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Painful Patellar Clunk or Crepitation of Contemporary Knee Prostheses

  • Symposium: Special Considerations for TKA in Asian Patients
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Painful patellar clunk or crepitation (PCC) is a resurgent complication of contemporary posterior-stabilized TKA. The incidence, time to presentation, causes, and treatment of PCC still remain controversial.

Questions/purposes

We therefore (1) compared the incidence of PCC with five contemporary TKA designs, (2) evaluated the time to presentation, (3) identified possible etiologies, and (4) determined recurrence rate and change in knee functional scores after treatment for PCC.

Methods

We reviewed 580 patients who had 826 posterior-stabilized TKAs involving five different designs. The incidences of PCC were compared among the prostheses. The knees were divided into two groups depending on the development of PCC, and possible etiologic factors of PCC, including prosthesis design and surgical or radiographic variables, were compared between groups. We investigated the onset time of PCC and evaluated treatment results by knee outcome scores. Minimum followup was 2.0 years (mean, 3.9 years; range, 2.0–9.8 years).

Results

The PCC incidence was higher in the Press-Fit Condylar® Sigma® Rotating Platform/Rotating Platform-Flex Knee System (11 of 113 knees, 9.7%) than in the others (seven of 713 knees, 1.0%). Increased risk of PCC was associated with using a specific prosthesis and patellar retention. PCC occurred in all cases within a year after TKA (mean, 7.4 months). Arthroscopic treatment (16 knees) and patellar replacement (two knees) improved knee scores, with no recurrence observed over an average followup of 29 months.

Conclusions

Prosthesis design and patellar retention were associated with PCC. Surgery resolved the PCC.

Level of Evidence

Level III, therapeutic study. See Instructions to Authors for a complete description of levels of evidence.

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Acknowledgments

The authors thank the Medical Research Collaborating Center of Seoul National University Hospital for support in the statistical analysis.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea

    Won Chul Choi MD, PhD & Keun-Jung Ryu MD

  2. Department of Orthopaedic Surgery, Seoul National University College of Medicine, 101 Daehang-ro, Jongno-gu, Seoul, 110-744, Korea

    Sahnghoon Lee MD, PhD, Sang Cheol Seong MD, PhD & Myung Chul Lee MD, PhD

Authors
  1. Won Chul Choi MD, PhD
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  2. Keun-Jung Ryu MD
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  3. Sahnghoon Lee MD, PhD
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Corresponding author

Correspondence to Myung Chul Lee MD, PhD.

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Each author certifies that he or she, or a member of his or her immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at Seoul National University College of Medicine, Seoul, Korea.

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Choi, W.C., Ryu, KJ., Lee, S. et al. Painful Patellar Clunk or Crepitation of Contemporary Knee Prostheses. Clin Orthop Relat Res 471, 1512–1522 (2013). https://doi.org/10.1007/s11999-012-2652-5

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  • DOI: https://doi.org/10.1007/s11999-012-2652-5

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