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World J Orthop. Sep 18, 2014; 5(4): 460-468
Published online Sep 18, 2014. doi: 10.5312/wjo.v5.i4.460
Common controversies in total knee replacement surgery: Current evidence
Vasileios S Nikolaou, Dimitrios Chytas, George C Babis
Vasileios S Nikolaou, Dimitrios Chytas, George C Babis, 2nd Department of Orthopaedics, Athens University, 15124 Athens, Greece
Author contributions: Nikolaou VS collected data and wrote the manuscript; Chytas D contributed to data analysis and manuscript preparation and writing; Babis GC had the final checking and proof editing of the manuscript.
Correspondence to: Vasileios S Nikolaou MD, PhD, MSc, 2nd Department of Orthopaedics, Athens University, 21 Dimitriou Ralli Str, Maroussi, 15124 Athens, Greece. vassilios.nikolaou@gmail.com
Telephone: +30-69-32543400 Fax: +30-21-08020671
Received: December 29, 2013
Revised: March 26, 2014
Accepted: May 31, 2014
Published online: September 18, 2014
Processing time: 234 Days and 17.1 Hours
Abstract

Total knee replacement (TKR) is a widely used operation that has radically improved the quality of life of millions of people during the last few decades. However, some technical details, concerning the surgical procedure and the rehabilitation following total knee arthroplasty, are still a matter of a strong debate. In this review of the literature, we have included the best evidence available of the last decade, in an effort to shed light on some of the most controversial subjects related to TKR surgery. Posterior-stabilized or cruciate-retaining prosthesis? To use a tourniquet during operation or not? Do patients need continuous passive motion for their post-surgery rehabilitation? To resurface patella or not? These are some of the most controversial topics that until now have been persistent dilemmas for the orthopedic surgeon. Results of this systematic review of the literature are highly controversial. These conflicting results are an indication that larger and more well conducted high quality trials are needed in order to gain more secure answers. At the same time, it is becoming apparent that a meticulous operative technique, respecting the soft tissue envelope and knowing the principles of alignment and soft tissue balancing, are some of the parameters that might contribute more to achieving the optimal results for the patients.

Keywords: Total knee replacement; Controversy; Literature review; Patella resurfacing; Patella eversion; Posterior stabilized; Cruciate retaining; Tourniquet; Continuous passive motion

Core tip: A literature review has been conducted in an effort to present the best available evidence of the last decade and to shed light on some of the most controversial subjects related to total knee replacement surgery. Patella resurfacing or not? Posterior cruciate retaining or sacrificing? Continuous passive motion or not? Tourniquet or not? These are some of the most debatable topics that until now have been persistent dilemmas for the orthopedic surgeon. Results of this systematic review of the literature are highly controversial. These conflicting results are an indication that larger and better conducted high quality trials are needed in order to gain more secure answers.