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Tsivelekas K, Pallis D, Lykos S, Triantafyllou E, Nikolakakos P, Tilentzoglou A, Papadakis SA. Patella Fracture After Total Knee Arthroplasty: A Review. Cureus 2024; 16:e53281. [PMID: 38435881 PMCID: PMC10905318 DOI: 10.7759/cureus.53281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2024] [Indexed: 03/05/2024] Open
Abstract
The management and underlying causes of patellar periprosthetic fractures (PPF) after total knee arthroplasty (TKA) constitute an issue of growing importance given the rising frequency of these procedures. Patella periprosthetic fractures, though relatively rare, pose significant challenges and are a frequent indication for revision surgeries. Despite a decrease in overall incidence, PPFs remain the second most common type of periprosthetic fractures after TKA. Several factors have been identified and associated with patient-specific factors, surgical technique errors, and implant-related causes. Currently extensor apparatus integrity, bone stock, and component loosening are the major concerns and indications for the selective treatment approach. In this study, a thorough review of the existing literature was performed summarizing the epidemiology, clinical manifestation, treatment approach, and functional outcome of PPF. This review aims to underline the significance of such predisposing factors, point out the severity of PPF, and offer insights into the optimal intra- and post-operative management of the patella.
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Affiliation(s)
| | - Dimitrios Pallis
- Second Department of Orthopaedics, KAT General Hospital of Attica, Athens, GRC
| | - Stavros Lykos
- Second Department of Orthopaedics, KAT General Hospital of Attica, Athens, GRC
| | | | - Petros Nikolakakos
- Second Department of Orthopaedics, KAT General Hospital of Attica, Athens, GRC
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Ferri R, Digennaro V, Panciera A, Bulzacki Bogucki BD, Cecchin D, Manzetti M, Brunello M, Faldini C. Management of patella maltracking after total knee arthroplasty: a systematic review. Musculoskelet Surg 2022; 107:143-157. [PMID: 36197592 DOI: 10.1007/s12306-022-00764-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 09/22/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Patella maltracking is among the most frequent causes of poor outcomes and early failure after total knee arthroplasty (TKA), with an incidence that ranges from 1 to 20%. Even if there is agreement between authors regarding the preoperative and intraoperative management of patella maltracking in TKA, less clear are postoperative conducts. The purpose of this systematic review is to summarize and compare surgical techniques used to treat patella maltracking after TKA. METHODS A systematic review of the literature was performed with a primary search on Medline through PubMed. The PRISMA 2009 flowchart and checklist were used to edit the review. Screened studies had to provide clinical, functional and radiological results and complications of the proposed treatment to be included in the review. RESULTS A total of 21 articles were finally included. Three main types of surgical procedures and other minor techniques have been identified to manage patella maltracking after TKA. The choice of the proper technique to use in the specific case depends on several factors, first of all the malpositioning of the prosthetic components. CONCLUSION Patella maltracking after TKA represents a frequent and challenging problem for orthopedic surgeons. Treatments described in the literature are often able to correct an abnormal patellar tracking; nevertheless, authors report variable percentages of residual knee pain and dissatisfaction in re-treated patients. Therefore, it would be desirable to prevent the maltracking condition at the time of primary arthroplasty, using proper surgical precautions.
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Affiliation(s)
- R Ferri
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy.
| | - V Digennaro
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
| | - A Panciera
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
| | - B D Bulzacki Bogucki
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
| | - D Cecchin
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
| | - M Manzetti
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
| | - M Brunello
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
| | - C Faldini
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
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Isolated effects of patellar resurfacing in total knee arthroplasty and their relation to native patellar geometry. Sci Rep 2022; 12:12979. [PMID: 35902607 PMCID: PMC9334631 DOI: 10.1038/s41598-022-16810-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/15/2022] [Indexed: 11/17/2022] Open
Abstract
The isolated effects of patellar resurfacing on patellar kinematics are rarely investigated. Nonetheless, knowing more about these effects could help to enhance present understanding of the emergence of kinematic improvements or deteriorations associated with patellar resurfacing. The aim of this study was to isolate the effects of patellar resurfacing from a multi-stage in vitro study, where kinematics after total knee arthroplasty before and after patellar resurfacing were recorded. Additionally, the influence of the native patellar geometry on these effects was analysed. Eight fresh frozen specimens were tested successively with different implant configurations on an already established weight bearing knee rig. The patello-femoral kinematics were thereby measured using an ultrasonic measurement system and its relation to the native patellar geometries was analysed. After patellar resurfacing, the specimen showed a significantly medialized patellar shift. This medialization of the patellar tracking was significantly correlated to the lateral facet angle of the native patella. The patellar shift after patellar resurfacing is highly influenced by the position of the patellar button and the native lateral patellar facet angle. As a result, the ideal medio-lateral position of the patellar component is affected by the geometry of the native patella.
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Ko YI, Yang JH, Choi CH. Comparison of Clinical Outcomes after Total Knee Arthroplasty with and without Patellar Resurfacing in the Same Patients. Clin Orthop Surg 2022; 14:361-369. [PMID: 36061849 PMCID: PMC9393276 DOI: 10.4055/cios20289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/18/2021] [Accepted: 04/26/2021] [Indexed: 11/06/2022] Open
Abstract
Background Methods Results Conclusions
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Affiliation(s)
- Young Il Ko
- Department of Orthopaedic Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Jae Hyuk Yang
- Department of Orthopedic Surgery, Division of Knee Surgery and Sports Medicine, Joint Reconstruction Center, Hanyang University Guri Hospital, Guri, Korea
| | - Choong Hyeok Choi
- Department of Orthopaedic Surgery, Hanyang University College of Medicine, Seoul, Korea
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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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Mei X, Ding H, Meng J, Zhao J. Anthropometric measurements of patellar ridge using computed tomography-based three-dimensional computer models. J Orthop Surg Res 2021; 16:436. [PMID: 34229682 PMCID: PMC8259142 DOI: 10.1186/s13018-021-02587-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 06/27/2021] [Indexed: 11/10/2022] Open
Abstract
Background The objectives of this study were to investigate the anatomic morphology of patellar ridge using computed tomography-based three-dimensional (3D) computer models and to assess the center of the patellar ridge after virtual resections. Methods We selected 80 patients, 40 males (age, 33.2±6.8 years) and 40 females (age, 30.6±7.2 years), who were slightly symptomatic with soft tissue injury of the knee joint. The right or left knees were scanned by computed tomography (CT). The CT data of 160 knees was used to construct 3D computer models by image analysis software (Mimics). Variables such as the angle between the patellar ridge and patellar long axis, the distance between the center of the patellar ridge and the center of patellar cut after virtual resections were measured. We detect differences between the sides and genders with the 3D computer models by Student’s t test. Simple linear regression and correlation test was used to correlate the patellar ridge center to the center of the patellar cut. Results According to the available data, there were significant gender differences in the length and width of patellar cut after virtual resections even with strict control for the height and weight of the patients. The angle between the patellar ridge and the patellar long axis was 11.24° ± 3.62°. The angle in male patients was 10.17° ± 4.82°, and it was 12.28°± 3.78° in female patients. The morphological difference was statistically significant (P < 0.05). After using the subchondral method to virtually resect the patellae, with reference to the center of the patellar cut, the center of the patellar ridge lies superiorly and medially in 88.75%, inferiorly and medially in 8.75%, laterally and superiorly in 2.5%, and in no case laterally and inferiorly. The intra-observer reliability regarding the dimensional measurements was excellent in this study. Conclusions Advances in 3D computer models had resulted in the availability of preoperative measurement and virtual planning. The anthropometric dimensions of this study could provide general information for guiding surgical management of the patella in total knee arthroplasty (TKA) and were useful in designing patellar implants. Clinical relevance The placement of the patellar component during TKA differs from one patella to another. The anatomic morphology information of the patellar ridge is helpful for surgeons to perform patellar resurfacing in TKA.
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Affiliation(s)
- Xiaoliang Mei
- Department of Orthopedics, Jinling Hospital, Jinling Clinical Medical College of Nanjing Medical University, Nanjing, 210002, Jiangsu, People's Republic of China.,Department of Orthopedics, Taizhou Clinical Medical School of Nanjing Medical University, Taizhou, 225300, Jiangsu, People's Republic of China
| | - Hao Ding
- Department of Orthopedics, Jinling Hospital, Jinling Clinical Medical College of Nanjing Medical University, Nanjing, 210002, Jiangsu, People's Republic of China
| | - Jia Meng
- Department of Orthopedics, Jinling Hospital, Jinling Clinical Medical College of Nanjing Medical University, Nanjing, 210002, Jiangsu, People's Republic of China
| | - Jianning Zhao
- Department of Orthopedics, Jinling Hospital, Jinling Clinical Medical College of Nanjing Medical University, Nanjing, 210002, Jiangsu, People's Republic of China.
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Yanke AB, Huddleston HP, Bodendorfer BM. Osteochondral Allograft Transplant of the Patella Using Femoral Condylar Allografts: Letter to the Editor. Orthop J Sports Med 2021; 9:23259671211000099. [PMID: 34017875 PMCID: PMC8114269 DOI: 10.1177/23259671211000099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Song SJ, Kim KI, Suh DU, Park CH. Comparison of Patellofemoral-Specific Clinical and Radiographic Results after Total Knee Arthroplasty Using a Patellofemoral Design-Modified Prosthesis and Its Predecessor. Clin Orthop Surg 2021; 13:175-184. [PMID: 34094008 PMCID: PMC8173230 DOI: 10.4055/cios20188] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 08/17/2020] [Accepted: 08/20/2020] [Indexed: 11/06/2022] Open
Abstract
Backgroud One recently developed total knee arthroplasty (TKA) prosthesis was designed to alter the patellofemoral geometry and optimize patellar tracking compared to its predecessor. Despite an expectation that the improved design would contribute to optimal patellofemoral compatibility, its effect has not been confirmed with patellofemoral-specific clinical scoring systems and radiographic parameters. Our purpose was to compare patellofemoral-specific clinical and radiographic results after TKA using a patellofemoral design-modified prosthesis and its predecessor. Methods The results of 200 TKAs with Attune (group A) were compared to those of 200 TKAs with PFC Sigma (group B). Clinically, the presence of anterior knee pain (AKP), patellar crepitation, and Kujala score were checked. Radiographically, anterior femoral offset (AFO), posterior femoral offset (PFO), position of patellar ridge, and patellar tilt and translation were compared. Results In group A, AKP and patellar crepitation occurred less frequently (AKP: 3% vs. 8%, p = 0.028; patellar crepitation: 2.5% vs. 9%, p = 0.005) and Kujala score was higher (81.8 vs. 77.9, p < 0.001), when compared to group B. The AFO decreased in group A postoperatively but increased in group B (-1.2 vs. 1.1 mm, p < 0.001). The change in PFO was smaller in group A than group B (-1.2 vs. -3.6 mm, p < 0.001). The change in patellar ridge after TKA was smaller in group A than group B (1.4% vs. 8.3%, p < 0.001). The postoperative patella of group A was more laterally tilted (5.9° vs. 2.2°, p < 0.001) and less laterally translated (0.9 vs. 2.6 mm, p < 0.001). The proportion of incompatible patella tilt angle (≥ ± 10°) was greater in group A than group B (21.7% vs. 4.5%, p < 0.001). Conclusions TKA using Attune provided better patellofemoral-specific clinical results and favorable radiographic parameters related with patellar ridge, AFO, and PFO than TKA using PFC Sigma did. However, the current prosthesis did not provide better radiographic patellar tracking, which might be due to the medial location of the patellar ridge.
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Affiliation(s)
- Sang Jun Song
- Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Seoul, Korea
| | - Kang Il Kim
- Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Seoul, Korea
| | - Dong Uk Suh
- Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Seoul, Korea
| | - Cheol Hee Park
- Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Seoul, Korea
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Joseph L, Batailler C, Roger J, Swan J, Servien E, Lustig S. Patellar component size effects patellar tilt in total knee arthroplasty with patellar resurfacing. Knee Surg Sports Traumatol Arthrosc 2021; 29:553-562. [PMID: 32274550 DOI: 10.1007/s00167-020-05984-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 04/06/2020] [Indexed: 01/16/2023]
Abstract
PURPOSE Patellar component positioning and patellofemoral kinematics are of great importance in total knee arthroplasty (TKA). The factors influencing patellar tilt are femoral rotation and lateral patellar release. However, the effect of patellar component size remains unknown. The aim of this study was to evaluate the intra-operative risk factors for patellar tilt, particularly the effect of the patellar component size. The hypothesis was that increasing the patellar component size would reduce the risk of patellar tilt. METHODS 878 primary TKAs with patellar resurfacing were included between January 2015 and October 2018. Analysis was performed at 1-year postoperatively on patients categorized into two groups: patellar tilt (PT) and no patellar tilt (NPT). A multivariate analysis was performed for the effect of patellar component size, femoral rotation, femoral overbuilding, patellar thickness and lateral release on patellar tilt risk. Secondary analysis was performed for any difference in clinical outcomes and revision rates between groups. RESULTS Multivariate analysis showed that increasing the patellar component size decreased the risk of patellar tilt by 37% (p < 0.001). Placing the femoral component at 3° of external rotation decreased the risk of patellar tilt by 67% (p < 0.001). Secondary analysis showed better clinical outcomes in the NPT group, especially regarding global satisfaction, and KSS objective and subjective scores. The revision for any cause was less in the NPT group (p = 0.019). The cause for TKA revision was related to the patellar in 11% of cases in the NPT group and 65% in the PT group (p < 0.001). CONCLUSION Increased patellar component size and positioning the femoral component in external rotation decreases the risk of patellar tilt, improves clinical outcomes and decreases the rate of surgical revision. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Léopold Joseph
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon North University Hospital, Hospices Civils de Lyon, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France
| | - Cécile Batailler
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon North University Hospital, Hospices Civils de Lyon, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France.
| | - Julien Roger
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon North University Hospital, Hospices Civils de Lyon, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France
| | - John Swan
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon North University Hospital, Hospices Civils de Lyon, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France
| | - Elvire Servien
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon North University Hospital, Hospices Civils de Lyon, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France
| | - Sébastien Lustig
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon North University Hospital, Hospices Civils de Lyon, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France
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Abstract
This is a review of the recent literature of the various factors that affect patellar tracking following total knee arthroplasty (TKA). Patellar tracking principally depends on the pre-existing patellar tracking and the rotational alignment of the femoral and tibial implants, but the detailed movements depend on the patellar shape. The latter means that the patellar kinematics of any implanted TKA does not return to normal. Laboratory cadaveric studies use normal knees and non-activity-based testing conditions and so may not translate into clinical findings. The recent literature has not added anything significant to change established clinical practice in achieving satisfactory patellar tracking following TKA.
Cite this article: EFORT Open Rev 2018;3:106-113. DOI: 10.1302/2058-5241.3.170036.
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Affiliation(s)
- Simon Donell
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, UK
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