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Sculco PK, Flevas DA, Jerabek SA, Jiranek WA, Bostrom MP, Haddad FS, Fehring TK, Gonzalez Della Valle A, Berry DJ, Brenneis M, Bornes TD, Rojas Marcos CE, Wright TM, Sculco TP. Management of Bone Loss in Revision Total Knee Arthroplasty: An International Consensus Symposium. HSS J 2024; 20:141-181. [PMID: 39281983 PMCID: PMC11393633 DOI: 10.1177/15563316231202750] [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: 06/09/2023] [Accepted: 06/20/2023] [Indexed: 09/18/2024]
Abstract
The evaluation, classification, and treatment of significant bone loss after total knee arthroplasty (TKA) continue to be a complex and debated topic in revision TKA (rTKA). Despite the introduction of new evidence and innovative technologies aimed at addressing the approach and care of severe bone loss in rTKA, there is no single document that systematically incorporates these newer surgical approaches. Therefore, a comprehensive review of the treatment of severe bone loss in rTKA is necessary. The Stavros Niarchos Foundation Complex Joint Reconstruction Center Hospital for Special Surgery, dedicated to clinical care and research primarily in revision hip and knee replacement, convened a Management of Bone Loss in Revision TKA symposium on June 24, 2022. At this meeting, the 42 international invited experts were divided into groups; each group was assigned to discuss questions related to 1 of the 4 topics: (1) assessing preoperative workup and imaging, anticipated bone loss, classification system, and implant surveillance; (2) achieving durable fixation in the setting of significant bone loss in revision TKA; (3) managing patellar bone loss and the extensor mechanism in cases of severe bone loss; and (4) considering the use of complex modular replacement systems: hinges, distal femoral, and proximal tibial replacements. Each group came to consensus, when possible, based on an extensive literature review and interactive discussion on their group topic. This document reviews each these 4 areas, the consensus of each group, and directions for future research.
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Affiliation(s)
- Peter Keyes Sculco
- Hospital for Special Surgery, New York, NY, USA
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA
| | - Dimitrios A Flevas
- Hospital for Special Surgery, New York, NY, USA
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA
| | | | - William A Jiranek
- Department of Orthopaedics, Duke University Medical Center, Durham, NC, USA
| | | | - Fares S Haddad
- University College London Hospitals NHS Foundation Trust, London, UK
- The Bone & Joint Journal, London, UK
| | - Thomas K Fehring
- Hip & Knee Center, OrthoCarolina, Charlotte, NC, USA
- Musculoskeletal Institute, Atrium Health, Charlotte, NC, USA
| | | | - Daniel J Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Marco Brenneis
- Hospital for Special Surgery, New York, NY, USA
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA
| | - Troy D Bornes
- Hospital for Special Surgery, New York, NY, USA
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA
| | - Carolena E Rojas Marcos
- Hospital for Special Surgery, New York, NY, USA
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA
| | | | - Thomas P Sculco
- Hospital for Special Surgery, New York, NY, USA
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA
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McDonald LK, Kurmis AP. Patellar button compatibility in the conversion of Patellofemoral Arthroplasty to a Total Knee Arthroplasty: A review of the contemporary literature. J Orthop Surg (Hong Kong) 2022; 30:10225536221084147. [PMID: 35282735 DOI: 10.1177/10225536221084147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Compared to total knee arthroplasty (TKA), patellofemoral arthroplasty (PFA) is a far less commonly performed operation. However, in carefully selected cohorts, PFA continues to be an appropriate treatment option for end-stage isolated patellofemoral joint osteoarthritis. In the later situation whereby a PFA is considered for conversion to a TKA - often due to disease progression - uncertainty remains regarding optimal management of the in situ patellar button. This review of the contemporary literature aimed to provide a summary of the current evidence to support surgeon decision-making, by evaluating the compatibility, efficacy, and survivorship of retained versus revised patellar buttons in PFA-to-TKA conversion. Specific focus was paid to implant design and technical considerations during revision, plus post-operative patient-reported outcomes and modes of secondary patellar component failure. METHODS A review of the Embase, Cochrane and PubMed databases was performed following PRISMA search principles. RESULTS This investigation highlights that the fate of patellar buttons in PFA-to-TKA conversion has previously been poorly studied, with scant publication data available. Most reports have been of singular cases or small cohort series. Larger formal RCTs and level 1 evidence are lacking. CONCLUSION The findings herein suggest that surgeons can confidently retain well-fixed, undamaged, dome-shaped all-polyethylene patellar buttons in the conversion of a PFA to TKA with the expectation of acceptable mid-term performance and survivorship, as long as congruent tracking with the new tibiofemoral components is achieved. This result is likely translatable to the majority of contemporary, all-polyethylene, dome-shaped patellar buttons, even with manufacturer mismatch.
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Affiliation(s)
| | - Andrew P Kurmis
- College of Medicine & Public Health, 1065Flinders University, Bedford Park, SA, Australia.,Discipline of Medical Specialties, University of Adelaide, Adelaide, SA, Australia
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Hines JT, Lewallen DG, Perry KI, Taunton MJ, Pagnano MW, Abdel MP. Biconvex Patellar Components: 96% Durability at 10 Years in 262 Revision Total Knee Arthroplasties. J Bone Joint Surg Am 2021; 103:1220-1228. [PMID: 33760782 DOI: 10.2106/jbjs.20.01064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The optimal strategy to address osseous deficiencies of the patella during revision total knee arthroplasty (TKA) remains controversial. One possible solution is a cemented biconvex patellar component used such that the non-articular convexity both improves fixation and makes up for bone loss. The aim of this study was to determine the outcomes of the use of biconvex patellar components in a large series of revision TKAs. METHODS From 1996 to 2014, 262 revision TKAs were performed at a single institution using a biconvex patellar component. Implant survivorship, clinical and radiographic results, and complications were assessed. The mean patient age at the TKA revision was 69 years, and 53% of the patients were female. The mean follow-up was 7 years. RESULTS The 10-year survivorship free of revision of the biconvex patellar component due to aseptic loosening was 96%. The 10-year survivorship free of any revision of the biconvex patellar component was 87%. The 10-year survivorship free of any rerevision and free of any reoperation was 75% and 70%, respectively. The mean Knee Society Score (KSS) improved from 45.4 before the index revision to 67.7 after it. The mean residual composite thickness seen on the most recent radiographs was 18.1 mm. In addition to the complications leading to revision, the most common complications were periprosthetic patellar fracture (6%), of which 3 required revision; superficial wound infection (6%) requiring antibiotic therapy only or irrigation and debridement; and arthrofibrosis (3%). CONCLUSIONS In this cohort of 262 revision TKAs, biconvex patellar components used to treat marked patellar bone loss demonstrated excellent durability with a 10-year survivorship free of patellar rerevision due to aseptic loosening of 96%. The biconvex patellar components were reliable as evidenced by substantial improvements in clinical outcomes scores and a low risk of complications. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jeremy T Hines
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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Shield WP, Greenwell PH, Chapman DM, Dalury DF. Ignore the Patella in Revision Total Knee Surgery: A Minimum 5-Year Follow-Up With Patella Component Retention. J Arthroplasty 2019; 34:S262-S265. [PMID: 30979670 DOI: 10.1016/j.arth.2019.03.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 03/05/2019] [Accepted: 03/07/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND In the setting of aseptic revision, a common question is: what should be done with the previously resurfaced patella? We report on a series of aseptic revision total knee arthroplasties (RTKA) where one or both components were revised and the patella was not. METHODS The study group was 147 consecutive RTKA in 137 patients with a mean age of 70.1 ± 9.3 years where the patella was not revised. The average body mass index was 31.0 ± 5.4 kg/m2. Follow-up was a minimum of 5 years (range, 5 to 12 years). At final follow-up, 13 patients died and 2 patients were lost to follow-up leaving 122 patients and 130 knees available for review. Mean time from primary surgery to RTKA was 9.2 ± 5.5 years. Both components were revised in 50 knees, the femur only in 11 knees, the tibia only in 12 knees, and 57 had an isolated polyethylene revision. We found 5 patients with a mismatch between the patella and femoral components and 30 cases with patella component wear identified intraoperatively. RESULTS At final follow-up, there were no reoperations on any patella and none were at risk of failure. There were 6 knees with a lateral patella tilt beyond 10°, but none were subluxed. Knee Society Scores averaged 85 ± 17.2 points at final follow-up. CONCLUSION At midterm follow-up in this group of RTKA where the patella was not revised, we identified no subsequent failures of the patella. This is despite the presence of mild patella polyethylene wear and mismatched shapes in several knees. LEVEL OF EVIDENCE III.
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Affiliation(s)
| | | | | | - David F Dalury
- The University of Maryland St. Joseph Medical Center, Towson, MD
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5
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Lewis PL, Gamboa AE, Campbell DG, Lorimer M. Outcome of prosthesis matched and unmatched patella components in primary and revision total knee replacement. Knee 2017; 24:1227-1232. [PMID: 28793979 DOI: 10.1016/j.knee.2017.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 05/26/2017] [Accepted: 07/09/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Although knee replacements have specifically designed patella prostheses that correspond to the geometry of their femoral components, a patella prosthesis that is unmatched to the femoral component may occasionally be inserted. In revision total knee arthroplasty (TKA), an originally resurfaced patella may be left, but the femoral component revised to one that does not match the patella. Few studies have compared the outcome of matched and unmatched patella components in TKA. This study compared the primary or revision TKA outcome of procedures where patella components matched to their femoral counterparts were inserted, with procedures using patella and femoral components that were unmatched. METHODS Data on all primary and revision TKA procedures without a patella component or a matched or an unmatched patella component were obtained from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR). Revision surgery was the outcome measure. Cumulative percent revised (CPR) were calculated and Hazard ratios with p values were used to test statistical significance. RESULTS In primary TKA, there were higher rates of revision where unmatched patella components were used, regardless of implant design. There was no difference in the second revision rates of unmatched versus matched patella component groups. This was evident where delayed resurfacing was carried out, and where the patella prosthesis was left alone but the femoral component was changed. CONCLUSIONS All primary TKA procedures require a patella component corresponding to the femoral component if the patella is resurfaced. Conversely, revision knee arthroplasties are not affected by the use of dissimilar patella and femoral components.
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Affiliation(s)
- Peter L Lewis
- Wakefield Orthopaedic Clinic, Adelaide, South Australia, Australia; Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, South Australia, Australia.
| | - Ai E Gamboa
- Wakefield Orthopaedic Clinic, Adelaide, South Australia, Australia
| | - David G Campbell
- Wakefield Orthopaedic Clinic, Adelaide, South Australia, Australia
| | - Michelle Lorimer
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
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6
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Tetreault MW, Gross CE, Yi PH, Bohl DD, Sporer SM, Della Valle CJ. A classification-based approach to the patella in revision total knee arthroplasty. Arthroplast Today 2017; 3:264-268. [PMID: 29204494 PMCID: PMC5712031 DOI: 10.1016/j.artd.2017.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 04/28/2017] [Accepted: 05/04/2017] [Indexed: 12/21/2022] Open
Abstract
Background There is a paucity of data to guide management of the patella in revision total knee arthroplasty (RTKA). The purpose of this study was to review our experience with patellar management in RTKA. Methods We retrospectively reviewed 422 consecutive RTKAs at a minimum of 2 years (mean, 42 months). Patellar management was guided by a classification that considered stability, size, and position of the implanted patellar component, thickness/quality of remaining bone stock, and extensor mechanism competence. Results Management in 304 aseptic revisions included retention of a well-fixed component in 212 (69.7%) and revision using an all-polyethylene component in 46 (15.1%). Patella-related complications included 5 extensor mechanism ruptures (1.6%), 3 cases of patellar maltracking (1.0%), and 2 periprosthetic patellar fractures (0.7%). Of 118 2-stage revisions for infection, an all-polyethylene component was used in 88 (74.6%), patelloplasty in 20 (16.9%), and patellectomy in 7 (5.9%). Patella-related complications included 4 cases of patellar maltracking (3.4%), 3 extensor mechanism ruptures (2.5%), and 1 periprosthetic patellar fracture (0.8%). Conclusions Septic revisions required concomitant lateral releases more frequently (38.1% vs 10.9%; P < .02) but had a similar rate of patellar complications (6.8% vs 3.3%; P = .40). No cases required rerevision specifically for failure of the patellar component. Patients who had a patelloplasty had worse postoperative Knee Society functional scores than those with a retained or revised patellar component. In most aseptic RTKAs, a well-fixed patellar component can be retained. If revision is required, a standard polyethylene component is sufficient in most septic and aseptic revisions. Rerevisions related to the patellar component are infrequent.
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Affiliation(s)
- Matthew W Tetreault
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Christopher E Gross
- Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Paul H Yi
- Department of Radiology, Johns Hopkins University, Baltimore, MD, USA
| | - Daniel D Bohl
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Scott M Sporer
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.,Joint Replacement Institute, Northwestern Medicine Central DuPage Hospital, Winfield, IL, USA
| | - Craig J Della Valle
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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8
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Dalury DF, Adams MJ. Minimum 6-year follow-up of revision total knee arthroplasty without patella reimplantation. J Arthroplasty 2012; 27:91-4. [PMID: 22677146 DOI: 10.1016/j.arth.2012.04.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Accepted: 04/13/2012] [Indexed: 02/01/2023] Open
Abstract
Management options for the polyethylene patellar button during a revision total knee arthroplasty (TKA) include retention, revision, or removal of the button without replacement (patelloplasty). Our purpose was to determine the midterm outcome of patients undergoing revision TKA with patelloplasty. We retrospectively reviewed a single surgeon's database for patients undergoing such surgery from May 2001 to June 2005 and identified 33 (34 knees). The 25 patients (26 knees) who had at least 6 years' follow-up formed our study group. We compared preoperative and final follow-up Knee Society Scores and radiographs. Mean Knee Society Scores had increased from 50 (range, 23-88) to 93 (range, 41-100), respectively. No patient required additional surgery. We conclude that, at midterm follow-up, patelloplasty appears to be a satisfactory option in the management of the patella in revision TKA.
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Patellar management in revision total knee arthroplasty: is patellar resurfacing a better option? J Arthroplasty 2010; 25:589-93. [PMID: 19493648 DOI: 10.1016/j.arth.2009.04.009] [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: 09/23/2008] [Accepted: 04/07/2009] [Indexed: 02/01/2023] Open
Abstract
The management of the patella during revision total knee arthroplasty (TKA) depends on the indication for revision, the type and stability of the patellar component in place, and availability of bone stock. We prospectively compared the clinical outcome and satisfaction rates in revision TKA patients managed with patellar resurfacing (n = 13, group I) to retention of the patellar component (n = 22, group II) or patelloplasty (n = 11, group III) at a minimum follow-up of 2 years. There were no differences in the improvement of Knee Society Scores, Short-Form 36 Scores, and satisfaction rates between the groups. There were no revision surgeries for patellar component failure or patellar fractures. Satisfactory results can be achieved using a variety of methods of patellar management in revision TKA by individualizing the treatment modality depending on the clinical scenario.
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Erak S, Bourne RB, MacDonald SJ, McCalden RW, Rorabeck CH. The cemented inset biconvex patella in revision knee arthroplasty. Knee 2009; 16:211-5. [PMID: 19073366 DOI: 10.1016/j.knee.2008.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2008] [Revised: 10/30/2008] [Accepted: 11/01/2008] [Indexed: 02/02/2023]
Abstract
Evaluation of a cemented biconvex inset patellar component used in revision knee arthroplasty at minimum five year follow-up was undertaken. Of the initial cohort of 89 knees in 85 patients, two patellar implants were revised for aseptic loosening following a transverse fracture of the patella associated with avascular necrosis. A further four implants were judged radiographically loose. Aseptic loosening of the implant was strongly correlated with the presence of avascular necrosis radiographically. Fracture of the patellar bone remnant was associated with a radiographically measured thickness of residual patellar bone of less than 6 mm. Survivorship of the implant using aseptic revision as the endpoint was 98% at 10 years and 86% at 14 years given one late failure. We conclude that the cemented biconvex inset patellar component can give satisfactory results in revision of patellar components if avascular necrosis does not occur.
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Affiliation(s)
- Sani Erak
- Division of Orthopaedic Surgery, London Health Sciences Centre, London, Ontario, Canada.
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11
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How to address the patella in revision total knee arthroplasty. Knee 2009; 16:92-7. [PMID: 18819807 DOI: 10.1016/j.knee.2008.08.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2008] [Revised: 08/10/2008] [Accepted: 08/16/2008] [Indexed: 02/02/2023]
Abstract
Patellar issues need to be carefully addressed during any revision TKA and the surgeon often faces the question of what to do with the patella at the time of revision. The choice of treatment is often made by balancing what is technically feasible with the risk of potential complications and takes into account the reason for the revision, the type of implant (i.e., metal-backing or all-polyethylene), the duration of implantation, the fixation, the stability, the sterilization technique, the wear, the presence of osteolysis, the compatibility with the femoral component, and most importantly the remaining bone stock. The various treatment options then include retention of the patellar component, revision of the patellar component, removal of the component with retention of the patellar bony shell (patelloplasty or resection arthroplasty), excision of the patella (partial or total patellectomy), secondary resurfacing, and reconstruction/augmentation of the patellar bone stock. Isolated patellar revision is associated with a high complication rate and recurrent failure when poor patellar tracking, incongruent designs and malalignment of the femoral and tibial components exist. Retention of a well-fixed all-PE (non-oxidized) patella is advocated where possible and revision of metal-backed patella is recommended (unless well fixed with poor bone stock). In the situation of a deficient patella, patelloplasty, augmentation procedures and very rarely patellectomy are other viable options.
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12
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Garcia RM, Kraay MJ, Conroy-Smith PA, Goldberg VM. Management of the deficient patella in revision total knee arthroplasty. Clin Orthop Relat Res 2008; 466:2790-7. [PMID: 18712583 PMCID: PMC2565018 DOI: 10.1007/s11999-008-0433-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
UNLABELLED There are a number of options available to manage the patella when revising a failed total knee arthroplasty. If the previous patellar component is well-fixed, undamaged, not worn, and compatible with the femoral revision component, then it can be retained. When a patellar component necessitates revision and is removed with adequate remaining patellar bone stock, an onlay-type all-polyethylene cemented implant can be used. Management of the patella with severe bony deficiency remains controversial. Treatment options for the severely deficient patella include the use of a cemented all-polyethylene biconvex patellar prosthesis, patellar bone grafting and augmentation, patellar resection arthroplasty (patelloplasty), performing a gull-wing osteotomy, patellectomy, or the use of newer technology such as a tantalum (trabecular metal) patellar prosthesis. Severe patellar bone deficiency is a challenging situation because restoration of the extensor mechanism, proper patellar tracking, and satisfactory anatomic relationships with the femoral and tibial components are critical for an optimal clinical outcome. LEVEL OF EVIDENCE Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Ryan M. Garcia
- Department of Orthopaedic Surgery, University Hospitals Case Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106 USA
| | - Matthew J. Kraay
- Department of Orthopaedic Surgery, University Hospitals Case Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106 USA
| | - Patricia A. Conroy-Smith
- Department of Orthopaedic Surgery, University Hospitals Case Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106 USA
| | - Victor M. Goldberg
- Department of Orthopaedic Surgery, University Hospitals Case Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106 USA
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Lavernia CJ, Alcerro JC, Drakeford MK, Tsao AK, Krackow KA, Hungerford DS. Resection arthroplasty for failed patellar components. INTERNATIONAL ORTHOPAEDICS 2008; 33:1591-6. [PMID: 18956182 DOI: 10.1007/s00264-008-0674-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2008] [Accepted: 09/07/2008] [Indexed: 11/26/2022]
Abstract
A total of 1,401 primary total knee arthroplasties (TKA) were reviewed; 44 (3.2%) had at least the patellar component revised. Nine of these knees (eight patients) had insufficient bone stock to allow reimplantation of another patellar component. Clinical data on the nine knees were obtained with recent follow-up evaluation, review of their medical records and radiographs. Evaluation included Hospital for Special Surgery (HSS) scores. Average follow-up was 4 years and 7 months, 2-year range (2 months to 8 years and 4 months). Common factors found in these nine knees included: thin patella after primary TKR status, osteoarthritis, good range of motion and patella alta. Results were good to excellent in seven knees and fair in two. The untoward associations with patellectomy such as quadriceps lag, extension weakness and anterior knee pain were not experienced. Resection of the patellar component, without reimplantation, is an acceptable alternative in revision TKA lacking adequate remaining bone stock.
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Affiliation(s)
- Carlos J Lavernia
- Orthopaedic Institute at Mercy Hospital, 3659 South Miami Avenue Suite 4008, Miami, FL 33133, USA.
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Hendrix MRG, Ackroyd CE, Lonner JH. Revision patellofemoral arthroplasty: three- to seven-year follow-up. J Arthroplasty 2008; 23:977-83. [PMID: 18534464 DOI: 10.1016/j.arth.2007.10.019] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2007] [Accepted: 10/04/2007] [Indexed: 02/01/2023] Open
Abstract
In this series, a failed first-generation patellofemoral arthroplasty was revised to a second-generation prosthesis. Fourteen knees were prospectively followed up for a mean of 60 months. Primary procedure failure was due to component malposition, subluxation, polyethylene wear, or overstuffing. Mean Bristol knee scores improved from 58 (range, 36-86) to 79 (range, 38-100) (P < .001). Mild femorotibial arthritis (Ahlbach stage I) was present in 5 knees and predicted a poorer outcome. At most recent follow-up, there was no evidence of wear, loosening, or subluxation. Significant improvement can be obtained when revising the failed patellofemoral arthroplasty, provided there is no femorotibial arthritis.
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Abstract
When planning for a revision arthroplasty, one of the most important parts of preoperative planning is determining what components are currently in place. This information is crucial. The previous operative report is not always available, and when it is, it does not always contain the appropriate information concerning components. This problem can easily be prevented by providing every patient who has an arthroplasty with an implant-specific patient identification card at the time of surgery as described in this article.
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Affiliation(s)
- Edward W Lambert
- Division of Joint Reconstructive Surgery, Bone and Joint Sports Medicine Institute, Naval Medical Center, Portsmouth, Virginia 23708, USA
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16
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Maeno S, Kondo M, Niki Y, Matsumoto H. Patellar impingement against the tibial component after total knee arthroplasty. Clin Orthop Relat Res 2006; 452:265-9. [PMID: 16760804 DOI: 10.1097/01.blo.0000224049.56130.86] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Patella baja developed in seven knees in five patients after posterior stabilized total knee arthroplasties when the patella became impinged against the tibial component. Patellar replacement was performed in four knees, and all patients were able to achieve deep flexion postoperatively. The mean followup was 50 months (range, 24-73 months) for these patients. The mean Insall-Salvati ratio changed from 0.87 (range, 0.70-1) immediately postoperatively to 0.66 (range, 0.55-0.84) at followup. Patellar erosion occurred in three knees without patellar replacements, accompanied by pain and reduced range of flexion. The four knees with patellar replacements showed marked erosion of the patellar component or the patella, but all remained asymptomatic. Achieving deep flexion in addition to patella baja was thought to be a key element. Patellar replacement, joint line preservation, shaving the anterior portion of the tibial component, preventing surgically induced patella baja, and careful radiographic followup should be considered when deep flexion is achieved in a knee with patella baja after a total knee arthroplasty.
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Affiliation(s)
- Shinichi Maeno
- Department of Orthopedic Surgery, Keio University Hospital, Tokyo, Japan.
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Abstract
There are numerous options that need to be considered by the surgeon at the time of revision total knee arthroplasty (TKA). One needs to consider the reason for the revision, the type of patella in place, and the length of time the patella has been in place. The surgeon also needs to consider the status of the patellar bone stock, the stability of the patellar component (well-fixed or loose), and the component type (cemented or metal-backed). Assuming that the existing prosthesis is not metal-backed and has minimal PE wear, then it is preferable to retain a well-fixed all-PE cemented patellar button. However, if the button is metal-backed, then it probably is best to remove the button and replace it with an all-PE domed patellar component. Assuming more than 8 mm of patellar bone stock is remaining, it usually is best to cement an all-PE dome-shaped patella. However, if less than 8 mm is remaining, then that patient can be left with a patelloplasty, recognizing that this individual is going to continue with a high likelihood of anterior knee pain, subluxation, and poor functional results. In that situation, it may be preferable to consider a bone stock augmentation.
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Affiliation(s)
- Cecil H Rorabeck
- Division of Orthopaedic Surgery, London Health Sciences Center, University of Western Ontario London, Ontario, Canada.
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