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Gunderson ZJ, Luster TG, Deckard ER, Meneghini RM. The Fate of Unresurfaced Patellae in Contemporary Total Knee Arthroplasty: Early to Midterm Results. J Arthroplasty 2024; 39:S65-S69. [PMID: 38336307 DOI: 10.1016/j.arth.2024.01.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Leaving the patella unresurfaced in total knee arthroplasty (TKA) has increased significantly over the past decade in the United States, likely due to modern patella-friendly implants, complications with resurfacing, and the knowledge that historical studies were scientifically confounded. This study evaluated revision-free survivorship out to 8.5 years in a cohort of contemporary primary TKAs with patella-friendly femoral components and unresurfaced patellae. METHODS A total of 1,053 consecutive primary TKAs with unresurfaced patellae were retrospectively reviewed. A selective patellar nonresurfacing protocol was used for all cases. Kaplan-Meier survivorship estimates were calculated based on patellar revision and the latest follow-up. An aggressive lateral patellar facetectomy was performed in 78% (823 of 1,053) of cases. The cohort was 62% women and 43% American Society of Anesthesiologists physical status classification I or II with a mean age and body mass index of 65 years (range, 35 to 94) and 35 kg/m2 (range, 18 to 65), respectively. RESULTS A total of 4 (0.4%, 4 of 1,053) unresurfaced patellae were revised. Three were resurfaced as part of other procedures: 2 for global instability and one for aseptic loosening at a mean of 1.6 years; and one patella was resurfaced by an outside surgeon for unexplained pain. The all-cause revision-free survivorship estimate specifically related to the patella was 98.9% (95% confidence interval, 98 to 100) out to 8.5 years. No significant difference in survivorship was related to patellae with or without a lateral patellar facetectomy (99.5 versus 98.1%, P ≥ .191); however, 3 of 4 patellar revisions occurred in TKAs without a lateral patellar facetectomy (P = .035). CONCLUSIONS The results of this study demonstrate excellent revision-free survivorship related to unresurfaced patellae, particularly when a lateral facetectomy was performed. These early to midterm results using modern patella-friendly femoral components are promising and comparable to resurfaced patellae in the literature. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Zachary J Gunderson
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Taylor G Luster
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Evan R Deckard
- Indiana Joint Replacement Institute, Indianapolis, Indiana
| | - R Michael Meneghini
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana; Indiana Joint Replacement Institute, Indianapolis, Indiana
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2
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Vasiliadis AV, Giovanoulis V. Patellar management in total knee arthroplasty: an educational aid. Singapore Med J 2024:00077293-990000000-00128. [PMID: 38993103 DOI: 10.4103/singaporemedj.smj-2023-154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/12/2023] [Indexed: 07/13/2024]
Affiliation(s)
- Angelo Vasileiou Vasiliadis
- Department of Orthopaedic Surgery, Sports Trauma Unit, St. Luke's Hospital, Thessaloniki, Greece
- Department of Orthopaedic Surgery and Sports Medicine, Croix-Rousse Hospital, Lyon, France
| | - Vasileios Giovanoulis
- Department of Orthopaedic Surgery, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France
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3
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Cieremans DA, Arraut J, Marwin S, Slover J, Schwarzkopf R, Rozell JC. Patellar Component Design Does Not Impact Clinical Outcomes in Primary Total Knee Arthroplasty. J Arthroplasty 2023:S0883-5403(23)00081-5. [PMID: 36764403 DOI: 10.1016/j.arth.2023.01.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 01/26/2023] [Accepted: 01/31/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Round or oval implants are used in patellar resurfacing during total knee arthroplasty (TKA). However, whether component geometry affects clinical outcomes is unclear. This study aimed to determine if one implant shape conferred superior outcomes to the other. METHODS A retrospective review of primary TKA cases performed from 2016 to 2020 was conducted at an urban, tertiary academic center. Four hundred consecutive, primary TKAs were included in these analyses. Cases were included if a surgeon used the round design then oval design for fifty consecutive cases. Baseline demographic data and radiographic measurements were assessed. Surgical data, reasons for revision, and patient-reported outcome measures were analyzed. Independent samples t-test and chi-square tests were used to compare means and proportions. There were no demographic differences between the cohorts. RESULTS Postoperative patellar tilt was statistically different between the cohorts. Sixteen patients required revision surgery; however, revision rates did not differ between the cohorts. Of the 9 rounds, 1 button was revised for infection. Of the 7 ovals, 1 button was revised for infection and 1 for loosening. Veterans RAND 12 Physical Component Score at 3 months postoperatively was higher for the round cohort, but no differences were observed at 1 year. CONCLUSION While radiographic patellar tilt was significantly different between the cohorts, there was no clinical correlation in outcomes at 3 months or 1 year postoperatively. Longer-term follow-up studies are needed to evaluate the implications of patellar component design on outcomes and function. Nevertheless, the current study affirms that both designs are clinically equivalent which should be used to guide clinical decision-making. LEVEL III EVIDENCE Retrospective Cohort.
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Affiliation(s)
| | - Jerry Arraut
- New York University Langone Orthopedic Hospital, New York, New York
| | - Scott Marwin
- New York University Langone Orthopedic Hospital, New York, New York
| | - James Slover
- New York University Langone Orthopedic Hospital, New York, New York
| | - Ran Schwarzkopf
- New York University Langone Orthopedic Hospital, New York, New York
| | - Joshua C Rozell
- New York University Langone Orthopedic Hospital, New York, New York
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4
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Teh HL, Kassim AF, Chopra S, Selvaratnam V. A Rare Presentation of Patella Button Aseptic Loosening After a Total Knee Replacement Without Evidence of Radiographic Loosening. Cureus 2023; 15:e34665. [PMID: 36909109 PMCID: PMC9997687 DOI: 10.7759/cureus.34665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 02/09/2023] Open
Abstract
Patella resurfacing in total knee replacement (TKR) has been shown to reduce the rate of anterior knee pain, but there are complications from patella resurfacing. A 54-year-old male underwent a left primary TKR with patella resurfacing 15 years ago. He developed spontaneous progressive anterior knee pain for six months. At revision surgery, his patella button was found to be loose. Loosening of a three-peg patella button is rare. A high index of suspicion of patella button loosening should be suspected in patients who present with anterior knee pain after patella resurfacing.
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Affiliation(s)
- Hak Lian Teh
- Exeter Hip Unit and Exeter Knee Reconstruction Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter National Health Service Foundation Trust, Exeter, GBR
| | | | - Suresh Chopra
- Arthroplasty Unit, Sultanah Bahiyah Hospital, Alor Setar, MYS
| | - Veenesh Selvaratnam
- National Orthopaedic Centre of Excellence in Research and Learning, Department of Orthopaedic Surgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, MYS
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5
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Gharaibeh MA, Tarassoli P, Chen DB, Wood JA, Beuzeville S, Quinn R, Harris IA, MacDessi SJ. Does Choice of Patellar Implant in Total Knee Arthroplasty Matter?: A Randomized Comparative Trial of 3 Commonly Used Designs. J Bone Joint Surg Am 2023; 105:145-156. [PMID: 36651890 DOI: 10.2106/jbjs.22.00655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND There is currently a lack of evidence to identify the optimal patellar implant design in total knee arthroplasty (TKA). The aim of this study was to assess clinical, intraoperative, radiographic, and scintigraphic differences between inlay (IN), onlay round (OR), and onlay oval (OO) patellar implants. METHODS A parallel-group, double-blinded, randomized trial compared IN, OR, and OO patellar implants using the same posterior-stabilized TKA prosthesis for each. Patient outcomes were prospectively followed for a minimum of 2 years, with survivorship outcomes followed for a mean of 5 years. The primary outcome was the between-group differences in the mean Kujala score change from preoperatively to 2 years postoperatively. The secondary outcomes included differences in other knee-specific and general health outcomes, intraoperative characteristics, radiographic parameters, patellar vascularity, and implant survivorship. RESULTS A total of 121 participants (40 in the IN group, 41 in OR group, 40 in the OO group) were allocated to 1 of 3 implant designs. At 2 years postoperatively, there were no significant differences in Kujala score changes between groups (p = 0.7; Kruskal-Wallis test). Compared with the IN group, the OR group showed greater improvements in Knee injury and Osteoarthritis Outcome Score (KOOS) Activities of Daily Living and in KOOS Quality of Life compared with the OO group. However, the OO design exhibited better bone coverage and lower lateral facetectomy rates compared with the IN and OR designs. The IN group had more lateral contact compared with the OO group (p = 0.02; Fisher exact test), but the overall value for lateral contact was not significant (p = 0.09; chi-square test). There were no differences in postoperative scintigraphic vascularity (p = 0.8; chi-square test). There was 1 revision for infection at 3 years postoperatively in the OO group, and no revision in the other groups. CONCLUSIONS Patellar design did not influence patellofemoral outcomes or survivorship. However, OR implants showed improvements in some secondary patient-reported outcome measures, and OO implants exhibited superior bone coverage and improvements in several intraoperative, radiographic, and scintigraphic outcomes. These findings, combined with superior long-term implant survivorship from previous studies, add support for the use of onlay designs in TKA. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Monther A Gharaibeh
- Department of General and Special Surgery, Faculty of Medicine, The Hashemite University, Zarqa, Jordan
| | - Payam Tarassoli
- Sydney Knee Specialists, Kogarah, New South Wales, Australia
| | - Darren B Chen
- Sydney Knee Specialists, Kogarah, New South Wales, Australia.,St George Private Hospital, Kogarah, New South Wales, Australia
| | - Jil A Wood
- Sydney Knee Specialists, Kogarah, New South Wales, Australia
| | - Scott Beuzeville
- St George Private Hospital Nuclear Medicine, Kogarah, New South Wales, Australia
| | - Richard Quinn
- St George Private Hospital Nuclear Medicine, Kogarah, New South Wales, Australia
| | - Ian A Harris
- Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Samuel J MacDessi
- Sydney Knee Specialists, Kogarah, New South Wales, Australia.,St George Private Hospital, Kogarah, New South Wales, Australia.,St George Hospital Clinical School, University of New South Wales, Sydney, New South Wales, Australia
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6
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Park HJ, Chang MJ, Kim TW, Chang CB, Kang KS, Kang SB. Subchondral Bone Condition and Intraoperative Grading of Cartilage Degeneration Underneath Patella Unrelated to the Clinical Outcome after TKA with Unresurfaced Patella. J Knee Surg 2022; 35:1417-1424. [PMID: 33607675 DOI: 10.1055/s-0041-1723980] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The degree of cartilage degeneration assessed intraoperatively may not be sufficient as a criterion for patellar resurfacing in total knee arthroplasty (TKA). However, single-photon emission tomography/computed tomography (SPECT/CT) is useful for detecting osteoarthritic involvement deeper in the subchondral bone. The purpose of the study was to determine whether SPECT/CT reflected the cartilage lesion underneath the patella in patients with end-stage osteoarthritis (OA) and whether clinical outcomes after TKA without patellar resurfacing differed according to the severity of patellofemoral (PF) OA determined by visual assessment and SPECT/CT findings. This study included 206 knees which underwent TKA. The degree of cartilage degeneration was graded intraoperatively according to the International Cartilage Repair Society grading system. Subjects were classified into low and high uptake groups according to the degree of bone tracer uptake (BTU) on SPECT/CT in the PF joint. The Feller's patella score and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were assessed preoperatively and postoperative 1 and 2 years. The increased BTU in the PF joint was associated with more severe degenerative cartilage changes underneath the patella (p < 0.001). The risk for the presence of denudated cartilage was greater in the high uptake group (odds ratio = 5.89). There was no association between clinical outcomes and visual grading of patellar cartilage degeneration or the degree of BTU on SPECT/CT. The visual assessment of the degree of cartilage degeneration underneath the patella and preoperative SPECT/CT evaluation of the PF joint were not predictive of clinical outcome after TKA with unresurfaced patella.
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Affiliation(s)
- Hyung Jun Park
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Moon Jong Chang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Tae Woo Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Chong Bum Chang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kee Soo Kang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Seung-Baik Kang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
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7
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Nagashima M, Otani T, Harato K, Sasaki R, Seki H, Takeshima K, Ishii K. Lateral Patellar Facetectomy Reduces the Incidence of Anterior Knee Pain in Patellar Resurfaced Total Knee Arthroplasty. J Knee Surg 2022; 36:773-778. [PMID: 35189663 DOI: 10.1055/s-0042-1743226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Lateral patellar facet impingement (LPFI) can cause anterior knee pain (AKP) after patellar resurfaced total knee arthroplasty (TKA). Recently, lateral patellar facetectomy (LPF), which has been used for LPFI, has been performed during primary TKA, providing good clinical outcomes. However, the effect of LPF on AKP in primary patellar resurfaced TKA has not been sufficiently studied. The purpose of this study was to examine the effect of LPF on the development of AKP in patellar resurfaced TKAs with minimum follow-up of 3 years. This retrospective cohort study included 84 knees of 66 consecutive patients who underwent patellar resurfaced TKA between April 2007 and November 2014 in our hospital. The subjects were divided into two groups: TKA with LPF (LPF group; 47 knees) and TKA without LPF (no-LPF group; 37 knees). Postoperative AKP, the primary outcome, the Japanese Orthopaedic Association (JOA) score, and range of motion were investigated at the final visit and compared between the two groups. Six knees (16.2%) had AKP in the no-LPF group, whereas none of the knees had AKP in the LPF group at the final visit. The incidence of AKP was significantly lower in the LPF group (p = 0.004). The postoperative JOA score and flexion angle were significantly higher in the LPF group than in the no-LPF group. LPF correlated with less incidence of postoperative AKP and improved the JOA score and knee flexion angle. In patellar resurfaced TKA, LPF may be considered an additional maneuver to avoid postoperative AKP.
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Affiliation(s)
- Masaki Nagashima
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Narita City, Chiba, Japan.,Department of Orthopaedic Surgery, International University of Health and Welfare Mita Hospital, Minato-ku, Tokyo, Japan
| | - Toshiro Otani
- Department of Orthopaedic Surgery, International University of Health and Welfare Ichikawa Hospital, Ichikawa City, Chiba, Japan
| | - Kengo Harato
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Ryo Sasaki
- Department of Orthopaedic Surgery, International University of Health and Welfare Mita Hospital, Minato-ku, Tokyo, Japan
| | - Hiroyuki Seki
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Narita City, Chiba, Japan.,Department of Orthopaedic Surgery, International University of Health and Welfare Mita Hospital, Minato-ku, Tokyo, Japan
| | - Kenichiro Takeshima
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Narita City, Chiba, Japan.,Department of Orthopaedic Surgery, International University of Health and Welfare Mita Hospital, Minato-ku, Tokyo, Japan.,Department of Orthopaedic Surgery, International University of Health and Welfare Narita Hospital, Narita City, Chiba, Japan
| | - Ken Ishii
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Narita City, Chiba, Japan.,Department of Orthopaedic Surgery, International University of Health and Welfare Mita Hospital, Minato-ku, Tokyo, Japan.,Department of Orthopaedic Surgery, International University of Health and Welfare Narita Hospital, Narita City, Chiba, Japan
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8
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Held MB, Gazgalis A, Sarpong NO, Geller JA, Shah RP, Cooper HJ. Management of the Patella During Total Knee Arthroplasty. JBJS Rev 2021; 9:01874474-202109000-00011. [PMID: 34516451 DOI: 10.2106/jbjs.rvw.21.00054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» The optimal management of the patella during total knee arthroplasty (TKA) remains a controversial topic with no consensus. » Patellar management techniques during TKA include patellar retention or resurfacing with or without patellaplasty, as well as circumferential denervation and partial lateral facetectomy (PLF). » Special considerations such as patient age, etiology of disease, implant design, and surgeon preference should be accounted for when determining optimal management. » We recommend that most patellae be circumferentially denervated, regardless of whether they are resurfaced, as the potential benefits outweigh the small associated risks. » Evidence demonstrates improved functional outcomes with the addition of PLF to nonresurfaced patellae. There is currently a paucity of evidence of this technique with respect to resurfaced patellae. » Patellar resurfacing adds additional costs and health-care resources that should be considered in the decision-making process.
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Affiliation(s)
- Michael B Held
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY
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9
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Zhang LZ, Li S, Jiang Y, Qiu ZL, Wang Y, Lu HK, Zhu RS, Tuladhar R, Chang SM. Clinical usefulness of single photon emission tomography/computed tomography with stress analysis in early diagnoses of stem instability of noncemented hip arthroplasty. Nucl Med Commun 2021; 42:244-252. [PMID: 33306622 DOI: 10.1097/mnm.0000000000001323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Hip pain arising from implant instability is generally caused by repetitive stress injury, which subsequently leads to induction or exacerbation of abnormal metabolism of bone around the implant. single photon emission tomography/computed tomography (SPECT-CT) has advantages in localizing areas of increased tracer uptake that reflects such abnormal bone metabolism. Therefore, we investigated whether the application of SPECT/CT with stress analysis can be an effective practice in evaluating the instability of stem in noncemented hip arthroplasty or not. METHOD In total 16 patients were collected for unexplained painful hip arthroplasties. When physical examination and blood tests were unremarkable, radiographs were inconclusive and bone scan indicated increased scintigraphic uptake at the proximal part and at the tip of the stem; SPECT/CT was performed. Stem stability was assessed by measuring whether there was consistency between the increased scintigraphic uptake and the direction of the stress around the implant along with the location of the prosthesis. RESULT Among the 16 symptomatic hips, 9 hips showed the stability of the stem, 3 hips showed the stem instability and 4 hips showed the acetabular loosening with the stem stability. With the application of SPECT/CT with stress analysis, 15 out of 16 (93.7%) cases were found to have the change in the diagnoses, and managements were implemented in 11 out of 16 (68.7%) cases. When comparing before and after SPECT/CT, there was no significant association in clinical diagnosis and management (Pearson chi- square test = 4.61 and 1.33, P = 0.33 and 0.25). CONCLUSION SPECT/CT combined with stress analysis can be a useful tool in early diagnosis of stem instability and can assist surgeons in subsequent management and decision implementation when other radiographic imagings are inconclusive.
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Affiliation(s)
- Li-Zhi Zhang
- Department of Orthopedic Surgery, ShangHai YangPu District Central Hospital, YangPu Hospital, TongJi University
| | - Shuang Li
- Department of Orthopaedic Surgery, Pudong New Area Poeples' Hospital, Shanghai University of Medicine and Health Sciences
| | - Yao Jiang
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Zhong-Ling Qiu
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yang Wang
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Han-Kui Lu
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Rui-Sen Zhu
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Rujan Tuladhar
- Department of Orthopedic Surgery, ShangHai YangPu District Central Hospital, YangPu Hospital, TongJi University
| | - Shi-Min Chang
- Department of Orthopedic Surgery, ShangHai YangPu District Central Hospital, YangPu Hospital, TongJi University
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10
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Shen XY, Zuo JL, Gao JP, Liu T, Xiao JL, Qin YG. New treatment of patellar instability after total knee arthroplasty: A case report and review of literature. World J Clin Cases 2020; 8:5487-5493. [PMID: 33269288 PMCID: PMC7674709 DOI: 10.12998/wjcc.v8.i21.5487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/19/2020] [Accepted: 09/28/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Patellar instability is an uncommon complication after total knee arthroplasty (TKA). Partial lateral patella facetectomy (LPF) with lateral retinaculum release treatment of patellar instability is rarely reported.
CASE SUMMARY We present a case of patellar instability 8 mo after primary TKA. Treatment of this complication was adapted to address the cause of the dislocation. To eliminate patellar instability, we restored the vastus medialis and performed LPF with lateral retinaculum release. We achieved normal patellar tracking. Clinical and radiographic evaluations at the 1-year postoperative follow-up were satisfactory.
CONCLUSION LPF with lateral retinaculum release represents a promising option to restore central patellar tracking in patients with patellar instability after TKA in cases without component malposition.
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Affiliation(s)
- Xian-Yue Shen
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun 130041, Jilin Province, China
| | - Jian-Lin Zuo
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Jian-Peng Gao
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Tong Liu
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Jian-Lin Xiao
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Yan-Guo Qin
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun 130041, Jilin Province, China
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11
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Gharaibeh MA, Chen DB, Wood JA, MacDessi SJ. Characteristics of three different patellar implant designs in total knee arthroplasty. ANZ J Surg 2020; 90:1303-1309. [PMID: 32455501 DOI: 10.1111/ans.15988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 04/11/2020] [Accepted: 04/26/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Despite debate over the role of patellar resurfacing in total knee arthroplasty, many surgeons feel it decreases re-operation rates and anterior pain, and an increasing number are adopting resurfacing. This study compares intra-operative characteristics of different patellar implants to assist surgeons in gaining better understanding of these implants. METHODS The three most commonly used patellar implants (inset, onlay round and onlay oval) were allocated randomly to 120 patients undergoing total knee arthroplasty. We compared the groups in terms of implant size, bone coverage, lateral underhang (uncovered lateral facet) and need for partial lateral facetectomy. We also compared the patient-reported outcome measures between the groups at 6 months post-operatively. RESULTS The inset, onlay round and onlay oval designs had bone coverage of 48.5%, 65.9% and 85.9%, respectively (P < 0.01). Similarly, the onlay-oval implant was found to have the smallest lateral underhang of all three designs (inset 11.6 mm; onlay round 6.9 mm, onlay oval 1.6 mm, P < 0.01). The onlay-oval design was the largest implant with a median size of 35 mm, compared to 23 mm for the inset and 32 mm for the onlay round (P < 0.01). In addition, patellae using onlay-oval implants required significantly fewer lateral facetectomies due to improved bone coverage (inset 95%; onlay round 87%; onlay oval 3%; P < 0.01). Finally, comparison of patient-reported outcome measures between the groups showed no difference at an early assessment of 6 months. CONCLUSION Onlay-oval design allows for the use of a larger implant, improving bone coverage and reducing the need for partial lateral facetectomy; however, early assessment of outcomes shows no difference between the three designs.
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Affiliation(s)
- Monther A Gharaibeh
- Sydney Knee Specialists, St George Private Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine, The Hashemite University, Zarqa, Jordan
| | - Darren B Chen
- Sydney Knee Specialists, St George Private Hospital, Sydney, New South Wales, Australia
| | - Jil A Wood
- Sydney Knee Specialists, St George Private Hospital, Sydney, New South Wales, Australia
| | - Samuel J MacDessi
- Sydney Knee Specialists, St George Private Hospital, Sydney, New South Wales, Australia.,St George Hospital Clinical School, University of New South Wales, Sydney, New South Wales, Australia
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12
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Moghtadaei M, Sajadi MRM, Farahini H, Yeganeh A. Osteophytes removal in patella versus lateral facetectomy of the patella in patella-retaining total knee arthroplasty. Interv Med Appl Sci 2017; 9:15-19. [PMID: 28932491 PMCID: PMC5598117 DOI: 10.1556/1646.9.2017.1.07] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND In this study, the results of the partial lateral facetectomy of the patella to better patellofemoral motion and congruence are compared with the results of the osteophyte removal of the patella and neurectomy only in total knee arthroplasty (TKA). METHODS Data from 55 patients undergoing TKA with osteophytes removal of the patella and neurectomy only, and those undergoing osteophytes removal of the patella and neurectomy and partial lateral facetectomy were reviewed retrospectively. Clinical outcomes were evaluated by knee society score (KSS) and functional score of knee. Clinical anterior knee pain (AKP) rating and knee range of motion and extension lag were assessed for each patient. RESULTS There was significant difference between two groups in AKP (p < 0.05), and the mean range of motion of the knee in groups 1 and 2 was 117° ± 9° and 116.6° ± 8.2°, respectively. Three (13%) patients of the reshaped patella group and three (11%) patients of the non-reshaped patella group had extension lag <10°, respectively. The mean KSS and knee functional scores showed no statistical difference between groups (p > 0.05). CONCLUSION Partial lateral facetectomy of the patella can decrease AKP and can be used routinely for every patient that surgeon does not decide to resurface the patella.
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Affiliation(s)
- Mehdi Moghtadaei
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Science, Tehran, Iran and Department of Orthopedics, Rasoul-e-akram Hospital, Iran University of Medical Science, Tehran, Iran
| | - Mohammad Reza Miniator Sajadi
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Science, Tehran, Iran and Department of Orthopedics, Rasoul-e-akram Hospital, Iran University of Medical Science, Tehran, Iran
| | - Hossein Farahini
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Science, Tehran, Iran and Department of Orthopedics, Rasoul-e-akram Hospital, Iran University of Medical Science, Tehran, Iran
| | - Ali Yeganeh
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Science, Tehran, Iran and Department of Orthopedics, Rasoul-e-akram Hospital, Iran University of Medical Science, Tehran, Iran
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13
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Yuenyongviwat V, Iamthanaporn K, Hongnaparak T. Lateral facetectomy decreased patellofemoral contact pressure in total knee replacement: A cadaveric study. J Clin Orthop Trauma 2017; 8:82-84. [PMID: 28360504 PMCID: PMC5359518 DOI: 10.1016/j.jcot.2016.07.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 07/28/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND To study the patellofemoral contact pressure in patellar non-resurfacing total knee replacement after lateral facetectomy in different amounts of bone removal. METHODS Eight knees from four fresh-frozen whole body cadavers were used for this study. Total knee replacement of all knees was performed by the same surgical technique. The contact pressure was measured and recorded when the knee performed passive motion from full extension to full flexion in native patella, lateral retinacular junction release, 10% lateral facetectomy, and 20% lateral facetectomy. RESULTS Peak patellofemoral contact pressure decreased progressively from native patellar, junctional release of the patella, 10% facetectomy, and 20% facetectomy. The peak patellofemoral contact pressures were statistically significantly different in each patellar condition (p = 0.025). CONCLUSION In the experimental study, lateral facetectomy can reduce the peak patellofemoral contact pressure in patellar non-resurfacing total knee arthroplasty.
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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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15
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Lakstein D, Naser M, Adar E, Atoun E, Edelman A, Hendel D. Partial lateral patellar facetectomy as an alternative to lateral release in Total Knee Arthroplasty (TKA). J Arthroplasty 2014; 29:2146-9. [PMID: 25064018 DOI: 10.1016/j.arth.2014.06.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 06/18/2014] [Accepted: 06/24/2014] [Indexed: 02/01/2023] Open
Abstract
This study presents the selective use of partial patellar lateral facetectomy for maltracking during primary TKA, as an alternative to lateral release. Twenty three partial facetectomies were performed out of 191 TKAs (12%). Balanced tracking was achieved in 22 knees. At follow-up 2 patients had persistent anterior knee pain. Mean Knee Society score (KSS) was 94 and mean functional KSS was 86. Mean patellar score was 28. Patellar tilt angles were within 2 degrees in all but one knee. Patellar translation was within 2 mm in all cases. No complications were recorded. A control group of 46 matched patients had similar functional and radiographic results. If tracking is not satisfactory at the conclusion of TKA, our method of choice would be partial lateral facetectomy.
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Affiliation(s)
- Dror Lakstein
- Orthopaedic Department, E. Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Muhammad Naser
- Orthopaedic Department, E. Wolfson Medical Center, Holon, Israel
| | - Eliyahu Adar
- Orthopaedic Department, E. Wolfson Medical Center, Holon, Israel
| | - Ehud Atoun
- Orthopaedic Department, Barzilai Medical Center, Ashkelon, Israel; Faculty of Medicine, Ben-Gurion University, Beer-Sheva, Israel
| | | | - David Hendel
- Orthopaedic Department, E. Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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16
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Keshmiri A, Maderbacher G, Baier C, Müller W, Grifka J, Springorum HR. Do surgical patellar interventions restore patellar kinematics in fixed-bearing, cruciate-retaining total knee arthroplasty?: An in vitro study. J Arthroplasty 2014; 29:2197-201. [PMID: 25108734 DOI: 10.1016/j.arth.2014.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 06/20/2014] [Accepted: 07/07/2014] [Indexed: 02/01/2023] Open
Abstract
Despite different surgical patellar interventions, the decision how to treat the patella during TKA remains controversial. The purpose of this study was to quantify the effect of different reconstructive patellar interventions on patellar kinematics during TKA using optical computer navigation. We implanted ten navigated TKAs in full body specimens. During passive motion, the effect of different surgical patellar interventions on patellar kinematics was analysed. A contrarily tilt behaviour was observed in the TKA group without patellar intervention compared to the natural knee. Lateral release led to similar tilt values (P < 0.05). All surgical interventions led to a 3 to 5mm medial shift of the patella (P < 0.05). None of the analysed surgical patellar interventions could restore natural patellar kinematics after TKA.
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Affiliation(s)
- Armin Keshmiri
- Department of Orthopaedic Surgery, University of Regensburg, Bad Abbach, Germany
| | - Günther Maderbacher
- Department of Orthopaedic Surgery, University of Regensburg, Bad Abbach, Germany
| | - Clemens Baier
- Department of Orthopaedic Surgery, University of Regensburg, Bad Abbach, Germany
| | - Werner Müller
- Department of Orthopaedic Surgery, Cantonal Hospital Bruderholz, Bruderholz, Swiss
| | - Joachim Grifka
- Department of Orthopaedic Surgery, University of Regensburg, Bad Abbach, Germany
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Pagenstert G, Seelhoff J, Henninger HB, Wirtz DC, Valderrabano V, Barg A. Lateral patellar facetectomy and medial reefing in patients with lateral facet syndrome after patellar-retaining total knee arthroplasty. J Arthroplasty 2014; 29:2156-62. [PMID: 25070901 DOI: 10.1016/j.arth.2014.06.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 06/13/2014] [Accepted: 06/24/2014] [Indexed: 02/01/2023] Open
Abstract
We analyzed clinical outcomes of partial lateral patellar facetectomy and medial reefing in patients with lateral patellar facet syndrome with painful patellar-retaining total knee arthroplasty. 34 patients were followed for a mean of 40 months. All 34 patients were matched with those having secondary patellar resurfacing without facetectomy. Both groups experienced significant pain relief and range of motion improvement. The facetectomy group had higher Kujala scores than those in patellar resurfacing group. Patients with facetectomy had significantly less pain postoperatively. There were significant differences in postoperative lateral patellar tilt and congruency angle in both groups. The mid-term results for LPF with medial reefing are promising to resolve pain in patients with lateral patellar facet syndrome in patellar-retaining TKA. Therapeutic level III (retrospective comparative study).
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Affiliation(s)
- Geert Pagenstert
- Department of Orthopaedic Surgery, University Hospital of Basel, Basel, Switzerland
| | | | - Heath B Henninger
- Department of Orthopaedics, Harold K. Dunn Orthopaedic Research Laboratory, University of Utah, Salt Lake City, UT
| | - Dieter C Wirtz
- Department of Orthopaedic Surgery, University Hospital, Friedrich-Wilhelms-University of Bonn, Bonn, Germany
| | - Victor Valderrabano
- Department of Orthopaedic Surgery, University Hospital of Basel, Basel, Switzerland
| | - Alexej Barg
- Department of Orthopaedic Surgery, University Hospital of Basel, Basel, Switzerland
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