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Zgouridou A, Kenanidis E, Potoupnis M, Tsiridis E. Global mapping of institutional and hospital-based (Level II-IV) arthroplasty registries: a scoping review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1219-1251. [PMID: 37768398 PMCID: PMC10858160 DOI: 10.1007/s00590-023-03691-y] [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: 07/04/2023] [Accepted: 08/13/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE Four joint arthroplasty registries (JARs) levels exist based on the recorded data type. Level I JARs are national registries that record primary data. Hospital or institutional JARs (Level II-IV) document further data (patient-reported outcomes, demographic, radiographic). A worldwide list of Level II-IV JARs must be created to effectively assess and categorize these data. METHODS Our study is a systematic scoping review that followed the PRISMA guidelines and included 648 studies. Based on their publications, the study aimed to map the existing Level II-IV JARs worldwide. The secondary aim was to record their lifetime, publications' number and frequency and recognise differences with national JARs. RESULTS One hundred five Level II-IV JARs were identified. Forty-eight hospital-based, 45 institutional, and 12 regional JARs. Fifty JARs were found in America, 39 in Europe, nine in Asia, six in Oceania and one in Africa. They have published 485 cohorts, 91 case-series, 49 case-control, nine cross-sectional studies, eight registry protocols and six randomized trials. Most cohort studies were retrospective. Twenty-three per cent of papers studied patient-reported outcomes, 21.45% surgical complications, 13.73% postoperative clinical and 5.25% radiographic outcomes, and 11.88% were survival analyses. Forty-four JARs have published only one paper. Level I JARs primarily publish implant revision risk annual reports, while Level IV JARs collect comprehensive data to conduct retrospective cohort studies. CONCLUSIONS This is the first study mapping all Level II-IV JARs worldwide. Most JARs are found in Europe and America, reporting on retrospective cohorts, but only a few report on studies systematically.
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Affiliation(s)
- Aikaterini Zgouridou
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
| | - Eustathios Kenanidis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece.
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece.
| | - Michael Potoupnis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
| | - Eleftherios Tsiridis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
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Poon G, Siow WM, Poon KB. A Crossed Screw Patellar Reconstruction Technique for the Treatment of the Severely Deficient Scaphoid Shaped Patella in Total Knee Arthroplasty. Arthroplast Today 2023; 24:101259. [PMID: 38023643 PMCID: PMC10665651 DOI: 10.1016/j.artd.2023.101259] [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: 07/25/2023] [Revised: 09/28/2023] [Accepted: 10/07/2023] [Indexed: 12/01/2023] Open
Abstract
One of the contraindications to patella resurfacing in total knee arthroplasty is a thin and severely eroded 'deficient' patella. However, such patients often present with severe patellofemoral joint arthritis, patellar lateral subluxation, and patella maltracking, which can only be treated effectively with resurfacing. While various treatments have been proposed, options remain limited. Here we introduce a method of patella reconstruction using four 2.7-mm titanium cortical screws crossing each other into the inner shell of the patella. This provides a scaffold onto which bone cement and any standard polyethylene patellar component can be fixed. Postoperatively, the patient had no anterior knee pain, no patella maltracking, and no component loosening. Advantages of this technique include minimization of extensor disruption, low costs, easy accessibility, reproducibility, and improved mechanical strength.
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Affiliation(s)
- Glenys Poon
- Department of Orthopaedic Surgery, National University Hospital, Singapore, Singapore
| | - Wei Ming Siow
- Department of Orthopaedic Surgery, Sengkang General Hospital, Singapore, Singapore
| | - Kein Boon Poon
- Department of Orthopaedic Surgery, Sengkang General Hospital, Singapore, Singapore
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Fahlbusch H, Ohlmeier M, Mau H, Ballhause T, Citak M, Gehrke T, Korth M. Total knee arthroplasty and patelloplasty in a patient with phocomelia caused by thalidomide. SAGE Open Med Case Rep 2023; 11:2050313X231154635. [PMID: 36798679 PMCID: PMC9926391 DOI: 10.1177/2050313x231154635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 01/17/2023] [Indexed: 02/17/2023] Open
Abstract
The treatment of osteoarthritis in patients with phocomelia with total knee arthroplasty is challenging due to the unusual anatomy and severe deformities. The authors present a case of phocomelia caused by thalidomide with end-stage osteoarthritis and grossly medialized patella. The patient was treated with a cemented constrained non-hinged prosthesis and patelloplasty. Six months later, the patient had complete relief of pain and was able to walk without walking assistance. To our knowledge, total knee replacement in a patient with phocomelia caused by thalidomide has not been described in literature.
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Affiliation(s)
- Hendrik Fahlbusch
- Department of Orthopedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany,Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,Hendrik Fahlbusch, Department of Orthopedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany.
| | - Malte Ohlmeier
- Department of Orthopedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany
| | - Hans Mau
- Department of Orthopedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany
| | - Tobias Ballhause
- Department of Orthopedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany,Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mustafa Citak
- Department of Orthopedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany
| | - Thorsten Gehrke
- Department of Orthopedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany
| | - Moritz Korth
- Department of Orthopedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany
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Wilson JM, Sullivan MH, Pagnano MW, Trousdale RT. The AAHKS Clinical Research Award: Resurfacing the Thin Native Patella: Is It Safe? J Arthroplasty 2023:S0883-5403(23)00096-7. [PMID: 36775215 DOI: 10.1016/j.arth.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/30/2023] [Accepted: 02/02/2023] [Indexed: 02/14/2023] Open
Abstract
BACKGROUND Whether to resurface the patella during total knee arthroplasty (TKA) remains debated. One often cited reason for not resurfacing is inadequate patellar thickness. The aim of this study was to describe the implant survivorships, reoperations, complications and clinical outcomes in patients who underwent patellar resurfacing of a thin native patella. METHODS From 2000 to 2010, 7,477 patients underwent primary TKA with patellar resurfacing and had an intraoperatively, caliper-measured patella thickness at our institution. Of these, 200 (2.7%) had a preresection patellar thickness of ≤19 millimeters (mm). Mean preresection thickness was 18 mm (range, 12-19). Mean age was 69 years, mean body mass index was 31 kg/m2, and 93% of the patients were women. Median follow-up was 10 years (range, 2-20). RESULTS At 10 years, survivorships free of any patella revision, patella-related reoperation, and periprosthetic patella fracture were 98%, 98%, and 99%, respectively. There were 3 patella revisions (1 aseptic loosening, 2 periprosthetic joint infections). There were 2 additional patella-related reoperations for patellar clunk. There were 3 nonoperatively managed periprosthetic patella fractures. Radiographically, all nonrevised knees had well-fixed patellae. Knee society scores improved from mean 36 points (interquartile range [IQR] 24-49) preoperatively to mean 81 points (IQR 77-81) at 10-year follow-up. CONCLUSION Resurfacing the thin native patella was associated with high survivorship free of patellar revision at 10-year follow-up. Nevertheless, there was 1 case of patellar loosening and 3 periprosthetic patella fractures. These risks must be weighed against the known higher incidence of revision when the thin native patella is left unresurfaced.
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Affiliation(s)
- Jacob M Wilson
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Mark W Pagnano
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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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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Cheng K, Zhu W, Weng X, Zhang L, Liu Y, Han C, Xia W. Injectable tricalcium phosphate/calcium sulfate granule enhances bone repair by reversible setting reaction. Biochem Biophys Res Commun 2021; 557:151-158. [PMID: 33865223 DOI: 10.1016/j.bbrc.2021.03.145] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 03/25/2021] [Indexed: 11/30/2022]
Abstract
Towards repairing bone defects, calcium sulfate and calcium phosphate cement have been recognized as promising bone grafts. However, the current bone cements are generally lack of proper porosity for cell migration and new tissue formation. On the other hand, porous scaffold cannot be delivered by injection, which limits its use its clinical use. Herein, we develop a novel tricalcium phosphate/calcium sulfate granule to overcome the limitations of injectable cements and traditional scaffolds. The biocompatible granule underwent in situ self-setting to form scaffold with porous structure after injection. It contributes to calcium deposition and upregulation of osteogenic genes of mesenchymal stem cells in a time-dependent manner. Within three months, cavitary bone defects of distal rabbit femurs implanted the granules exhibited better bone formation than those with those implanted with autologous bone.
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Affiliation(s)
- Kaiyuan Cheng
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1 Shuaifuyuan, Beijing, 100730, China; Chinese Academy of Medical Sciences and Peking Union Medical College, 9 Dongdan 3rd Alley, Beijing, 100730, China.
| | - Wei Zhu
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1 Shuaifuyuan, Beijing, 100730, China.
| | - Xisheng Weng
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1 Shuaifuyuan, Beijing, 100730, China.
| | - Linjie Zhang
- Chinese Academy of Medical Sciences and Peking Union Medical College, 9 Dongdan 3rd Alley, Beijing, 100730, China.
| | - Yang Liu
- Department of Engineering Sciences: Applied Materials Sciences, The Ångström Laboratory, SE-751 21, Uppsala, Sweden; National Key Laboratory of Science and Technology on Advanced Composites in Special Environments, Harbin Institute of Technology, Harbin, 150001, China.
| | - Chang Han
- Chinese Academy of Medical Sciences and Peking Union Medical College, 9 Dongdan 3rd Alley, Beijing, 100730, China.
| | - Wei Xia
- Department of Engineering Sciences: Applied Materials Sciences, The Ångström Laboratory, SE-751 21, Uppsala, Sweden.
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Patellar Rebar Augmentation in Revision Total Knee Arthroplasty. J Arthroplasty 2021; 36:670-675. [PMID: 32951925 DOI: 10.1016/j.arth.2020.08.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/26/2020] [Accepted: 08/27/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND In revision total knee arthroplasty, osteolysis, mechanical abrasion, and infection may leave patellar bone stock severely attenuated with cavitary and/or segmental rim deficiencies that compromise fixation of patellar implant pegs. The purpose of this study was to retrospectively review the use of cortical "rebar" screws to augment cement fixation in revision patelloplasty. METHODS From 2006 to 2018, dorsal patellar rebar technique was used for patellar reconstruction in 128 of 1037 revision total knee arthroplasty cases (12.3%). Follow-up was achieved with serial radiographs and prospective comparison of Knee Society Scores (KSSs) for clinical outcome. Complications and implant failures requiring reoperation or modified rehabilitation were also assessed. RESULTS Of the 128 patellar revisions performed using the rebar technique, 69 patients were women and 59 patients were men. The average age of the group was 69.5 years (range, 32-83 years). The mean follow-up of the cohort was 37 months (range, 13-109 months). The most common causes for revision were kinematic conflict, periprosthetic joint infection, and aseptic loosening. The median number of rebar screws used was 5 (range, 1-13). Preoperative KSSs for the study cohort averaged 50 (range, 0-90) At latest follow-up, mean KSS was 85 (range, 54-100). There were 4 patellar-related complications (3.1%) with no implant failures at study conclusion. Retrieval analysis revealed rigid fixation of the reconstructed patellar component in all cases. CONCLUSIONS Patellar rebar screw augmentation is a useful technique when there are significant cavitary deficiencies and limited segmental rim deficiencies. This technique allows the surgeon to extend indications for patellar revision arthroplasty.
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Beck CM, Nwannunu BI, Teigen KJ, Wagner RA. Biomechanical Study of Patellar Component Fixation with Varying Degrees of Bone Loss. J Arthroplasty 2021; 36:739-743. [PMID: 32978021 DOI: 10.1016/j.arth.2020.08.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/06/2020] [Accepted: 08/21/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The decision as to whether or not to resurface the patella in revision total knee arthroplasty (TKA) is affected by the amount of patellar bone stock remaining; however, the impact of the cancellous bone status on patellar component fixation has not been studied. Therefore, we conducted a biomechanical study of patellar component fixation with varying degrees of cancellous bone loss. METHODS Sixty pairs of cadaveric patellae were randomly assigned between 3 groups and prepared in similar manner to a TKA with the standard 3-hole configuration. A control patella and an experimental patella were designated in each pair. To simulate bone loss in the experimental patellae, 1, 2, and 3 of the standard drill holes were uniformly enlarged to 12 mm in group 1, group 2, and group 3, respectively. Afterward, an all-polyethylene patellar component was cemented to each patella, as done intraoperatively. Patellar components were then sheared off using a materials testing system. The resulting mean offset yield force was analyzed within each group using paired t-tests. RESULTS The mean offset yield force for the control patellae was greater than the experimental patellae in group 1. In groups 2 and 3, the experimental patellae produced a greater mean offset yield force than the control patellae. Comparison within each group did not demonstrate a statistically significant difference. CONCLUSION Bone loss with enlargement of the patellar fixation holes, as is frequently seen in revision TKA, with holes up to 12 mm, does not significantly decrease patellar component fixation shear strength in this biomechanical cadaveric study.
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Affiliation(s)
- Cameron M Beck
- Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, TX
| | - Brian I Nwannunu
- Department of Orthopaedic Surgery, John Peter Smith Hospital, Fort Worth, TX
| | - Kari J Teigen
- Office of Clinical Research, John Peter Smith Hospital, Fort Worth, TX
| | - Russell A Wagner
- Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, TX; Department of Orthopaedic Surgery, John Peter Smith Hospital, Fort Worth, TX
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Petis SM, Taunton MJ, Perry KI, Lewallen DG, Hanssen AD, Abdel MP. Patellar Bone-Grafting for Severe Patellar Bone Loss During Revision Total Knee Arthroplasty. JBJS Essent Surg Tech 2020; 10:ST-D-19-00065. [PMID: 34055466 DOI: 10.2106/jbjs.st.19.00065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Treatment of severe patellar bone loss during revision total knee arthroplasty (TKA) is difficult. Patellar bone-grafting is a simple procedure that can improve patient outcomes following revision TKA. Description The patient is prepared and draped in the usual sterile fashion. The previous longitudinal knee incision is utilized for exposure. Scar tissue is excised from the medial gutter. However, tissue in the lateral gutter is largely maintained. An assessment of the surrounding quadriceps and patellar scar tissue ensues. This tissue can be utilized to create an envelope for holding the bone graft in place. If insufficient tissue is present, fascia from the iliotibial band or vastus medialis, allograft fascia, or synthetics can be used.A careful assessment of component fixation and rotation is critical to the success of patellar bone-grafting. Component revision for aseptic loosening or malrotation should be performed in the usual fashion. During component revision, it is recommended to preserve any additional bone as autograft for the patellar bone-grafting procedure. Common sites of autograft harvest include the femoral box cut and proximal tibial resection.The patella is then addressed by carefully removing the previous implant to avoid additional bone loss. This step is performed with a combination of an oscillating saw, osteotomes, and high-speed burr. The retropatellar bone is then prepared by debriding excess soft tissue, cysts, or cement. A high-speed burr is then utilized to produce a punctate bleeding surface for bone-graft incorporation.The harvested tissue is closed around the perimeter of the patella with use of interrupted nonabsorbable sutures, leaving a window to pack in the bone graft. The bone graft (allograft and autograft) is morselized and place through the window.The optimal patellar thickness is variable. After packing the bone graft through the soft-tissue window, the thickness is measured with a caliper. It is recommended to acquire a thickness of >20 mm because bone-graft resorption and remodeling occur with knee range of motion. The remaining soft-tissue window is closed with use of nonabsorbable sutures. The knee is cycled through a range of motion to ensure optimal patellofemoral tracking. If necessary, a lateral release or medial soft-tissue advancement can be performed to ensure patellofemoral tracking is adequate. Finally, the wound is irrigated and closed in layers. Alternatives Nonsurgical:Patellar knee braceHinged knee braceSurgical:Gull-wing osteotomyPatellar resurfacing with biconvex patellaBulk allograft reconstructionPartial or complete patellectomyPatelloplastyInterpositional arthroplastyTantalum metal-backed reconstruction. Rationale There is a myriad of surgical options for severe patellar bone loss following TKA. Patellar bone-grafting is simple, reproducible, and relatively cost-effective1,2, and avoids the need for the amount of bone for reconstruction that may be required for metal-backed or biconvex patellar implants3,4. The procedure allows for the restoration of the quadriceps lever arm, which may not be restored with other techniques, such as gull-wing osteotomy or patellectomy5. Patellar bone-grafting avoids the cost and risks of disease transmission associated with allograft reconstruction6. Finally, the procedure provides excellent long-term survivorship and patient-reported outcomes. Expected Outcomes Following this procedure, patients should experience a reduction in knee pain and improved patient-reported outcomes2,6, with a prior study showing that the percentage of patients reporting anterior knee pain decreased from 51% to 27% following patellar bone-grafting. Patients also demonstrated an improvement in knee range of motion, with a mean increase in knee flexion of 7o and knee extension of 2o1. Complications related to this procedure are minimal. Bone stock restoration can be utilized for patellar resurfacing in the future1. Radiographically, patellar bone resorption, loss of patellar height, and patellar remodeling do occur; however, despite these radiographic changes, Knee Society scores increased from 50 to 85 at the time of the latest follow-up. Important Tips Careful preoperative physical examination should document range of motion, areas of pain, and patellofemoral tracking and/or instabilityBe prepared to revise the femoral and/or tibial components if malrotated in order to optimize patellofemoral trackingRetain any autogenous bone harvested during component revision to use as patellar bone graftEnsure that allograft bone is available to ensure sufficient restoration of patellar thicknessConsider having allograft tissue available in the event that scar tissue in situ is not adequate to create an envelope for packing the bone graftA bleeding retropatellar surface prepared with a high-speed burr will increase the chance of bone incorporationA watertight closure of the soft-tissue envelope is critical to avoid loss of bone graft during knee range of motion.
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