation of patellar height
title_short Métodos de medición de la altura patelar y definiciones de patela baja en la artroplastia total de rodilla: una revisión sistemática de la literatura
title_full Métodos de medición de la altura patelar y definiciones de patela baja en la artroplastia total de rodilla: una revisión sistemática de la literatura
title_fullStr Métodos de medición de la altura patelar y definiciones de patela baja en la artroplastia total de rodilla: una revisión sistemática de la literatura
title_full_unstemmed Métodos de medición de la altura patelar y definiciones de patela baja en la artroplastia total de rodilla: una revisión sistemática de la literatura
title_sort Métodos de medición de la altura patelar y definiciones de patela baja en la artroplastia total de rodilla: una revisión sistemática de la literatura
dc.contributor.advisor.none.fl_str_mv Rincon, Gustavo
Rojas, Jorge
dc.subject.none.fl_str_mv Altura patelar
Artroplastia total de rodilla
Evaluación de la altura patelar
topic Altura patelar
Artroplastia total de rodilla
Evaluación de la altura patelar
Patellar height
Total knee arthroplasty
Evaluation of patellar height
dc.subject.keyword.none.fl_str_mv Patellar height
Total knee arthroplasty
Evaluation of patellar height
description Antecedentes: La artroplastia total de rodilla (ATR) es crucial para tratar la artrosis avanzada de rodilla, pero el éxito del procedimiento depende en gran medida de la correcta medición de la altura patelar. La patela baja (PB) postoperatoria está asociada con dolor, limitación de movimiento y desgaste de la prótesis. Sin embargo, existe una significativa heterogeneidad en los métodos para medir la altura patelar y en las definiciones de PB, lo que puede afectar los resultados clínicos y las decisiones terapéuticas. Métodos: Se realizó una revisión sistemática en bases de datos como PubMed, MEDLINE, EMBASE, PROSPERO, LILACS, Epistemonikos, Web of Science y Central de Cochrane, incluyendo estudios publicados en español, inglés, alemán y portugués. Se seleccionaron estudios que describían métodos de medición de la altura patelar y definiciones de PB en pacientes sometidos a ATR, excluyendo aquellos con complicaciones post-traumáticas, infecciones o tumores. Resultados: De los 52 artículos evaluados, los métodos más comúnmente utilizados incluyen el índice de Insall-Salvati y el de Caton-Deschamps, con variaciones significativas en la definición de PB. La mayoría de estudios no ofrecen una definición consistente de PB, lo que sugiere una falta de consenso que podría complicar la interpretación clínica y el manejo postoperatorio. Conclusiones: La revisión identificó una clara necesidad de estandarización en la medición de la altura patelar y las definiciones de PB en la artroplastia total de rodilla. Se recomienda el desarrollo de guías clínicas basadas en la evidencia para unificar los métodos de medición, mejorar la precisión diagnóstica y optimizar los resultados de la ATR. La estandarización facilitaría también la comparación entre estudios y mejoraría la calidad de los meta-análisis en investigaciones futuras.
publishDate 2024
dc.date.accessioned.none.fl_str_mv 2024-08-22T19:04:27Z
dc.date.available.none.fl_str_mv 2024-08-22T19:04:27Z
dc.date.created.none.fl_str_mv 2024-05-24
dc.type.none.fl_str_mv bachelorThesis
dc.type.coar.fl_str_mv http://purl.org/coar/resource_type/c_7a1f
dc.type.document.none.fl_str_mv Trabajo de grado
dc.type.spa.none.fl_str_mv Trabajo de grado
dc.identifier.uri.none.fl_str_mv https://repository.urosario.edu.co/handle/10336/43308
url https://repository.urosario.edu.co/handle/10336/43308
dc.language.iso.none.fl_str_mv spa
language spa
dc.rights.*.fl_str_mv Attribution-NonCommercial-ShareAlike 4.0 International
dc.rights.coar.fl_str_mv http://purl.org/coar/access_right/c_abf2
dc.rights.acceso.none.fl_str_mv Abierto (Texto Completo)
dc.rights.uri.*.fl_str_mv http://creativecommons.org/licenses/by-nc-sa/4.0/
rights_invalid_str_mv Attribution-NonCommercial-ShareAlike 4.0 International
Abierto (Texto Completo)
http://creativecommons.org/licenses/by-nc-sa/4.0/
http://purl.org/coar/access_right/c_abf2
dc.format.extent.none.fl_str_mv 36 PP
dc.format.mimetype.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Universidad del Rosario
dc.publisher.department.none.fl_str_mv Escuela de Medicina y Ciencias de la Salud
dc.publisher.program.none.fl_str_mv Especialización en Ortopedia y Traumatología FSFB
publisher.none.fl_str_mv Universidad del Rosario
institution Universidad del Rosario
dc.source.bibliographicCitation.none.fl_str_mv Cabral F, Sousa-Pinto B, Pinto R, Torres J. Patellar Height After Total Knee Arthroplasty: Comparison of 3 Methods. J Arthroplasty. 2017 Feb;32(2):552-557.e2.
Behrend H, Graulich T, Gerlach R, Spross C, Ladurner A. Blackburne–Peel ratio predicts patients’ outcomes after total knee arthroplasty. Knee Surgery, Sports Traumatology, Arthroscopy. 2019 May 8;27(5):1562–9.
Xu B, Xu W xing, Lu D, Sheng H feng, Xu X wei, Ding W guo. Application of different patella height indices in patients undergoing total knee arthroplasty. J Orthop Surg Res. 2017 Dec 12;12(1):191.
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Koshino T, Ejima M, Okamoto R, Morii T. Gradual low riding of the patella during postoperative course after total knee arthroplasty in osteoarthritis and rheumatoid arthritis. J Arthroplasty. 1990 Dec;5(4):323–7.
Drexler M, Dwyer T, Marmor M, Sternheim A, Cameron HU, Cameron JC. The treatment of acquired patella baja with proximalize the tibial tuberosity. Knee Surgery, Sports Traumatology, Arthroscopy. 2013 Nov 2;21(11):2578–83.
Gaillard R, Bankhead C, Budhiparama N, Batailler C, Servien E, Lustig S. Influence of Patella Height on Total Knee Arthroplasty: Outcomes and Survival. J Arthroplasty. 2019 Mar;34(3):469–77.
Meneghini RM, Ritter MA, Pierson JL, Meding JB, Berend ME, Faris PM. The Effect of the Insall-Salvati Ratio on Outcome After Total Knee Arthroplasty. J Arthroplasty. 2006 Sep;21(6):116–20.
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Robin BN, Ellington MD, Jupiter DC, Allen BC. Plateau–Patella Angle in Evaluation of Patellar Height After Total Knee Arthroplasty. J Arthroplasty. 2014 Jul;29(7):1394–7.
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Jawhar A, Sohoni S, Shah V, Scharf HP. Alteration of the patellar height following total knee arthroplasty. Arch Orthop Trauma Surg. 2014 Jan 28;134(1):91–7.
Cao L, Sun K, Yang H, Wang H, Zeng R, Fan H. Influence of Patellar Morphology Classified by Wiberg Classification on Knee Joint Function and Patellofemoral Tracking After Total Knee Arthroplasty Without Patellar Resurfacing. J Arthroplasty. 2021 Sep;36(9):3148–53.
Sasaki H, Kubo S, Matsumoto T, Muratsu H, Matsushita T, Ishida K, et al. The influence of patella height on intra-operative soft tissue balance in posterior-stabilized total knee arthroplasty. Knee Surgery, Sports Traumatology, Arthroscopy. 2012 Nov 27;20(11):2191–6.
Rassir R, van de Bunt F, Sierevelt IN, Nolte PA. The value of postoperative prosthesis alignment and patellar height measurements on standard X-rays after Total Knee Arthroplasty: Does it relate to knee function after 5 years? Knee. 2019 Jan;26(1):213–21.
Schiapparelli FF, Ahmadi P, Amsler F, Hirschmann MT. No reduced patellar loading with latest-generation cruciate-retaining total knee arthroplasty—a comparative study of Attune and Press-Fit Condylar®. Int Orthop. 2021 May 17;45(5):1205–13.
Vives-Barquiel MA, Torrents A, Lozano L, Martínez-Pastor JC, Maculé F, Segur JM, et al. Proximalize osteotomy of tibial tuberosity (POTT) as a treatment for stiffness secondary to patella baja in total knee arthroplasty (TKA). Arch Orthop Trauma Surg. 2015 Oct 23;135(10):1445–51.
Slevin O, Schmid FA, Schiapparelli F, Rasch H, Hirschmann MT. Increased in vivo patellofemoral loading after total knee arthroplasty in resurfaced patellae. Knee Surgery, Sports Traumatology, Arthroscopy. 2018 Jun 29;26(6):1805–10.
Thiengwittayaporn S, Srungboonmee K, Chiamtrakool B. Resurfacing in a Posterior-Stabilized Total Knee Arthroplasty Reduces Patellar Crepitus Complication: A Randomized, Controlled Trial. J Arthroplasty. 2019 Sep;34(9):1969–74.
Khakharia S, Scuderi GR. Restoration of the Distal Femur Impacts Patellar Height in Revision TKA. Clin Orthop Relat Res. 2012 Jan;470(1):205–10.
Franck F, Ouanezar H, Jacquel A, Pibarot V, Wegrzyn J. The predictive factors of secondary patellar resurfacing in computer-assisted total knee arthroplasty. A prospective cohort study. Int Orthop. 2018 May 9;42(5):1051–60.
Mouton J, Gaillard R, Bankhead C, Batailler C, Servien E, Lustig S. Increased Patellar Fracture Rate in Total Knee Arthroplasty With Preoperative Varus Greater Than 15°: A Case-Control Study. J Arthroplasty. 2018 Dec;33(12):3685–93.
Chun KC, Kweon SH, Nam DJ, Kang HT, Chun CH. Tibial Tubercle Osteotomy vs the Extensile Medial Parapatellar Approach in Revision Total Knee Arthroplasty: Is Tibial Tubercle Osteotomy a Harmful Approach? J Arthroplasty. 2019 Dec;34(12):2999–3003.
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Jenkins D, Rodriguez J, Ranawat A, Alexiades M, Deshmukh A, Fukunaga T, et al. A Randomized, Controlled, Prospective Study Evaluating the Effect of Patellar Eversion on Functional Outcomes in Primary Total Knee Arthroplasty. Journal of Bone and Joint Surgery. 2014 May 21;96(10):851–8.
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Inoue A, Arai Y, Nakagawa S, Inoue H, Yoshihara Y, Yamazoe S, et al. Differences in patellofemoral alignment as a result of patellar shape in cruciate-retaining total knee arthroplasty without patellar resurfacing at a minimum three-year follow-up. Knee. 2017 Dec;24(6):1448–53.
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İmren Y, Dedeoğlu S, Çakar M, Çabuk H, Bayraktar T, Gürbüz H. Infrapatellar Fat Pad Excision during Total Knee Arthroplasty Did Not Alter the Patellar Tendon Length: A 5-Year Follow-Up Study. J Knee Surg. 2017 Jun 29;30(05):479–83.
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Stetzelberger V, Obertacke U, Jawhar A. Tourniquet application during TKA did not affect the accuracy of implant positioning: a randomized clinical trial. Knee Surgery, Sports Traumatology, Arthroscopy. 2018 Jun 20;26(6):1728–36.
Yuan M, Wang Y, Wang H, Ding Z, Xiao Q, Zhou Z. Optimal Handling of the Patella in Tourniquet‐Free Total Knee Arthroplasty: Eversion or Lateral Retraction? Orthop Surg. 2020 Dec 28;12(6):1870–81.
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spelling Rincon, Gustavofbd9e746-04ea-4ba0-bc51-75b8513980a4-1Rojas, Jorge9a83981f-05f6-4797-bafd-72b3455aab4b-1Rizo Rojas, JairoTorres Ayala, GabrielEspecialista en Ortopedia y TraumatologíaMaestríaFull time8da46d57-7643-489d-899c-8221a38ee90c-1ac1c2803-660b-42c2-b0fe-c122c9cebf6d-12024-08-22T19:04:27Z2024-08-22T19:04:27Z2024-05-24Antecedentes: La artroplastia total de rodilla (ATR) es crucial para tratar la artrosis avanzada de rodilla, pero el éxito del procedimiento depende en gran medida de la correcta medición de la altura patelar. La patela baja (PB) postoperatoria está asociada con dolor, limitación de movimiento y desgaste de la prótesis. Sin embargo, existe una significativa heterogeneidad en los métodos para medir la altura patelar y en las definiciones de PB, lo que puede afectar los resultados clínicos y las decisiones terapéuticas. Métodos: Se realizó una revisión sistemática en bases de datos como PubMed, MEDLINE, EMBASE, PROSPERO, LILACS, Epistemonikos, Web of Science y Central de Cochrane, incluyendo estudios publicados en español, inglés, alemán y portugués. Se seleccionaron estudios que describían métodos de medición de la altura patelar y definiciones de PB en pacientes sometidos a ATR, excluyendo aquellos con complicaciones post-traumáticas, infecciones o tumores. Resultados: De los 52 artículos evaluados, los métodos más comúnmente utilizados incluyen el índice de Insall-Salvati y el de Caton-Deschamps, con variaciones significativas en la definición de PB. La mayoría de estudios no ofrecen una definición consistente de PB, lo que sugiere una falta de consenso que podría complicar la interpretación clínica y el manejo postoperatorio. Conclusiones: La revisión identificó una clara necesidad de estandarización en la medición de la altura patelar y las definiciones de PB en la artroplastia total de rodilla. Se recomienda el desarrollo de guías clínicas basadas en la evidencia para unificar los métodos de medición, mejorar la precisión diagnóstica y optimizar los resultados de la ATR. La estandarización facilitaría también la comparación entre estudios y mejoraría la calidad de los meta-análisis en investigaciones futuras.Background: Total knee arthroplasty (TKA) is crucial for treating advanced knee osteoarthritis, but the success of the procedure largely depends on the correct measurement of patellar height. Postoperative patella baja (PB) is associated with pain, limitation of motion, and prosthesis wear. However, there is significant heterogeneity in methods for measuring patellar height and definitions of PB, which may affect clinical outcomes and therapeutic decisions. Methods: A systematic review was performed in databases such as PubMed, MEDLINE, EMBASE, PROSPERO, LILACS, Epistemonikos, Web of Science, and Cochrane Central, including studies published in Spanish, English, German, and Portuguese. Studies describing methods for measuring patellar height and definitions of PB in patients undergoing TKA were selected, excluding those with post-traumatic complications, infections, or tumors. Results: Of the 52 articles evaluated, the most commonly used methods included the Insall-Salvati and Caton-Deschamps indexes, with significant variations in the definition of PB. Most studies did not provide a consistent definition of PB, suggesting a lack of consensus that could complicate clinical interpretation and postoperative management. Conclusions: The review identified a clear need for standardization in patellar height measurement and PB definitions in total knee arthroplasty. The development of evidence-based clinical guidelines is recommended to unify measurement methods, improve diagnostic accuracy, and optimize TKA outcomes. Standardization would also facilitate comparison between studies and improve the quality of meta-analyses in future research.36 PPapplication/pdfBogotáhttps://repository.urosario.edu.co/handle/10336/43308spaUniversidad del RosarioEscuela de Medicina y Ciencias de la SaludEspecialización en Ortopedia y Traumatología FSFBAttribution-NonCommercial-ShareAlike 4.0 InternationalAbierto (Texto Completo)EL AUTOR, manifiesta que la obra objeto de la presente autorización es original y la realizó sin violar o usurpar derechos de autor de terceros, por lo tanto la obra es de exclusiva autoría y tiene la titularidad sobre la misma. PARGRAFO: En caso de presentarse cualquier reclamación o acción por parte de un tercero en cuanto a los derechos de autor sobre la obra en cuestión, EL AUTOR, asumirá toda la responsabilidad, y saldrá en defensa de los derechos aquí autorizados; para todos los efectos la universidad actúa como un tercero de buena fe. EL AUTOR, autoriza a LA UNIVERSIDAD DEL ROSARIO, para que en los términos establecidos en la Ley 23 de 1982, Ley 44 de 1993, Decisión andina 351 de 1993, Decreto 460 de 1995 y demás normas generales sobre la materia, utilice y use la obra objeto de la presente autorización. -------------------------------------- POLITICA DE TRATAMIENTO DE DATOS PERSONALES. Declaro que autorizo previa y de forma informada el tratamiento de mis datos personales por parte de LA UNIVERSIDAD DEL ROSARIO para fines académicos y en aplicación de convenios con terceros o servicios conexos con actividades propias de la academia, con estricto cumplimiento de los principios de ley. 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J Bone Joint Surg Br. 2008 Jul;90-B(7):870–3.instname:Universidad del Rosarioreponame:Repositorio Institucional EdocURAltura patelarArtroplastia total de rodillaEvaluación de la altura patelarPatellar heightTotal knee arthroplastyEvaluation of patellar heightMétodos de medición de la altura patelar y definiciones de patela baja en la artroplastia total de rodilla: una revisión sistemática de la literaturaMeasuring methods of patellar height and definitions of patella baja in total knee arthroplasty: a systematic review of the literaturebachelorThesisTrabajo de gradoTrabajo de gradohttp://purl.org/coar/resource_type/c_7a1fEscuela de Medicina y Ciencias de la SaludBogotáLICENSElicense.txtlicense.txttext/plain1483https://repository.urosario.edu.co/bitstreams/f8ebd3da-8e82-4f5d-96b5-2cc6dbe6f6f4/downloadb2825df9f458e9d5d96ee8b7cd74fde6MD52ORIGINALMetodos_de_medicion_altura_patelar_Rizo_Rojas_Jairo_Andres.pdfMetodos_de_medicion_altura_patelar_Rizo_Rojas_Jairo_Andres.pdfapplication/pdf1167321https://repository.urosario.edu.co/bitstreams/27e804f7-8376-46c2-aa3b-80db92d007d3/downloadaf8a5b45e32d386644c58c126aacca7bMD53CC-LICENSElicense_rdflicense_rdfapplication/rdf+xml; charset=utf-81160https://repository.urosario.edu.co/bitstreams/ec9f1806-f46f-49ff-8017-32e0c0a05b3f/download5643bfd9bcf29d560eeec56d584edaa9MD54TEXTMetodos_de_medicion_altura_patelar_Rizo_Rojas_Jairo_Andres.pdf.txtMetodos_de_medicion_altura_patelar_Rizo_Rojas_Jairo_Andres.pdf.txtExtracted texttext/plain53610https://repository.urosario.edu.co/bitstreams/93a5a148-dfe2-4963-bc84-82595d92022a/downloadcb275f103ed1e872794c3e2c1e763516MD55THUMBNAILMetodos_de_medicion_altura_patelar_Rizo_Rojas_Jairo_Andres.pdf.jpgMetodos_de_medicion_altura_patelar_Rizo_Rojas_Jairo_Andres.pdf.jpgGenerated Thumbnailimage/jpeg2457https://repository.urosario.edu.co/bitstreams/bd6b026c-3f19-4c8b-ae9e-dcf3b4c5212a/download998dc6d9884e50cbb5cedc58e60042d6MD5610336/43308oai:repository.urosario.edu.co:10336/433082024-08-23 03:02:39.284http://creativecommons.org/licenses/by-nc-sa/4.0/Attribution-NonCommercial-ShareAlike 4.0 Internationalhttps://repository.urosario.edu.coRepositorio institucional EdocURedocur@urosario.edu.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