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Jia J, Weng X. [Long-term effectiveness of different patellar treatments in primary total knee arthroplasty]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:1479-1484. [PMID: 36545855 DOI: 10.7507/1002-1892.202208025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objective To compare the long-term effectiveness of patellar denervation by electrotomy combined with patellar replacement and patellar denervation by electrotomy alone in primary total knee arthroplasty (TKA). Methods A retrospective analysis was conducted on the clinical data of 30 patients treated with primary TKA of both knees between July 2013 and March 2015 who met the selection criteria. There were 11 males and 19 females, aged 56-79 years, with an average age of 67.6 years. One knee was randomly selected for patellar denervation by electrotomy combined with patellar replacement during TKA (combined group), while the other knee was treated with patellar denervation by electrotomy alone (control group). All patients adopted the same type of total knee prosthesis. After surgery, the patients were followed up regularly, and the occurrence of complications was recorded. The functions of the knee and patella were evaluated using the Knee Society Score (KSS) and Feller score, respectively. The position of the prosthesis, patella trajectory, and prosthesis loosening and wear were observed by imaging examination. Results All 30 patients were followed up 81.4-103.5 months, with an average of 90.4 months. The patellar thickness of the combined group ranged from 21 to 26 mm, with an average of 23.0 mm. The position of the prosthesis and patella trajectory in the combined group and the control group were good, without obvious loosening or wear. After operation, 2 sides (6.7%) in the combined group and 3 sides (10.0%) in the control group presented joint adhesion and poor activities. No complication such as lower limb deep vein thrombosis, aseptic fractures, and infections around the prosthesis occurred in both groups. At last follow-up, the KSS clinical score, KSS function score, and Feller score showed no significant difference between the two groups ( P>0.05). According to the KSS score, 24 patients (80.0%) had no obvious preference for patellar denervation combined with patellar replacement, 3 patients (10.0%) preferred patellar replacement combined with patellar denervation, and 3 patients (10.0%) preferred no patellar replacement. Anterior knee pain occurred in 6 sides (20.0%) of both groups. Conclusion There is no significant difference in the long-term effectiveness between patellar denervation combined with patellar replacement and patellar denervation alone conducted in patients with knee osteoarthritis undergoing primary TKA.
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Affiliation(s)
- Junce Jia
- Deparment of Orthopedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, P. R. China
| | - Xisheng Weng
- Deparment of Orthopedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, P. R. China
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McConaghy K, Derr T, Molloy RM, Klika AK, Kurtz S, Piuzzi NS. Patellar management during total knee arthroplasty: a review. EFORT Open Rev 2021; 6:861-871. [PMID: 34760286 PMCID: PMC8559560 DOI: 10.1302/2058-5241.6.200156] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The optimal management of the patella during total knee arthroplasty (TKA) remains controversial and surgeons tend to approach the patella with one of three general mindsets: always resurface the patella, never resurface the patella, or selectively resurface the patella based on specific patient or patellar criteria. Studies comparing resurfacing and non-resurfacing of the patella during TKA have reported inconsistent and contradictory findings. When resurfacing the patella is chosen, there are a number of available patellar component designs, materials, and techniques for cutting and fixation. When patellar non-resurfacing is chosen, several alternatives are available, including patellar denervation, lateral retinacular release, and patelloplasty. Surgeons may choose to perform any of these alone, or together in some combination. Prospective randomized studies are needed to better understand which patellar management techniques contribute to superior postoperative outcomes. Until then, this remains a controversial topic, and options for patellar management will need to be weighed on an individual basis per patient.
Cite this article: EFORT Open Rev 2021;6:861-871. DOI: 10.1302/2058-5241.6.200156
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Affiliation(s)
- Kara McConaghy
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Tabitha Derr
- Implant Research Core, School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, Pennsylvania, USA
| | - Robert M Molloy
- Cleveland Clinic, Department of Orthopedic Surgery, Cleveland, Ohio, USA
| | - Alison K Klika
- Cleveland Clinic, Department of Orthopedic Surgery, Cleveland, Ohio, USA
| | - Steven Kurtz
- Implant Research Core, School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, Pennsylvania, USA.,Exponent, Philadelphia, Pennsylvania, USA
| | - Nicolas S Piuzzi
- Cleveland Clinic, Department of Orthopedic Surgery, Cleveland, Ohio, USA
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Antinolfi P, Manfreda F, Placella G, Teodori J, Cerulli G, Caraffa A. The Challenge of Managing the "Third-Space" in Total Knee Arthroplasty: Review of Current Concepts. JOINTS 2018; 6:204-210. [PMID: 30582109 PMCID: PMC6301849 DOI: 10.1055/s-0038-1675845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 10/07/2018] [Indexed: 12/17/2022]
Abstract
Total knee arthroplasty (TKA) is the best treatment for advanced knee osteoarthritis and it has proven to be durable and effective. Anterior knee pain (AKP) is still one of the most frequent complications after TKA, but sometimes no recognized macroscopic causes can be found. The correct treatment of patella is considered the key for a proper management of AKP. The inclusion of patellar resurfacing during TKA has been described as a potential method for the reduction of AKP. After surgeons started to resurface the patella, new complications emerged, such as component failure, instability, fracture, tendon rupture, and soft tissue impingement. Patelloplasty has been proposed as a good alternative to resurfacing but whether or not to resurface the patella is still a controversial topic in the literature. Therefore, patellofemoral joint is a complex critical aspect in TKA and choosing between the several options of treatment of patella could not be sufficient. In this review, evidence-based studies do not succeed in resolving this difficult argument. The accurate management of the so-called “third space” should include an accurate assessment of cartilage layers, balance of soft tissue, preoperative anterior tracking, and positioning of the femoral and tibial components. In fact, the selection of suitable implants and adherence to proper surgical technique are the fundamental principles for the success of TKA.
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Affiliation(s)
- Pierluigi Antinolfi
- Service of Orthopedics and Trauma Surgery, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Francesco Manfreda
- Department of Orthopedics and Traumatology, University of Perugia, Perugia, Italy
| | - Giacomo Placella
- Service of Orthopedics and Traumatology, Azienda Ospedaliera Regionale San Carlo, Potenza, Italy
| | - Julien Teodori
- Department of Orthopedics and Traumatology, University of Perugia, Perugia, Italy
| | - Giuliano Cerulli
- I.R.T.A.L. Istituto di Ricerca Traslazionale Apparato Locomotore, Nicola's Foundation, Arezzo, Italy
| | - Auro Caraffa
- Service of Orthopedics and Trauma Surgery, Santa Maria della Misericordia Hospital, Perugia, Italy.,Department of Orthopedics and Traumatology, University of Perugia, Perugia, Italy
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Cho WJ, Bin SI, Kim JM, Lee BS, Sohn DW, Kwon YH. Total Knee Arthroplasty With Patellar Retention: The Severity of Patellofemoral Osteoarthritis Did Not Affect the Clinical and Radiographic Outcomes. J Arthroplasty 2018; 33:2136-2140. [PMID: 29576487 DOI: 10.1016/j.arth.2018.02.075] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 02/11/2018] [Accepted: 02/19/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The purpose of this study is to compare the clinical and radiographic outcomes of total knee arthroplasty (TKA) with patellar retention in accordance with the severity of patellofemoral arthritis. METHODS We retrospectively reviewed patients who underwent TKA with patellar retention using the NexGen LPS or LPS-flex system between September 2010 and May 2015. The radiographic severity of patellofemoral arthritis was categorized according to the Iwano classification system, and subjects were divided into mild (stage 0-I) and moderate to severe (stage II-IV) groups. Clinical outcomes were evaluated using the Hospital for Special Surgery score, Knee Society Score, function score, Western Ontario and McMaster Universities Osteoarthritis Index, and Feller score. Radiographic outcomes were assessed using the congruence angle, patellar tilt angle, and lateral patellar displacement. The minimum follow-up for clinical and radiographic evaluation was 2 years. Clinical and radiographic outcomes were compared between the 2 groups preoperatively and at the time of the last follow-up. RESULTS Four hundred seventy-four knees were enrolled and assigned to mild (n = 208) or moderate to severe (n = 266) groups. The preoperative Feller score was significantly lower in the moderate to severe group (P = .030), whereas the postoperative clinical and radiographic results did not differ significantly between the 2 groups. CONCLUSION Clinical and radiographic outcomes did not differ in accordance with the severity of patellofemoral arthritis after a minimum 2 years of follow-up of patients treated with TKA with patellar retention. Good outcomes were obtained with patellar retention in TKA, even in patients with advanced patellofemoral osteoarthritis.
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Affiliation(s)
- Won-Joon Cho
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Republic of Korea
| | - Seong-Il Bin
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Republic of Korea
| | - Jong-Min Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Republic of Korea
| | - Bum-Sik Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Republic of Korea
| | - Dong-Wook Sohn
- Department of Orthopedic Surgery, Myongji Hospital, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Young-Hee Kwon
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Republic of Korea
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Cerciello S, Robin J, Lustig S, Maccauro G, Heyse TJ, Neyret P. The role of patelloplasty in total knee arthroplasty. Arch Orthop Trauma Surg 2016; 136:1607-1613. [PMID: 27687176 DOI: 10.1007/s00402-016-2577-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Anterior knee pain (AKP) is a frequent complication after total knee arthroplasty (TKA). Patelloplasty, defined as reshaping the patella for optimal tracking in the trochlea, has been proposed to reduce the rate of this complication in patellar retaining implants. Aim of this study was to analyze the available literature regarding the outcomes of patelloplasty and to assess its methodological quality. MATERIALS AND METHODS A comprehensive review of the English literature was performed using the keywords "total knee arthroplasty", "patelloplasty" and "patellaplasty" with no limit regarding the year of publication. All the selected articles were evaluated with the Coleman score. RESULTS Seven full text articles were retrieved. The initial cohort included 461 knees in the study groups and 465 in the control groups. At an average FU of 70.6 months 447 knees were reviewed in the study group and 447 in the control groups. The global rate of AKP after patelloplasty was 11.3 % which compared to 7.9 % in the patella resurfacing control group. No signs of specific patellar complications due to patelloplasty were reported. Average Coleman score was 66.9. CONCLUSION Most of the literature has barely sufficient methodological quality. Patelloplasty aims at reducing patellar thickness and improve its tracking with TKA. This procedure is a safe and easy option with no reported adverse effects. In the included studies, outcome seemed to be superior in comparison with isolated osteophyte removal and denervation with a lower rate of AKP. The included studies, however, report a lower rate of AKP following TKA with patellar resurfacing. Patelloplasty may have the potential to improve the outcome of patellar retaining implants. LEVEL OF EVIDENCE 4, systematic review.
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Affiliation(s)
- Simone Cerciello
- Casa di Cura Villa Betania, Via Piccolomini 27, 00165, Rome, Italy. .,Marrelli Hospital, Via Gioacchino da Fiore, 0962, Crotone, Italy.
| | - Jonathan Robin
- Albert Trillat Center, Lyon North University Hospital, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France
| | - Sébastien Lustig
- Albert Trillat Center, Lyon North University Hospital, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France
| | - Giulio Maccauro
- Department of Geriatric Neurosciences and Orthopaedics, Catholic University, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Thomas J Heyse
- Center for Orthopaedics and Trauma Surgery, University Hospital, Baldingerstrasse, 35043, Marburg, Germany
| | - Philippe Neyret
- Albert Trillat Center, Lyon North University Hospital, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France
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A 21 % conversion rate to total knee arthroplasty of a first-generation patellofemoral prosthesis at a mean follow-up of 9.7 years. INTERNATIONAL ORTHOPAEDICS 2015; 39:1857-64. [DOI: 10.1007/s00264-015-2941-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 06/24/2015] [Indexed: 10/23/2022]
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Huang AB, Wang HJ, Yu JK, Yang B, Ma D, Zhang JY. Optimal patellar alignment with minimally invasive approaches in total knee arthroplasty after a minimum five year follow-up. INTERNATIONAL ORTHOPAEDICS 2015; 40:487-92. [PMID: 26162985 DOI: 10.1007/s00264-015-2896-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 06/20/2015] [Indexed: 12/18/2022]
Abstract
PURPOSE Patellofemoral syndrome is still a common complication after total knee arthroplasty (TKA). However, the effects of specific surgical approaches on patellar tracking and alignment remain incompletely understood. In this study, we compared patellar alignment in patients who underwent TKA via three different techniques. METHODS A total of 96 patients who completed a minimum follow-up of five years were involved in three groups: 30 patients were treated with the traditional medial parapatellar approach (MPP group), 35 patients were treated with the mini-medial parapatellar approach (MMP group) and 31 were treated with a quadriceps-sparing approach (QS group). Radiographic data for patellar alignment and clinical results were compared. RESULTS Patellar tilt and patellar displacement at the final follow-up evaluation differed significantly among the three groups [P < 0.01, analysis of variance (ANOVA)]. The MMP and QS groups exhibited more proper patellar alignment than the MPP group. The clinical results did not differ significantly among the groups (P > 0.05, ANOVA). In addition, there were no correlations between postoperative patellar alignment and clinical scores. CONCLUSIONS The results of this study indicate that TKA performed using minimally invasive approaches yields superior patellar alignment compared to the traditional MPP approach.
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Affiliation(s)
- Ai-Bing Huang
- Institute of Sports Medicine, Peking University Third Hospital, No. 49, North Garden Road, Haidian District, Beijing, 100191, China
| | - Hai-Jun Wang
- Institute of Sports Medicine, Peking University Third Hospital, No. 49, North Garden Road, Haidian District, Beijing, 100191, China
| | - Jia-Kuo Yu
- Institute of Sports Medicine, Peking University Third Hospital, No. 49, North Garden Road, Haidian District, Beijing, 100191, China.
| | - Bo Yang
- Institute of Sports Medicine, Peking University Third Hospital, No. 49, North Garden Road, Haidian District, Beijing, 100191, China
| | - Dong Ma
- Institute of Sports Medicine, Peking University Third Hospital, No. 49, North Garden Road, Haidian District, Beijing, 100191, China
| | - Ji-Ying Zhang
- Institute of Sports Medicine, Peking University Third Hospital, No. 49, North Garden Road, Haidian District, Beijing, 100191, China
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Turktas U, Piskin A, Poehling GG. Short-term outcomes of robotically assisted patello-femoral arthroplasty. INTERNATIONAL ORTHOPAEDICS 2015; 40:919-24. [PMID: 25940605 DOI: 10.1007/s00264-015-2786-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 04/04/2015] [Indexed: 12/25/2022]
Abstract
PURPOSE The purpose of this study was to determine the outcomes in patients treated with robotically assisted patello-femoral arthroplasty (PFA). METHODS This technique offers a safe, reliable, and reproducible way of obtaining correct implant positioning in patello-femoral arthroplasty, and as a result, reduces revision surgery due to implant malalignment. We evaluated 30 knees in 29 patients who underwent robotically assisted patello-femoral arthroplasty between June 2009 and May 2011. Mean follow-up was 15.9 months. This was a retrospective study that involved chart reviews and radiographic analysis. Radiographic analysis included pre-operative and postoperative plain films for implant positioning. Functional outcomes were evaluated using the Oxford Knee Score (OKS), range of motion, University of California at Los Angeles (UCLA) patient activity-level ratings, visual analog pain scale (VAS), and the Knee Society Score (KSS). RESULTS The patients had an average OKS of 21.7 pre-operatively and reached an average of 33.5 postoperatively (p = 0.0033). Pre-operative UCLA patient activity-level ratings was 3.1, compared with 4.8 postoperatively. Average VAS pre-operatively was 8 and postoperatively it decreased to 2.1 (p = 0.0033). The average KSS final score pre-operatively was 56 and postoperatively it increased to 68.3 while the functional score pre-operatively was 47.2 compared to 68.1 postoperatively (p = 0.011). As a result, patello-femoral arthroplasty is an emerging knee resurfacing technique that is an alternative to the total knee arthroplasty. CONCLUSIONS The early retrospective data for robotically-assisted PFA show encouraging results. Advantages of this technique include a smaller incision, faster rehabilitation, preservation of bone stock, and implantation without malalignment.
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Affiliation(s)
- Ugur Turktas
- Department of Orthopaedics and Traumatology, Turgut Ozal University School of Medicine, Ankara, Turkey.
| | - Ahmet Piskin
- Department of Orthopaedics and Traumatology, Ondokuzmayis University School of Medicine, Samsun, Turkey
| | - Gary G Poehling
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Scheurer P, Reininga IHF, van Jonbergen HPW, van Raay JJAM. Secondary patellar resurfacing following total knee arthroplasty : A cohort study in fifty eight knees with a mean follow-up of thirty one months. INTERNATIONAL ORTHOPAEDICS 2015; 39:1301-6. [PMID: 25638476 DOI: 10.1007/s00264-015-2684-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Accepted: 01/10/2015] [Indexed: 02/07/2023]
Abstract
PURPOSE If anterior knee pain (AKP) emerges or persists following total knee arthroplasty (TKA), secondary patellar resurfacing (SPR) may offer relief of AKP. The purpose of our study was to evaluate the mid-term clinical outcomes after secondary patellar resurfacing for persistent AKP. Secondary objectives were to correlate surgical outcomes with clinical and radiological parameters including 99 m-technetium bone scintigraphy. METHODS In this study, 57 patients (58 knees, 51 women and 6 men) with a mean age of 70 years at the time of SPR were included. Patients were asked about their satisfaction regarding the outcome of the procedure. Patellar position was assessed by axial radiographs, and we reassessed the preoperatively performed bone scintigraphy. RESULTS After a median follow-up of 31 (6-76) months, 42 patients (43 knees) were satisfied and 15 were dissatisfied regarding the outcome of the procedure. Dissatisfied patients had more often a shorter time interval between TKA and SPR, patellar tilt on axial radiographs, and a 'hot' bone scan. CONCLUSION In patients with persistent AKP following TKR, secondary resurfacing leads to patient satisfaction in a relatively large number of patients. Better results were seen in patients without tilting of the patella. The added value of a bone scan as an indicator to perform SPR is not clarified in the present study.
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Affiliation(s)
- Philip Scheurer
- Department of Orthopaedics, Martini Hospital Groningen, Groningen, The Netherlands,
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