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Zygogiannis K, Koulalis D, Kalatzis D, Thivaios GC. Periprosthetic Transpatellar Fracture Replacement With Autogenous Iliac Graft: A Technical Note. Cureus 2024; 16:e64394. [PMID: 39130897 PMCID: PMC11317029 DOI: 10.7759/cureus.64394] [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: 07/12/2024] [Indexed: 08/13/2024] Open
Abstract
Periprosthetic fractures involving total knee arthroplasty (TKA) components, particularly involving the patella, can present a significant challenge regarding orthopedic surgery. This technical note outlines an approach for the reconstruction of complicated periprosthetic transpatellar fractures, with poor bone stock, utilizing autogenous iliac graft. This kind of procedure requires careful preoperative evaluation of imaging, precise intraoperative planning, and strict postoperative management to achieve adequate postoperative results. The inventive option of utilizing an autogenous iliac graft for reconstruction suggests its potential benefits in addressing the unique biomechanical demands of patellar fractures in TKA patients with poor bone stock. Key technical aspects of this approach are highlighted and include graft harvest, graft preparation, and fixation techniques. Overall, this technique can provide a golden standard bailout for periprosthetic transpatellar fracture reconstruction and potentially offer orthopedic surgeons a comprehensive framework for addressing this challenging clinical scenario.
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Affiliation(s)
| | | | - Dimitrios Kalatzis
- Orthopedics and Traumatology, Laiko General Hospital of Athens, Athens, GRC
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Andronic O, Suravaram V, Lu V, Wall SJ, Bucher TA, Prosser GH, Yates PJ, Jones CW. What are the Outcomes of Secondary Patella Resurfacing for Dissatisfaction Following Primary Knee Arthroplasty? A Systematic Review and Meta-Analysis of 604 Knees. J Arthroplasty 2024; 39:1093-1107.e1. [PMID: 37871862 DOI: 10.1016/j.arth.2023.10.027] [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: 08/03/2023] [Revised: 10/07/2023] [Accepted: 10/14/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Secondary patella resurfacing is often performed for dissatisfaction following primary knee arthroplasty where the native patella was retained. The purpose of this meta-analysis was to evaluate outcomes of secondary patella resurfacing. METHODS The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies reporting on patients who underwent secondary patella resurfacing after previous primary knee arthroplasty with retention of the native patella were considered eligible. The risk of bias was assessed using the Methodological Index for Non-Randomized studies tool. A random-effects model and the inverse-variance weighting method was used for meta-analysis. There were sixteen retrospective studies including 604 knees (594 patients) with a mean follow up of 42 months (range, 2 to 197). RESULTS An overall improvement in patient-reported outcomes (PROMs) was achieved in 53% of cases from pooled data available for 293 knees [95% Confidence Interval (CI) (0.44, 0.62), I2=68% - moderate heterogeneity]. The pooled proportion of patients satisfied with the procedure was 59% [95% CI (48, 68), I2 = 70% - moderate heterogeneity] in a sample size of 415. There was a minimal rate (2%) of complication incidence when performing secondary patella resurfacing and a pooled rate of revision surgery of 10%. CONCLUSIONS An improvement in pain, satisfaction, and PROMs was achieved in slightly more than half of the patients following secondary patella resurfacing. However, studies lacked standardized objective selection criteria for the procedure and the available data was predominantly retrospective, with high heterogeneity and variation in outcome reporting.
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Affiliation(s)
- Octavian Andronic
- The Orthopaedic Research Foundation of Western Australia (ORFWA), Perth, Australia; Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Vishwa Suravaram
- Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Perth, Australia
| | - Victor Lu
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Simon J Wall
- The Orthopaedic Research Foundation of Western Australia (ORFWA), Perth, Australia
| | - Thomas A Bucher
- The Orthopaedic Research Foundation of Western Australia (ORFWA), Perth, Australia
| | - Gareth H Prosser
- The Orthopaedic Research Foundation of Western Australia (ORFWA), Perth, Australia
| | - Piers J Yates
- The Orthopaedic Research Foundation of Western Australia (ORFWA), Perth, Australia
| | - Christopher W Jones
- The Orthopaedic Research Foundation of Western Australia (ORFWA), Perth, Australia; Curtin University, Perth, Australia
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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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Sobhi S, Finsterwald MA, Häckel S, Holzer LA, Yates PJ. Medialized Dome and Anatomic Onlay Patella Designs in the Modern Posterior Stabilized Rotating Platform Total Knee Arthroplasty Demonstrate No Clinical or Radiological Differences at One Year. J Arthroplasty 2024; 39:87-95. [PMID: 37321517 DOI: 10.1016/j.arth.2023.06.005] [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: 03/24/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND A successful outcome after total knee arthroplasty (TKA) includes the restoration of patellofemoral function. Modern patella component designs in TKA include a medialized dome and more recently, an anatomic design. There is a paucity of literature comparing these 2 implants. METHODS This prospective nonrandomized study examined 544 consecutive TKAs with patella resurfacing using a posterior-stabilized, rotating platform knee prothesis performed by a single surgeon. A medialized dome patella design was used in the first 323 cases and an anatomic design in the subsequent 221 cases. Patients were assessed preoperatively, at 4 weeks and 1-year post-TKA for Oxford Knee Score (OKS) (total, pain, and kneeling components) and range of movement (ROM). Radiolucent lines (RLLs), patellar tilts and displacements, as well as reoperations were assessed at 1-year post-TKA. RESULTS At 1-year post-TKA, both groups demonstrated similar improvements in ROM, OKS, pain, and kneeling scores, and had a similar incidence of fixed-flexion deformity (all P > .05). Radiographically, there was no clinically significant difference in the incidence of RLLs, patellar tilts, and displacements. The prevalence of reoperations (1.8 versus 3.2%, P = .526) was similar between the designs with no patella-related complications. CONCLUSION Both medialized dome and anatomic patella designs result in improved ROM and OKS with no patella-related complications. However, our study showed no differences between the designs at 1 year.
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Affiliation(s)
- Salar Sobhi
- Orthopaedic Research Foundation of Western Australia, Perth, Western Australia, Australia; Department of Orthopaedic Surgery, Fiona Stanley Fremantle Hospitals Group, Murdoch, Western Australia, Australia
| | - Michael A Finsterwald
- Orthopaedic Research Foundation of Western Australia, Perth, Western Australia, Australia; Department of Orthopaedic Surgery, Fiona Stanley Fremantle Hospitals Group, Murdoch, Western Australia, Australia
| | - Sonja Häckel
- Orthopaedic Research Foundation of Western Australia, Perth, Western Australia, Australia; Department of Orthopaedic Surgery, Fiona Stanley Fremantle Hospitals Group, Murdoch, Western Australia, Australia
| | - Lukas A Holzer
- Orthopaedic Research Foundation of Western Australia, Perth, Western Australia, Australia; Department of Orthopaedic Surgery, Fiona Stanley Fremantle Hospitals Group, Murdoch, Western Australia, Australia
| | - Piers J Yates
- Orthopaedic Research Foundation of Western Australia, Perth, Western Australia, Australia; Department of Orthopaedic Surgery, Fiona Stanley Fremantle Hospitals Group, Murdoch, Western Australia, Australia; School of Surgery (Orthopaedics), University of Western Australia, Perth, Western Australia, Australia; Department of Orthopaedic Surgery, St John of God Hospital, Murdoch, Perth, Western Australia, Australia
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Mirapurkar TS, Boob MA, Bhoge SS, Phansopkar P. A Comprehensive Physiotherapeutic Rehabilitation Protocol for Malunited Post-operative Patellar Fractures: A Case Report. Cureus 2023; 15:e51252. [PMID: 38283525 PMCID: PMC10822036 DOI: 10.7759/cureus.51252] [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] [Received: 11/09/2023] [Accepted: 12/28/2023] [Indexed: 01/30/2024] Open
Abstract
A patellar fracture is a fracture of the kneecap. The patella is a shield that plays a vital function in the biomechanics of the knee joint. Traumatic knee injuries produced by direct trauma or quick quadriceps contraction with the knee bent can result in the loss of the extensor mechanism. A 69-year-old female patient presented with pain in her right knee following a slip at her home, which resulted in an injury to her knee. Subsequently, a radiological investigation suggests a patellar fracture. The purpose of this case report is to investigate the rehabilitation techniques and concrete the result. This report emphasizes the value of a comprehensive rehabilitation program designed to assist people with this type of fracture pattern in reaching their peak operational capacity. The patient underwent a comprehensive rehabilitation regimen that included cryotherapy, range of motion exercises, strengthening exercises, gait training, balance and proprioception training. The functional outcomes were assessed using a visual analogue scale, goniometry, manual muscle testing, Berg balance scale and lower extremity functional scale. The patient exhibited significant improvement and a positive response to the therapeutic techniques and outcome assessments. This underscores the necessity for a well-rounded treatment approach to manage patellar fractures and optimize patient outcomes effectively.
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Affiliation(s)
- Tanvi S Mirapurkar
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Manali A Boob
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shruti S Bhoge
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pratik Phansopkar
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Masoni V, Giustra F, Bosco F, Lo Carmine L, Capella M, Cacciola G, Risitano S, Sabatini L, Massè A. Periprosthetic patella fractures in total knee replacement and revision surgeries: how to diagnose and treat this rare but potentially devastating complication-a review of the current literature. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:2765-2772. [PMID: 37000239 PMCID: PMC10504128 DOI: 10.1007/s00590-023-03535-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/20/2023] [Indexed: 04/01/2023]
Abstract
PURPOSE Periprosthetic patella fractures (PPPFs) are infrequent but potentially devastating complications after total knee arthroplasty (TKA) and revision TKA (rTKA). These fractures may occur both in resurfaced and un-resurfaced patella. This review summarizes the current literature on PPPFs to help orthopedic surgeons diagnose and treat this uncommon but extremely challenging TKA complication. METHODS A comprehensive search was performed in three databases: PubMed, SCOPUS, and EMBASE. All relevant information was retrieved and summarized in this narrative review. RESULTS In the studies analyzed, there is a general trend in favor of nonsurgical treatment, except for implant loosening or extensor lag with extensor apparatus disruption, because surgery is often associated with poor clinical outcomes and high complication rates. CONCLUSION PPPF is a rare but catastrophic event in TKA and rTKA, occurring mainly in a reconstructed patella. Patient-, implant-, and surgical technique-related factors contribute to its multifactorial etiopathogenesis. Prevention plays a crucial role in reducing the PPPFs rate. Conservative management is the treatment of choice due to high surgery complication rates unless implant loosening, or extensor apparatus disruption occurs.
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Affiliation(s)
- Virginia Masoni
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
| | - Fortunato Giustra
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
- Department of Orthopaedics and Traumatology, Ospedale San Giovanni Bosco di Torino - ASL Città di Torino, Turin, Italy
| | - Francesco Bosco
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy.
- Department of Orthopaedics and Traumatology, Ospedale San Giovanni Bosco di Torino - ASL Città di Torino, Turin, Italy.
| | - Lorenzo Lo Carmine
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
| | - Marcello Capella
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
| | - Giorgio Cacciola
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
- Istituto Ortopedico del Mezzogiorno d'Italia "Franco Scalabrino", Via Consolare Pompea, 98100, Messina, Italy
| | - Salvatore Risitano
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
| | - Luigi Sabatini
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
| | - Alessandro Massè
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
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Perna A, Mancino F, Campana V, Satta P, Marcialis V, Glorioso D, Monterossi M, Proietti L, De Santis V. Is it time to resume elective knee arthroplasty surgery? A multidisciplinary experience in a Sardinian center during the SARS-CoV-2 pandemic. Orthop Rev (Pavia) 2022; 14:33768. [PMID: 35774931 PMCID: PMC9239359 DOI: 10.52965/001c.33768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 10/24/2021] [Indexed: 09/19/2023] Open
Abstract
Background Starting in January 2020, the SARS-CoV-2 pandemic caused changes in the nation's health systems. The hospital's reorganization led to a near-total stop of non-urgent, elective surgeries across all specialties, including hip and knee arthroplasty. However, in May 2020, a gradual elective surgery restarting was possible. Considering the risk of COVID-19 infections, the European Knee Associates suggest the need to implement specific protocols for a safe return to orthopaedic elective surgery. Methods A retrospective analysis regarding all patients who underwent primary knee arthroplasty (TKA) between March 1st and October 1st, 2020 using an institutional database was performed. The study time was divided into 2 periods: Pandemic (from March 2020 to May 2020), Post Pandemic (from June 2020 to October 2020). A specific protocol was designed to safeguard the health of patients and healthcare workers during the SARS-CoV-2 pandemic. Results A total of 147 patients underwent total knee replacement surgery in the analyzed period. The mean surgical time was 77.6 (+/-18.9). The intraoperative mean blood loss was 54 (+/-28) ml. The mean hospital stay was 3-4 days. Among the treated patients no case of COVID-19 infection was observed. Conclusion The use of our protocol, developed ad hoc for the management of elective orthopedic patients, allowed the restart of elective orthopedic surgery in a safe and reproducible way with an average increase of 374% on surgical activity between the pandemic and post-pandemic periods without record cases of contagion among the treated patients.
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Affiliation(s)
- Andrea Perna
- Department of Geriatrics, Neurosciences and Orthopaedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS
| | - Fabio Mancino
- Department of Geriatrics, Neurosciences and Orthopaedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS
| | | | - Paolo Satta
- Department of Orthopaedics, Mater Olbia Hospital
| | | | - Davide Glorioso
- Department of Geriatrics, Neurosciences and Orthopaedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS
| | - Martina Monterossi
- Department of Anaesthesiology, Intensive Care Medicine and Toxicology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS
| | - Luca Proietti
- Department of Geriatrics, Neurosciences and Orthopaedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS
| | - Vincenzo De Santis
- Department of Orthopaedics and Traumatology, Università Cattolica del Sacro Cuore
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