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Palanisamy Y, Naidu SP, Prasad AR, Natarajan S, Rajan DV. When to Do Selective Patellar Resurfacing in Total Knee Arthroplasty: A Decision-Making Algorithm Based on Pre-operative and Intra-operative Findings. Indian J Orthop 2024; 58:30-39. [PMID: 38161405 PMCID: PMC10754792 DOI: 10.1007/s43465-023-01039-6] [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: 09/04/2023] [Accepted: 10/28/2023] [Indexed: 01/03/2024]
Abstract
Background Persistent anterior knee pain post total knee arthroplasty (TKA) is a significant cause of patient dissatisfaction. Selective patellar resurfacing is commonly practiced for primary total knee replacement (TKR) but there is a paucity in literature regarding its decision making. Study Objective This study aims to develop a decision-making algorithm for selective patellar resurfacing using Hospital for Special Surgery Patello-femoral Assessment score (HSS PFA score), weight-bearing patellofemoral X-ray, and intraoperative cartilage wear assessment based on the Outerbridge classification. Materials and Methods This prospective study enrolled 65 patients, assessing preoperative factors including HSS PFA score and Baldini view radiography. Intraoperative cartilage wear was categorized using the Outerbridge classification. Preoperative findings were correlated with intraoperative outcomes through statistical analysis, leading to the development of a predictive algorithm. The efficiency of algorithm was assessed at 3-year follow-up using HSS PFA score. Results A significant negative correlation (r = - 0.272, p = 0.029) was observed between HSS PFA score and cartilage wear. However, no significant relationships were established between HSS PFA score and Baldini view observations, including radiological tilt (p = 0.517) and displacement (p = 0.277). Intraoperative cartilage wear versus patellar tilt (p = 0.65) and displacement (p = 0.837) also yielded non-significant results. Three-year follow-up examinations revealed no complications and significant HSS PFA score improvements in all patients. Conclusion The requirement for patellar resurfacing can be predicted using a combination of preoperative parameter such as HSS PFA score and the intra-operative cartilage wear. We put forward an algorithm based on above findings to aid in the decision making.
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Affiliation(s)
| | - Surya Prakash Naidu
- Ortho-One Orthopaedic Speciality Centre, Tamil Nadu, Coimbatore, 641005 India
| | - Arjun R. Prasad
- Ortho-One Orthopaedic Speciality Centre, Tamil Nadu, Coimbatore, 641005 India
| | - Sugumar Natarajan
- Ortho-One Orthopaedic Speciality Centre, Tamil Nadu, Coimbatore, 641005 India
| | - David V. Rajan
- Ortho-One Orthopaedic Speciality Centre, Tamil Nadu, Coimbatore, 641005 India
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Tammachote N, Kraisin T, Kanitnate S. Do we need to restore patellar thickness after total knee arthroplasty with patellar resurfacing? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:3677-3682. [PMID: 37291460 DOI: 10.1007/s00590-023-03607-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/24/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE The aim of this study was to investigate whether increased patellar thickness after resurfacing decreased knee flexion angle and had any effect on functional outcomes comparing with patellar thickness restoration (patelloplasty) in patients undergoing primary total knee arthroplasty (TKA) or not. METHODS We retrospectively reviewed 220 patients undergoing primary TKA: 110 patients undergoing patelloplasty and 110 patients received overstuffed patellar resurfacing using subchondral bone cut at lateral facet technique were recruited. The mean increase in patellar thickness after resurfacing equal to 2 ± 1.2 mm. The outcomes were postoperative knee flexion angle and modified Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score at minimum 2 year after surgery. RESULTS The mean postoperative knee flexion angles were similar between overstuffed resurfacing group and patelloplasty group (132 ± 7° vs. 134 ± 8°, 95% confidence interval [CI] - 6.9-1.8°, p = 0.1). The mean increase in postoperative knee flexion was 13° in both groups (p = 0.94). The mean change of overall modified WOMAC score was also similar between the two groups (42 ± 12 vs. 39 ± 9 points, 95% CI - 1.7-9.4 points, p = 0.17). CONCLUSION This study demonstrated that increased patellar thickness has no effect on postoperative knee flexion angle and functional outcomes in TKA. The finding clarified the misunderstanding principle of native patellar thickness restoration after resurfacing which had made many surgeons to refrain from resurfacing especially in patient who had thin patella.
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Affiliation(s)
- Nattapol Tammachote
- Investigation Performed at the Orthopedic Unit, Thammasat University Hospital, Thammasat University, Khlong Luang, 12120, Pathum Thani, Thailand.
- Department of Orthopaedics, Faculty of Medicine, Thammasat University, Khlong Luang, 12120, Pathum Thani, Thailand.
| | - Teeramate Kraisin
- Investigation Performed at the Orthopedic Unit, Thammasat University Hospital, Thammasat University, Khlong Luang, 12120, Pathum Thani, Thailand
- Department of Orthopaedics, Faculty of Medicine, Thammasat University, Khlong Luang, 12120, Pathum Thani, Thailand
| | - Supakit Kanitnate
- Investigation Performed at the Orthopedic Unit, Thammasat University Hospital, Thammasat University, Khlong Luang, 12120, Pathum Thani, Thailand
- Department of Orthopaedics, Faculty of Medicine, Thammasat University, Khlong Luang, 12120, Pathum Thani, Thailand
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Jungwirth-Weinberger A, List K, Bechler U, Hanreich C, Rueckl S, Boettner F. Patella component diameters of 38 mm and up might be associated with higher revision rates after patella resurfacing. J Orthop Surg Res 2023; 18:325. [PMID: 37106469 PMCID: PMC10141901 DOI: 10.1186/s13018-023-03705-9] [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: 11/21/2022] [Accepted: 03/13/2023] [Indexed: 04/29/2023] Open
Abstract
PURPOSE Patellar resurfacing is considered the standard of care for total knee arthroplasty in the USA. Complications of patella resurfacing include aseptic loosening or patella fractures and can threaten the integrity of the extensor mechanism. The goal of this study was to report on patella button revision rates in posterior stabilized total knee arthroplasty. MATERIAL AND METHODS Between 01/2010 and 08/2016 patella buttons were implanted in 1056 patients (267 men and 550 women) as part of a posterior stabilized total knee arthroplasty. RESULTS Of 1056 cases, 35 cases (14 women, 15 men, 5 bilateral, 3.3%) showed early loosening at a mean 52.5 months postoperatively. Patella components of 38 mm or larger diameters showed a significantly higher loosening rate than the 29, 32, 35 mm buttons (p < 0.01). Mean BMI of patients identified with aseptic loosening was 31.7 kg/m2, mean age at time of revision surgery was 63.3 years. All of the patients with loosening of the patella button required revision surgery; in 33 cases an exchange of the button was performed, in two cases a removal of the button and patellar bone grafting was indicated. No complications occurred after revision surgery. CONCLUSION The current study reports a 3.3% patella loosening rate during this mid-term follow-up. Size 38 mm and larger patella components showed a significantly higher revision rate than smaller buttons and the authors advise caution when using large diameter patella components.
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Affiliation(s)
| | - Kilian List
- Hospital for Special Surgery, New York, USA
- Orthopädische Klinik König-Ludwig-Haus, Würzburg, Germany
| | - Ulrich Bechler
- Hospital for Special Surgery, New York, USA
- Universitätsklinik Hamburg-Eppendorf, Hamburg, Germany
| | - Carola Hanreich
- Hospital for Special Surgery, New York, USA
- Inselspital, Bern, Switzerland
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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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Jhurani A, Agarwal P, Aswal M, Rasquinha C, Srivastava M. Subvastus Exposure Compared to Parapatellar Approach in Navigated Sequential Bilateral Total Knee Arthroplasty (SBTKA): A Prospective Randomized Study. J Knee Surg 2021; 34:635-643. [PMID: 31683350 DOI: 10.1055/s-0039-1700496] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Subvastus approach preserves the quadriceps mechanism and may lead to improved early functional outcomes as compared with a parapatellar approach in primary knee arthroplasty. We performed a prospective randomized study to test the hypothesis if subvastus approach improves patient- and physician-reported outcomes in navigated sequential bilateral knee arthroplasty when compared with the standard parapatellar approach. A total of 93 patients were allotted in each group after power analysis and randomization done by computer-generated sequence: group S by subvastus approach and control group P by parapatellar approach. The patient's ability to walk without an aid, range of motion, blood loss, tourniquet time, complications, Knee Society Score (KSS), Knee Society Functional Score (KSFS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS), High Flexion Knee Score (HFKS), and visual analog scale (VAS) for pain were recorded preoperatively and postoperatively at 2 and 6 weeks and 3, 6, and 12 months. Final follow-up was done at 2 years. There was no statistical difference in the patient's ability to achieve a straight leg raise (p = 0.88), walk without an aid (p = 0.25), leaving pain medication (p = 0.48), and mean duration of hospital stay (p = 0.58) between both groups. There was no difference in KSS, FS, KOOS, WOMAC, HFKS, and VAS at 2 weeks and later follow-ups. There was no significant difference in range of motion or lateral retinacular release in both groups. Blood loss was significantly less in group S (p < 0.05), but there was a higher rate of proximal wound dehiscence and delayed healing in subvastus group (p = 0.03). Subvastus approach does not improve patient- and physician-reported outcome measures except blood loss in computer-navigated sequential bilateral knee arthroplasty and has an increased incidence of wound healing problems. The Level of evidence for the study is I.
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Affiliation(s)
- Anoop Jhurani
- Joint Replacement Unit, Fortis Escorts Hospital, Jaipur, Rajasthan, India
| | - Piyush Agarwal
- Joint Replacement Unit, Fortis Escorts Hospital, Jaipur, Rajasthan, India
| | - Mukesh Aswal
- Joint Replacement Unit, Fortis Escorts Hospital, Jaipur, Rajasthan, India
| | - Chetan Rasquinha
- Joint Replacement Unit, Fortis Escorts Hospital, Jaipur, Rajasthan, India
| | - Mudit Srivastava
- Joint Replacement Unit, Fortis Escorts Hospital, Jaipur, Rajasthan, India
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Jhurani A, Agarwal P, Aswal M, Meena I, Srivastava M, Sheth NP. Do spacer blocks accurately estimate deformity correction and gap balance in total knee arthroplasty? A prospective study with computer navigation. Knee 2020; 27:214-220. [PMID: 31918963 DOI: 10.1016/j.knee.2019.09.006] [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: 05/07/2019] [Revised: 07/12/2019] [Accepted: 09/06/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Spacer blocks are used commonly in knee arthroplasty to estimate gaps and ligament balance. Their use continues along with modern technology despite dearth of literature regarding their accuracy and reliability. This prospective study aims to determine the difference in values of gap and balance measurements between spacers and trials in computer assisted TKA. METHODS 50 patients with moderate varus deformity of <20° undergoing primary TKA were recruited for this prospective study. After navigation assisted cuts and requisite ligament release, gaps and balance were recorded in extension and 90° flexion with spacer block followed by implant trials. RESULTS There were 33 females and 17 males with average BMI of 28.2 ± 5kg/m2. The average preoperative flexion deformity was 6.5° ± 4.4° and varus deformity was 8.2° ± 3.8°. Average difference of deformity in sagittal plane in extension between spacer and trial was 6.2° which was statistically significant (p = 0.001) implying that knee achieves more extension with spacer blocks as compared to trials because the blocks do not have posterior offset of the condyles. However, there was no difference between values of soft tissue balance and coronal plane correction between spacer blocks and trials in extension and 90° flexion (p > 0.05). CONCLUSION Spacer blocks do not estimate extension space accurately with knee achieving 6.2 more flexion with trials as compared to spacer blocks when assessed for sagittal plane correction in extension. Spacer blocks should pass in easily in extension to avoid any flexion deformity when the actual trials are inserted.
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Affiliation(s)
- Anoop Jhurani
- Joint Replacement Unit, Fortis Escorts Hospital, Jaipur, Rajasthan, India.
| | - Piyush Agarwal
- Joint Replacement Unit, Fortis Escorts Hospital, Jaipur, Rajasthan, India
| | - Mukesh Aswal
- Joint Replacement Unit, Fortis Escorts Hospital, Jaipur, Rajasthan, India
| | - Ishwar Meena
- Joint Replacement Unit, Fortis Escorts Hospital, Jaipur, Rajasthan, India
| | - Mudit Srivastava
- Joint Replacement Unit, Fortis Escorts Hospital, Jaipur, Rajasthan, India
| | - Neil P Sheth
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
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