1
|
Ishibashi T, Tomita T, Tamaki M, Fujito T, Okada S. Total Knee Arthroplasty Without Reduction of the Patella for Genu Valgum With Permanent Dislocation of the Patella: A Case of Nail Patella Syndrome. Arthroplast Today 2023; 20:101099. [PMID: 36793587 PMCID: PMC9922780 DOI: 10.1016/j.artd.2023.101099] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 12/30/2022] [Accepted: 01/02/2023] [Indexed: 01/29/2023] Open
Abstract
A 75-year-old woman presented with progressive bilateral knee pain and severe genu valgum. She could walk utilizing braces and T-canes, with a 20° flexion contracture and 150° of maximum flexion. During knee flexion, the patella laterally dislocated. Radiographs demonstrated severe bilateral lateral tibiofemoral osteoarthritis and patellar dislocation. She underwent posterior-stabilized total knee arthroplasty without patellar reduction. After implantation, the knee range of motion was 0°-120°. Intraoperative findings revealed that the affected patella was too small, low articular cartilage volume resulted in the diagnosis of nail patella syndrome with the tetrad of nail dysplasia, patella dysplasia, elbow dysplasia, and iliac horn. At the 5-year follow-up visit, she could walk without a brace and had a knee range of motion (10°-135°) with clinically favorable results.
Collapse
Affiliation(s)
- Teruya Ishibashi
- Department of Orthopaedic Biomaterial Science, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Tetsuya Tomita
- Department of Orthopaedic Biomaterial Science, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.,Morinomiya University of Medical Sciences, Graduate School of Health Sciences, Osaka, Japan
| | - Masashi Tamaki
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Toshitaka Fujito
- Department of Orthopaedic Surgery, Hoshigaoka Medical Center, Hirakata, Osaka, Japan
| | - Seiji Okada
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| |
Collapse
|
2
|
Abstract
Valgus malalignment is an important risk factor in recurrent patella instability. This article explores the role of corrective osteotomy and discusses the various described methods both on the femoral and tibial sides of the joint. A detailed operative technique of medial closing wedge distal femoral osteotomy is included.
Collapse
Affiliation(s)
- Scott Taylor
- Department of Surgery, Fowler Kennedy Sports Medicine Clinic, Western University, London, Ontario, Canada
| | - Alan Getgood
- Department of Surgery, Fowler Kennedy Sports Medicine Clinic, Western University, London, Ontario, Canada.
| |
Collapse
|
3
|
Kubo M, Kumagai K, Maeda T, Amano Y, Fujikawa H, Imai S. Knee osteoarthritis with patellar dislocation treated by total knee arthroplasty using a lateral parapatellar approach-ingenuity of exposure and closure. Arthroplast Today 2021; 11:173-177. [PMID: 34646923 PMCID: PMC8495702 DOI: 10.1016/j.artd.2021.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/20/2021] [Accepted: 08/22/2021] [Indexed: 11/04/2022] Open
Abstract
Knee osteoarthritis with patellar dislocation is a rare and difficult-to-treat condition. Several reports of total knee arthroplasty (TKA) combined with various realignment procedures have been published. A 77-year-old man with knee pain was referred to our hospital. Plain radiography revealed a laterally dislocated patella, with osteoarthritic changes in the femorotibial joint. He simply underwent TKA via a lateral parapatellar approach without realignment. We devised methods of exposure and closure to maximize the effect of lateral release by the lateral parapatellar approach. TKA using the lateral parapatellar approach might be effective in treating knee osteoarthritis with patellar dislocation.
Collapse
Affiliation(s)
- Mitsuhiko Kubo
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Kosuke Kumagai
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Tsutomu Maeda
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Yasutaka Amano
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Hitomi Fujikawa
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Shinji Imai
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| |
Collapse
|
4
|
Garcia-Mansilla I, Jones KJ, Sassoon AA. Combined Total Knee Arthroplasty and Medial Patellofemoral Ligament Reconstruction for Chronic Patellar Dislocation and Severe Osteoarthritis. Arthroplast Today 2020; 7:47-53. [PMID: 33521197 PMCID: PMC7818631 DOI: 10.1016/j.artd.2020.11.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 11/21/2020] [Accepted: 11/25/2020] [Indexed: 11/30/2022] Open
Abstract
Chronic patellar dislocation in the setting of severe knee osteoarthritis is a rare clinical problem. Surgical management often consists of total knee arthroplasty combined with realignment of the extensor mechanism. Several techniques have been described to anatomically restore the extensor apparatus, and literature regarding this topic consists mainly of case reports. We describe a technique using combined medial patellofemoral ligament reconstruction using allograft tissue and total knee arthroplasty with patellar resurfacing for the treatment of chronic patellar dislocation and severe osteoarthritis.
Collapse
Affiliation(s)
| | - Kristofer J Jones
- Department of Orthopaedic Surgery, Division of Sports Medicine and Shoulder Surgery, David Geffen School of Medicine at UCLA, Los Angeles California, Los Angeles, CA, USA
| | - Adam A Sassoon
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles California, Los Angeles, CA, USA
| |
Collapse
|
5
|
Extensive Proximal Extensor Mechanism Realignment for Chronic Patella Dislocations in Revision Knee Arthroplasty: Surgical Technique. Knee 2020; 27:1821-1832. [PMID: 33197822 DOI: 10.1016/j.knee.2020.09.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 09/09/2020] [Accepted: 09/23/2020] [Indexed: 02/02/2023]
Abstract
Patella dislocation after primary or revision total knee arthroplasty (TKA) is a major challenge in revision surgery. In practice, the main reason for patella maltracking and instability following TKA is malrotation of the femoral and/or tibial components. A number of soft tissue procedures, once component malrotation is corrected, have been described including proximal realignment, quadricepsplasty and distal realignment of patellar tendon with tibial tubercle osteotomy. Here, we describe our modified surgical technique in managing chronically dislocated patellae in knee arthroplasty which comprises of extensive lateral releases, vastus medialis obliquus (VMO) advancement and soft tissue reconstruction of the extensor mechanism with accompanying three case presentations achieving satisfactory clinical outcomes.
Collapse
|
6
|
Attia AK, AlSaei J, Mekhaimar MM. Conservative Management of Neglected Post-Traumatic Chronic Patellar Dislocation: A Case Report and Literature Review. JBJS Case Connect 2020; 10:e0041. [PMID: 32044780 DOI: 10.2106/jbjs.cc.19.00041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We present a case of a 44-year-old gentleman with a left post-traumatic chronic patellar dislocation that has been neglected and remained irreducible for 20 years. Our patient has maintained his full knee range of motion and has minimal symptoms and hence was treated nonoperatively. We also present a review of the rather scarce literature of similar cases and the decision-making process performed in our case to decide for nonoperative management. CONCLUSION Early surgical management of this condition may not be warranted if the patient is able to perform high-demand physical activities. However, a later surgery may be indicated when/if his symptoms and/or function deteriorates.
Collapse
Affiliation(s)
| | - Jassim AlSaei
- Orthopedic Surgery Department, Hamad Medical Corporation, Doha, Qatar
| | | |
Collapse
|
7
|
Albuquerque RPE, Sousa Filho PGTD, Loures FB, Cobra H, Barretto JM, Cavanellas N. Artroplastia total do joelho em paciente com luxação permanente da patela. Relato de dois casos e revisão da literatura. Rev Bras Ortop 2018. [DOI: 10.1016/j.rbo.2017.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
8
|
Albuquerque RPE, Sousa Filho PGTD, Loures FB, Cobra H, Barretto JM, Cavanellas N. Total knee arthroplasty in patients with permanent patella dislocation. Report of two cases and literature review. Rev Bras Ortop 2018; 53:503-509. [PMID: 30027087 PMCID: PMC6051965 DOI: 10.1016/j.rboe.2018.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 03/16/2017] [Indexed: 11/30/2022] Open
Abstract
The occurrence of permanent patellar dislocation associated with severe osteoarthritis is considered rare and difficult to treat. Literature: The literature is quite controversial on the subject. The objective of the study is to report two rare cases of severe osteoarthritis with permanent dislocation of the patella that underwent total knee arthroplasty, in addition to a review of the literature on the subject and related surgical technique. Total knee arthroplasty with using the medial parapatellar approach associated with lateral release was a good surgical option in patients with permanent patellar dislocation associated with advanced osteoarthritis.
Collapse
Affiliation(s)
| | | | - Fabrício Bolpato Loures
- Centro de Cirurgia do Joelho, Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brazil
| | - Hugo Cobra
- Centro de Cirurgia do Joelho, Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brazil
| | - João Maurício Barretto
- Centro de Cirurgia do Joelho, Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brazil
| | - Naasson Cavanellas
- Centro de Cirurgia do Joelho, Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brazil
| |
Collapse
|
9
|
Figueroa D, Garín A, Figueroa F. Total knee replacement in patients with osteoarthritis and concomitant inveterate patellar dislocation. Arthroplast Today 2018; 5:68-72. [PMID: 31020026 PMCID: PMC6470316 DOI: 10.1016/j.artd.2018.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 04/18/2018] [Accepted: 04/24/2018] [Indexed: 12/05/2022] Open
Abstract
The inveterate patellar dislocation is an uncommon entity. The most frequent findings correspond to a misaligned valgus associated with lateral patellar dislocation. When severe knee osteoarthritis is present, total knee arthroplasty is an option, whether it is associated or not with realignment of the extensor apparatus. We present a review of published literature on correction of inveterate patellar dislocation associated with knee arthritis and our surgical technique with a case of inveterate patellar dislocation associated with tricompartmental knee osteoarthritis, in which a total knee arthroplasty was performed associated with proximal and distal realignment of the extensor apparatus. Total knee arthroplasty is a useful procedure in knee osteoarthritis associated with inveterate patellar dislocation, which can be associated with techniques on the extensor apparatus to achieve an adequate patellar alignment.
Collapse
Affiliation(s)
- David Figueroa
- Knee Unit, Department of Orthopaedic Surgery Clínica Alemana de Santiago, Facultad de Medicina, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - Alan Garín
- Orthopaedic Surgery Resident, Department of Orthopaedic Surgery Clinica Alemana de Santiago, Facultad de Medicina Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - Francisco Figueroa
- Knee Unit, Department of Orthopaedic Surgery Clínica Alemana de Santiago, Facultad de Medicina, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
| |
Collapse
|
10
|
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.
Collapse
Affiliation(s)
- Simon Donell
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, UK
| |
Collapse
|
11
|
Mobile Bearing Total Knee Arthroplasty for Valgus Knee Osteoarthritis with Permanent Patellar Dislocation: A Case Report and Review of the Literature. Case Rep Orthop 2017; 2017:1230412. [PMID: 28465849 PMCID: PMC5390651 DOI: 10.1155/2017/1230412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 03/15/2017] [Indexed: 11/17/2022] Open
Abstract
Permanent patellar dislocation with tibiofemoral joint osteoarthritis is a relatively rare condition. To treat this condition, total knee arthroplasty with proximal or distal realignment of the extensor mechanism has been reported. We report a challenging case of an 80-year-old woman diagnosed with permanent patellar dislocation with tibiofemoral joint osteoarthritis treated by a mobile bearing total knee arthroplasty utilizing navigation system. Lateral retinaculum release was performed to improve patellar tracking; other proximal or distal realignment of the extensor mechanism was not necessary. Postoperative radiographs show stable patellar tracking and recurrent patellar dislocation was not observed. This clinical case indicates that the implant's precise alignment and rotation during total knee arthroplasty could settle anatomical abnormalities of permanent patellar dislocation and the mobile bearing insert could contribute to stabilizing patellar tracking.
Collapse
|
12
|
Kumagai K, Kubo M, Maeda T, Araki S, Shioji S, Okumura N, Fujikawa H, Kawasaki T, Imai S, Matsusue Y. Total knee arthroplasty for treatment of osteoarthritis with prolonged patellar dislocation. Arthroplast Today 2016; 3:25-28. [PMID: 28378002 PMCID: PMC5365408 DOI: 10.1016/j.artd.2016.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 10/01/2016] [Accepted: 10/03/2016] [Indexed: 11/02/2022] Open
Abstract
Prolonged dislocation of the patella is a rare condition and is often related to severe osteoarthritis (OA) of the femorotibial (FT) joint. For this condition's treatment, numerous surgical techniques using total knee arthroplasty (TKA) have been published. To the best of our knowledge, this case report is the first description of the use of lateral release alone to treat recurrent patellar subluxation with TKA. An interesting point in this case is that the patient had a good recovery after TKA in spite of quite a long-term (a duration of almost 55 years) dislocation of her patella and development of secondary OA. We describe a case that we treated by TKA for FT-OA with a prolonged patellar dislocation. We were able to obtain good patellar reduction without additional surgery by performing adequate lateral release of the patellar retinaculum. This clinical case indicates the usefulness of lateral patellar retinaculum release for obtaining stable patellar tracking in TKA for FT-OA with remaining lateral patellar dislocation. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Collapse
Affiliation(s)
- Kosuke Kumagai
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan; Department of Musculoskeletal Biology, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Mitsuhiko Kubo
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Tsutomu Maeda
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Susumu Araki
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Suguru Shioji
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Noriaki Okumura
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Hitomi Fujikawa
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Taku Kawasaki
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Shinji Imai
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Yoshitaka Matsusue
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| |
Collapse
|
13
|
Junqueira JJM, Helito CP, Bonadio MB, Pécora JR, Demange MK. Total knee arthroplasty with subvastus approach in patient with chronic post-traumatic patellar dislocation. Rev Bras Ortop 2016; 51:614-618. [PMID: 27818987 PMCID: PMC5091017 DOI: 10.1016/j.rboe.2016.06.005] [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] [Received: 09/30/2015] [Accepted: 11/06/2015] [Indexed: 11/30/2022] Open
Abstract
Chronic lateral dislocation of the patella is a rare condition and acquired causes are usually secondary to knee trauma. The neglected chronic dislocation leads to progressive genu valgum and external tibial torsion deformities with subsequent gonarthrosis, which becomes painful and debilitating. There is no consensus regarding treatment of these patients, but total knee arthroplasty (TKA) is a useful therapy in cases of painful symptomatic gonarthrosis. Few reports have shown that subvastus approach and lateral release may be a valid option for TKA, since it allows the correction of valgus deformity and patellar tracking without interrupting vascular blood supply of patella. This article reports a case of TKA and extensor mechanism realignment without patellar resurfacing in a patient with genu valgum and chronic post-traumatic patellar dislocation with satisfactory results after two years of follow-up.
Collapse
Affiliation(s)
| | - Camilo Partezani Helito
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Ortopedia e Traumatologia, São Paulo, SP, Brazil
| | - Marcelo Batista Bonadio
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Ortopedia e Traumatologia, São Paulo, SP, Brazil
| | - Jose Ricardo Pécora
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Ortopedia e Traumatologia, São Paulo, SP, Brazil
| | - Marco Kawamura Demange
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Ortopedia e Traumatologia, São Paulo, SP, Brazil
| |
Collapse
|
14
|
Artroplastia total de joelho por via subvasto em paciente com luxação crônica pós‐traumática de patela. Rev Bras Ortop 2016. [DOI: 10.1016/j.rbo.2015.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
15
|
Baldini A, Castellani L, Traverso F, Balatri A, Balato G, Franceschini V. The difficult primary total knee arthroplasty: a review. Bone Joint J 2015; 97-B:30-9. [PMID: 26430084 DOI: 10.1302/0301-620x.97b10.36920] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Primary total knee arthroplasty (TKA) is a reliable procedure with reproducible long-term results. Nevertheless, there are conditions related to the type of patient or local conditions of the knee that can make it a difficult procedure. The most common scenarios that make it difficult are discussed in this review. These include patients with many previous operations and incisions, and those with severe coronal deformities, genu recurvatum, a stiff knee, extra-articular deformities and those who have previously undergone osteotomy around the knee and those with chronic dislocation of the patella. Each condition is analysed according to the characteristics of the patient, the pre-operative planning and the reported outcomes. When approaching the difficult primary TKA surgeons should use a systematic approach, which begins with the review of the existing literature for each specific clinical situation.
Collapse
Affiliation(s)
- A Baldini
- IFCA Institute, via del Pergolino 4, Florence 50139, Italy
| | - L Castellani
- IFCA Institute, via del Pergolino 4, Florence 50139, Italy
| | - F Traverso
- Humanitas Clinical and Research Center, via Manzoni 56 Rozzano, Milan, Italy
| | - A Balatri
- IFCA Institute, via del Pergolino 4, Florence 50139, Italy
| | - G Balato
- IFCA Institute, via del Pergolino 4, Florence 50139, Italy
| | - V Franceschini
- "Sapienza" University of Rome, via F. Faggiana 1668 Latina, Italy
| |
Collapse
|
16
|
Nishikawa M, Owaki H, Kaneshiro S, Fuji T, Shi K. Acquired permanent dislocation of the patella in a patient with rheumatoid genu valgum. J Clin Orthop Trauma 2015; 6:120-5. [PMID: 25983519 PMCID: PMC4411355 DOI: 10.1016/j.jcot.2015.01.094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 01/07/2015] [Indexed: 11/16/2022] Open
Abstract
A case of acquired permanent dislocation of the patella associated with severe genu valgum in a patient with rheumatoid arthritis (RA) is herein reported. The pain and genu valgum progressed because of poor RA control. The patient had no history of major trauma of the knee before or after the onset of RA. The most reasonable hypothesis to explain this patient's pathology is that occult patellar dislocation developed after a minor trauma and progressed to permanent dislocation; poor RA control then worsened both the patellar dislocation and genu valgum. Total knee arthroplasty (TKA) with patella reduction was successfully performed with release of the lateral retinaculum and extension of the extensor mechanism by partial snipping of the rectus femoris tendon. Two years after the operation, the patient exhibited improvement in her Knee Society Knee and Function Scores from preoperative scores of 18 and 20 to postoperative scores of 94 and 80, respectively. Acquired permanent dislocation of the patella associated with severe genu valgum in patients with RA is rare. Excellent results were obtained with TKA, and the proximal realignment method was a useful procedure for patella reduction.
Collapse
Affiliation(s)
- Masataka Nishikawa
- Department of Orthopaedic Surgery, Japan Community Healthcare Organization Osaka Hospital, 4-2-78 Fukushima, Fukushima-ku, Osaka City, Osaka 553-0003, Japan,Corresponding author. Tel.: +81 6 6441 5451; fax: +81 6 6445 8900.
| | - Hajime Owaki
- Department of Orthopaedic Surgery, Japan Community Healthcare Organization Osaka Hospital, 4-2-78 Fukushima, Fukushima-ku, Osaka City, Osaka 553-0003, Japan,Department of Rheumatology, Japan Community Healthcare Organization Osaka Hospital, 4-2-78 Fukushima, Fukushima-ku, Osaka City, Osaka 553-0003, Japan
| | - Shoichi Kaneshiro
- Department of Orthopaedic Surgery, Japan Community Healthcare Organization Osaka Hospital, 4-2-78 Fukushima, Fukushima-ku, Osaka City, Osaka 553-0003, Japan
| | - Takeshi Fuji
- Department of Orthopaedic Surgery, Japan Community Healthcare Organization Osaka Hospital, 4-2-78 Fukushima, Fukushima-ku, Osaka City, Osaka 553-0003, Japan
| | - Kenrin Shi
- Department of Orthopaedics, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka 565-0871, Japan
| |
Collapse
|
17
|
Yoshvin S, Southern EP, Wang Y. Surgical treatment of congenital patellar dislocation in skeletally mature patients: surgical technique and case series. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2015; 25:1081-6. [PMID: 25764002 DOI: 10.1007/s00590-015-1619-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 02/10/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Congenital patellar dislocation is a rarely encountered condition and is readily treated in childhood to prevent lasting disability, knee pain, decreased range of motion and ambulation problems. This condition is very rarely seen in skeletally mature patients, and the treatment of the condition represents a challenge to the orthopedic surgeon. SURGICAL TECHNIQUE AND METHODS Patients were treated with soft tissue reconstruction and tibial tubercle transfer with or without a prior medial close-wedge distal femoral osteotomy, depending on the degree of valgus deformity. We, then, searched the database of our orthopedics center for cases of congenital patellar dislocation in skeletally mature patients who were surgically treated. We collected a total of five knees and analyzed the cases according to the type of surgery performed and difference between pre- and postoperative functions. RESULTS Five knees with congenital patellar dislocation were treated. The mean age of the patients was 29.6 years, and mean follow-up time was 4.3 years. Mean preoperative range of motion was 65°, and it increased to a mean of 105.5° after surgical treatment. The mean preoperative Kujala score was 29.2 and increased to 67.2 after surgical treatment. DISCUSSION Congenital patellar dislocations that are allowed to proceed to adulthood are difficult to treat, and surgical treatment depends on the degree of deformity of the patella and of the knee joint. This study shows that surgical treatment is able to correct the deformity and provide better knee function.
Collapse
Affiliation(s)
- Sunnassee Yoshvin
- Department of Orthopedics, Building No.6, 8th floor, Shanghai Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai Institute of Orthopedics and Traumatology, 197, Ruijin Er Lu, Shanghai, People's Republic of China,
| | | | | |
Collapse
|
18
|
Oh KJ, Yoon JR, Yang JH. Total knee arthroplasty in a pseudoachondroplastic dwarfism patient with bilateral patellar dislocation. Knee 2013. [PMID: 23177661 DOI: 10.1016/j.knee.2012.10.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Late presentation of congenital patellar dislocation with advanced osteoarthritis is rare. This article presents a case of a 59-year-old man with underlying pseudoachondroplastic dwarfism. Advanced osteoarthritis due to bilateral neglected congenital patellar dislocation was treated with total knee arthroplasty without patella relocation surgery. Two years later, the patient had an improvement in Knee Society scores, painless function, and stability.
Collapse
Affiliation(s)
- Kwang-Jun Oh
- Department of Orthopedic Surgery, KonKuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | | | | |
Collapse
|
19
|
Purushothaman B, Agarwal A, Dawson M. Posttraumatic chronic patellar dislocation treated by distal femoral osteotomy and medial patellofemoral ligament reconstruction. Orthopedics 2012; 35:e1668-72. [PMID: 23127463 DOI: 10.3928/01477447-20121023-30] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Chronic patellar dislocation is a rare condition where the patella remains dislocated throughout knee range of motion during flexion and extension. In adults, the delayed presentation of this condition is often due to symptoms caused by the onset of severe secondary osteoarthritis. To the authors' knowledge, all of the cases reported in the literature have been treated by patellofemoral or total knee replacements depending on patient age and the extent of the arthritis. This article describes a rare case of a 22-year-old woman who sustained a traumatic chronic patellar dislocation for 5 months. Clinical examination revealed a valgus deformity of the left leg secondary to childhood injury and that the patella lay lateral to the lateral femoral condyle throughout flexion and extension. Radiographs of the knee revealed patellar dislocation. Long-leg radiographs of the left leg showed an anatomic tibiofemoral angle of 17° valgus. The anatomical (74°) and mechanical (80°) lateral distal femoral angles were abnormal, whereas the medial proximal tibial angle (87°) was normal, confirming that the valgus deformity was due to the abnormal distal femur. The authors performed a distal femoral osteotomy to correct the valgus deformity. Medial patellofemoral ligament reconstruction using a hamstring autograft was performed to stabilize the patella.
Collapse
Affiliation(s)
- Balaji Purushothaman
- Department of Trauma & Orthopaedics, Cumberland Infirmary, Carlisle, United Kingdom.
| | | | | |
Collapse
|
20
|
Rebolledo BJ, Nam D, Cross MB, Green DW, Sculco TP. Familial association of femoral trochlear dysplasia with recurrent bilateral patellar dislocation. Orthopedics 2012; 35:e574-9. [PMID: 22495863 DOI: 10.3928/01477447-20120327-30] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Femoral trochlear dysplasia is an anatomic deformity that predisposes patients to patellar instability, including patellar subluxation and dislocation, and can lead to severe patellofemoral joint degeneration if left untreated. Femoral trochlear dysplasia leading to recurrent bilateral patellar dislocation has rarely been reported as having a familial association. Orthopedic surgeons who encounter patients presenting with chronic patellar instability with no underlying disease or syndrome should be aware of the presence of femoral trochlear dysplasia leading to recurrent bilateral patellar dislocation. Although femoral trochlear dysplasia remains uncommon, the presence of bilateral recurrent patellar dislocation in multiple members of the same family is highly suggestive of genetic inheritance.This article describes 3 patients from 1 family who presented with femoral trochlear dysplasia leading to recurrent bilateral patellar dislocation. To our knowledge, this is the second article to describe a familial form of femoral trochlear dysplasia associated with recurrent bilateral patellar dislocation and is the first article in English. A lower threshold for screening and early intervention for symptomatic family members may be indicated to prevent the long-term effects of chronic patellar subluxation, dislocation, and patellofemoral arthritis.
Collapse
Affiliation(s)
- Brian J Rebolledo
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York 10021, USA.
| | | | | | | | | |
Collapse
|
21
|
Adult congenital permanent bilateral dislocation of the patella with full knee function: case report and literature review. Case Rep Med 2012; 2012:182795. [PMID: 22287971 PMCID: PMC3263588 DOI: 10.1155/2012/182795] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2011] [Accepted: 10/06/2011] [Indexed: 11/22/2022] Open
Abstract
Congenital permanent dislocation of the patella is a rare disorder of the knee joint in which the patella is permanently displaced, even in extension and is fixed on the lateral aspect of the femoral condyle. The dislocation is irreducible without surgical techniques. This rare condition is usually detected within the first decade of life, because of inability of active extension in the knee and impaired ability during walking. This report presents an unusual case of a 51-year-old man with bilateral congenital permanent dislocation of the patella. The pathology had never been treated because there were few symptoms. The patient presented with right knee pain caused by a fall on the knee during his work. The right knee was painful on the lateral side and the clinical signs were positive for pathology of the lateral meniscus, confirmed by MRI. The clinical and the imaging findings suggested a lesion of the lateral meniscus as the probable cause of the pain. Therefore we performed a knee arthroscopy, whose intra-operative findings confirmed the MRI findings. During the surgery we performed just a selective arthroscopic meniscectomy, without correcting patella dislocation, because the condition was unusually asymptomatic before the trauma.
Collapse
|
22
|
Noda M, Saegusa Y, Kashiwagi N, Seto Y. Surgical treatment for permanent dislocation of the patella in adults. Orthopedics 2011; 34:e948-51. [PMID: 22146216 DOI: 10.3928/01477447-20111021-27] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Permanent dislocation of the patella in adults is a rare condition that presents with complete irreducible lateral dislocation of the patella, combined with secondary changes, such as valgus deformity and leg-length discrepancy. Because these secondary changes cannot heal spontaneously after skeletal maturation if left untreated, the patients frequently possess pathology not limited to the knee joint and extending to the whole lower extremity, such as malalignment or leg-length discrepancy, that can develop into osteoarthritis of the knee. However, to our knowledge, few surgeons advocate the significance of correcting the malalignment in treating adult patients. We treated a 34-year-old woman with permanent dislocation of the patella in a 2-stage surgery, consisting of first-stage correction of valgus deformity and limb shortening using a Ilizarov external fixator and second-stage realignment of the dislocated patella over the trochlea. A follow-up examination conducted 3 years after the second operation revealed plantigrade gait with normal alignment of the lower extremity without limping and medial thrust. The patella was tracking centrally in the patellofemoral groove. Radiographs showed a neutral mechanical axis of the lower extremity, no evidence of patellar subluxation, and no deteriorating osteoarthritic changes at the tibiofemoral joint. This case highlights the importance of correcting secondary changes, such as valgus deformity and leg-length discrepancy, to reduce the risk of future osteoarthrosis and postoperative dislocation, especially when these deformities are substantial.
Collapse
Affiliation(s)
- Mitsuaki Noda
- Konan Hospital, Kobe, and Drs Kashiwagi and Seto are from SKY Orthopedic Clinic, Osaka, Japan.
| | | | | | | |
Collapse
|
23
|
Dao Q, Chen DB, Scott RD. Proximal patellar quadricepsplasty realignment during total knee arthroplasty for irreducible congenital dislocation of the patella: a report of two cases. J Bone Joint Surg Am 2010; 92:2457-61. [PMID: 20962197 DOI: 10.2106/jbjs.h.00812] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Quang Dao
- Brigham and Women’s Hospital, Boston, Massachusetts, USA.
| | | | | |
Collapse
|
24
|
Tunay S, Ozkan H, Köse O, Atik A, Basbozkurt M. Total knee arthroplasty in a patient with neglected congenital patellar dislocation. Orthopedics 2009; 32:orthopedics.43777. [PMID: 19824599 DOI: 10.3928/01477447-20090818-22] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Late presentation of congenital patellar dislocation with advanced osteoarthritis is rare. This article presents a case of 56-year-old woman with advanced osteoarthritis due to right neglected congenital patellar dislocation treated with total knee arthroplasty (TKA) with release of the lateral retinaculum and proximal extensor mechanism realignment. One year later, the patient had improvement of her Knee Society scores and painless function, stability, and better extensor strength. A literature search revealed a limited number of similar cases in which congenital patellar dislocation was treated with TKA. Total knee arthroplasty provides a valid treatment option for adults with congenital patellar dislocation who have absence of the femoral sulcus and associated osteoarthritis. Total knee arthroplasty has the ability to correct the pathologies seen with congenital patellar dislocation, eg, external tibial rotation, absence of femoral groove, and patellar hypoplasia. Realignment of extensor mechanism restores quadriceps strength, normal knee biomechanics, and may prevent complications such as dislocation.
Collapse
Affiliation(s)
- Servet Tunay
- Department of Orthopedics and Traumatology, Gulhane Military Medical Academy, Ankara, Turkey
| | | | | | | | | |
Collapse
|
25
|
In Y, Kong CG, Sur YJ, Choi SS. TKA using the subvastus approach and lateral retinacular release in patients with permanent post-traumatic patellar dislocation: a report of two cases. Knee Surg Sports Traumatol Arthrosc 2009; 17:254-9. [PMID: 19039576 DOI: 10.1007/s00167-008-0676-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2008] [Accepted: 11/07/2008] [Indexed: 10/21/2022]
Abstract
Permanent post-traumatic patellar dislocation is a rare condition, and total knee arthroplasty (TKA) can be performed for osteoarthritic knees with this condition. There have been only a few reports about using the standard medial parapatellar approach and extensive lateral release or extensor mechanism realignment for patients with permanent post-traumatic patellar dislocation. We performed two TKAs with using a subvastus approach and lateral release for osteoarthritic knees with permanent post-traumatic patellar dislocation. The patients were well satisfied with their results. The patellae tracked very well in the femoral trochlear groove throughout the full range of motion after the operations. Bone scans were done 1 year postoperatively on both patients, and the scans showed normal vascularity for the patella.
Collapse
Affiliation(s)
- Yong In
- Department of Orthopaedic Surgery, Uijongbu St. Mary's Hospital, The Catholic University of Korea, 65-1 Kumoh-Dong, Uijongbu-Si, Kyonggi-Do 480-130, South Korea.
| | | | | | | |
Collapse
|
26
|
Hau RCY, Newman JH. Knee replacement for osteoarthritis secondary to chronic patellar dislocation and trochlear dysplasia. Knee 2008; 15:447-50. [PMID: 18692396 DOI: 10.1016/j.knee.2008.06.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2006] [Revised: 04/28/2008] [Accepted: 06/24/2008] [Indexed: 02/02/2023]
Abstract
Fifteen knees in patients suffering from symptomatic osteoarthritis secondary to chronically dislocated extensor mechanisms have been treated by knee replacement. Five knees had permanently dislocated patellae while 10 knees (four of which had undergone patellectomies) had dislocations of the extensor mechanisms with knee flexion. In fourteen instances satisfactory realignment of the extensor mechanism was obtained. In twelve knees, a substantial functional improvement was achieved. Two knees had persistent pain and one had unexpected tibio-femoral instability.
Collapse
|
27
|
Kumagi M, Ikeda S, Uchida K, Ono T, Tsumara H. Total knee replacement for osteoarthritis of the knee with congenital dislocation of the patella. ACTA ACUST UNITED AC 2007; 89:1522-4. [DOI: 10.1302/0301-620x.89b11.19598] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We carried out three total knee replacements with proximal realignment in two patients with severe osteoarthritis of the knee and congenital dislocation of the patella. During the operation, the femur and the tibia were cut according to the recommendations of the manufacturer of the implant. The femoral component was placed in external rotation and the centre of the tibial component aligned in relation to the tibial tuberosity with regard to rotation and translation. After making the bone cuts, the iliotibial tract was detached from Gerdy’s tubercle, the popliteus tendon divided, and the biceps femoris tendon elongated by Z-plasty. After the trial implants were positioned, a proximal re-alignment procedure was performed. One knee had deep infection. There was one dislocated patella which was repositioned, and walking ability was improved in all knees. We believe that the rotational alignment of a prosthesis is as important as the soft-tissue surgery.
Collapse
Affiliation(s)
- M. Kumagi
- Oita University, 1-1 Idaigaoka, Hasamamachi Yufushi, Oita 879-5593, Japan
| | - S. Ikeda
- Oita University, 1-1 Idaigaoka, Hasamamachi Yufushi, Oita 879-5593, Japan
| | - K. Uchida
- Oita University, 1-1 Idaigaoka, Hasamamachi Yufushi, Oita 879-5593, Japan
| | - T. Ono
- Oita University, 1-1 Idaigaoka, Hasamamachi Yufushi, Oita 879-5593, Japan
| | - H. Tsumara
- Oita University, 1-1 Idaigaoka, Hasamamachi Yufushi, Oita 879-5593, Japan
| |
Collapse
|
28
|
Yoshino N, Watanabe N, Kobayashi M, Fukuda Y, Tanaka C, Takai S. Permanent patellar dislocation due to malunion of supracondylar fracture after total knee arthroplasty. J Orthop Sci 2006; 11:521-3. [PMID: 17013742 DOI: 10.1007/s00776-006-1054-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2005] [Accepted: 06/07/2006] [Indexed: 10/24/2022]
Affiliation(s)
- Nobuyuki Yoshino
- Department of Orthopaedic Surgery, Kyoto Kujo Hospital, 10 Karahashi Rajomoncho, Minami-ku, Kyoto, 601-8453, Japan
| | | | | | | | | | | |
Collapse
|
29
|
Watanabe N, Kubo Y, Yoshino N, Mizutani S, Kubo T. Permanent patellar dislocation and osteoarthritis of the knee after femoral fracture in childhood. A case report. Knee 2006; 13:61-5. [PMID: 16309910 DOI: 10.1016/j.knee.2005.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2005] [Revised: 08/22/2005] [Accepted: 09/12/2005] [Indexed: 02/02/2023]
Abstract
A 52 year-old woman suffered bilateral femoral shaft fractures when she was 5 years old and they were treated surgically. She had been able to walk without pain and giving way throughout her young and adult life, however, when she came to us with a 1-year history of the right knee pain, she could walk only 10 m continuously. The right knee revealed valgus deformity with complete lateral patellar dislocation. The femoro-tibial angle was 154 degrees and arthritic change was seen in the femorotibial joint. Surfaces of both the patella and the femur were degraded. Twenty-two degrees of rotational deformity was also found internally in the involved side. Varus osteotomy with external rotation of the distal fragment and lateral retinacular release combined with reefing of vastus medialis muscle were performed. Twenty-four months after surgery, knee score and functional score were, respectively, 85/100 and 71/100, using knee society clinical rating system and there was no pain associating patella incongruity.
Collapse
Affiliation(s)
- Nobuyoshi Watanabe
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, 602-8566 Kyoto, Japan.
| | | | | | | | | |
Collapse
|
30
|
Gunes T, Sen C, Erdem M. Knee arthrodesis using circular external fixator in the treatment of infected knee prosthesis: case report. Knee Surg Sports Traumatol Arthrosc 2005; 13:329-34. [PMID: 15164165 DOI: 10.1007/s00167-004-0528-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2003] [Accepted: 03/16/2004] [Indexed: 10/26/2022]
Abstract
A patient (68 years old and male) underwent total knee replacement because of arthrosis, but he subsequently had infection due to a wound problem. Although he underwent early debridement, antibiotherapy, and soft-tissue operation, treatment failed because of improper soft-tissue coverage and progression of the infection. Therefore, the prosthesis was removed and a spacer with antibiotic was placed, in order to provide soft-tissue coverage and to eradicate infection. After 2 months, the patient underwent knee arthrodesis using a circular external fixator to achieve a stable lower extremity and to facilitate return to activities of daily living. We obtained knee fusion at 4 months without any requirement for secondary procedure of soft tissue and bone graft. There was no major complication. Arthrodesis with circular external fixator is a reliable and successive method that should be preferred for the treatment of infected knee replacement.
Collapse
Affiliation(s)
- Taner Gunes
- Ortopedi ve Travmatoloji Anabilim Dali, Gaziosmanpasa Universitesi Tip Fakultesi Dekanligi, 60100, Tokat, Turkey.
| | | | | |
Collapse
|
31
|
Hudson J, Reddy VRM, Krikler SJ. Total knee arthroplasty for neglected permanent post-traumatic patellar dislocation--case report. Knee 2003; 10:207-12. [PMID: 12788009 DOI: 10.1016/s0968-0160(02)00144-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Permanent post-traumatic patellar dislocation is a rare entity resulting from recurrent trauma. This uncommon condition is often confused clinically with congenital dislocation of the patella. Treatment options, although not well defined, include observation, various soft tissue and bony procedures for realigning the patella and patellectomy. To our knowledge, this is the first case reporting the use of conventional non-constrained total knee arthroplasty with patellar resurfacing and soft tissue realignment procedure for long-standing patellar dislocation in a single stage. An interesting feature of this case was the patient's ability to function reasonably well for nearly 40 years with a dislocated patella until the development of secondary osteoarthritis, and the surprisingly good recovery after total knee replacement.
Collapse
Affiliation(s)
- J Hudson
- University Hospitals, Coventry and Warwickshire NHS Trust, Coventry CV1 4FH, UK
| | | | | |
Collapse
|
32
|
Abstract
John N. Insall was a pioneer in the field of knee surgery. He was a rare individual who accomplished unparalleled levels of success as a surgeon, designer, and teacher. During the past 4 decades, he was instrumental in evolving total knee arthroplasty to its current state of excellence. Insall's impact on orthopaedics is felt by all who have come in contact with him.
Collapse
Affiliation(s)
- G R Scuderi
- The Insall Scott Kelly Institute for Orthopaedics and Sports Medicine, New York, NY 10128, USA
| | | | | |
Collapse
|