Abstract
Purpose
Pseudo-patella baja (PPB) is a surgical complication that can arise from total knee arthroplasty and occurs when the patella tendon is not shortened but the level of the femorotibial joint line is elevated. The goal of this study was to assess the performance of a technique specifically designed to prevent the occurrence of PPB and its radiological results.
Methods
Ninety-nine patients undergoing total knee arthroplasty were included. Patients were divided into a non-correction group and a correction group. The correction group were applied an additional metal block in order to reduce the excess resection of the distal femur. To evaluate PPB, the change in the pre- and postoperative joint line was measured using the modified Blackburne–Peel Index (BPI).
Results
In the non-correction group, 68 of 74 cases showed an occurrence of PPB (92 %), in the correction group, 6 of 57 cases showed an occurrence of PPB (11 %). The preoperative-modified BPI of the non-correction group was not significantly different from that of the correction group (0.6 ± 0.1 vs. 0.6 ± 0.2). The modified BPI decreased significantly in the non-correction group after TKA (0.6 ± 0.1 vs. 0.2 ± 0.1, p < 0.05). However, the modified BPI did not change significantly in the correction group after TKA (0.6 ± 0.2 vs. 0.6 ± 0.2).
Conclusion
The comparison of preoperative and postoperative radiological results showed that our intervention maintained the joint line without elevation. We proposed an effective method to prevent various complications due to the joint line elevation that occur in PPB.
Level of evidence
III.
Similar content being viewed by others
References
Anagnostakos K, Lorbach O, Kohn D (2012) Patella baja after unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 20:1456–1462
Babazadeh S, Dowsey MM, Swan JD, Stoney JD, Choong PF (2011) Joint line position correlates with function after primary total knee replacement: a randomised controlled trial comparing conventional and computer-assisted surgery. J Bone Joint Surg Br 93:1223–1231
Bellemans J (2004) Restoring the joint line in revision TKA: does it matter? Knee 11:3–5
Blackburne JS, Peel TE (1977) A new method of measuring patellar height. J Bone Joint Surg Br 59:241–242
Chonko DJ, Lombardi AV Jr, Berend KR (2004) Patella baja and total knee arthroplasty (TKA): etiology, diagnosis, and management. Surg Technol Int 12:231–238
Delport H, Labey L, De Corte R, Innocenti B, Vander Sloten J, Bellemans J (2013) Collateral ligament strains during knee joint laxity evaluation before and after TKA. Clin Biomech (Bristol, Avon) 28:777–782
Emodi GJ, Callaghan JJ, Pedersen DR, Brown TD (1999) Posterior cruciate ligament function following total knee arthroplasty: the effect of joint line elevation. Iowa Orthop J 19:82–92
Estupinan JA, Bartel DL, Wright TM (1998) Residual stresses in ultra-high molecular weight polyethylene loaded cyclically by a rigid moving indenter in nonconforming geometries. J Orthop Res 16:80–88
Figgie HE 3rd, Goldberg VM, Heiple KG, Moller HS 3rd, Gordon NH (1986) The influence of tibial-patellofemoral location on function of the knee in patients with the posterior stabilized condylar knee prosthesis. J Bone Joint Surg Am 68:1035–1040
Goldberg VM, Figgie HE 3rd, Figgie MP (1989) Technical considerations in total knee surgery. Management of patella problems. Orthop Clin North Am 20:189–199
Hofmann AA, Kurtin SM, Lyons S, Tanner AM, Bolognesi MP (2006) Clinical and radiographic analysis of accurate restoration of the joint line in revision total knee arthroplasty. J Arthroplasty 21:1154–1162
Iacono F, Lo Presti M, Bruni D, Raspugli GF, Bignozzi S, Sharma B, Marcacci M (2013) The adductor tubercle: a reliable landmark for analysing the level of the femorotibial joint line. Knee Surg Sports Traumatol Arthrosc 21:2725–2729
Kawamura H, Bourne RB (2001) Factors affecting range of flexion after total knee arthroplasty. J Orthop Sci 6:248–252
Kazemi SM, Daftari Besheli L, Eajazi A, Miniator Sajadi MR, Okhovatpoor MA, Farhang Zanganeh R, Minaei R (2011) Pseudo-patella baja after total knee arthroplasty. Med Sci Monit 17:CR292–CR296
Laskin RS (2002) Joint line position restoration during revision total knee replacement. Clin Orthop Relat Res 404:169–171
Martin JW, Whiteside LA (1990) The influence of joint line position on knee stability after condylar knee arthroplasty. Clin Orthop Relat Res 259:146–156
Meftah M, Jhurani A, Bhat JA, Ranawat AS, Ranawat CS (2012) The effect of patellar replacement technique on patellofemoral complications and anterior knee pain. J Arthroplasty 27(1075–1080):e1071
Partington PF, Sawhney J, Rorabeck CH, Barrack RL, Moore J (1999) Joint line restoration after revision total knee arthroplasty. Clin Orthop Relat Res 367:165–171
Porteous AJ, Hassaballa MA, Newman JH (2008) Does the joint line matter in revision total knee replacement? J Bone Joint Surg Br 90:879–884
Rand JA (1990) Patellar resurfacing in total knee arthroplasty. Clin Orthop Relat Res 260:110–117
Sabbioni G, Rani N, Del Piccolo N, Ben Ayad R, Carubbi C, Tigani D (2011) Gap balancing versus measured resection technique using a mobile-bearing prosthesis in computer-assisted surgery. Musculoskelet Surg 95:25–30
Scuderi GR, Insall JN (1992) Total knee arthroplasty. Current clinical perspectives. Clin Orthop Relat Res 276:26–32
Selvarajah E, Hooper G (2009) Restoration of the joint line in total knee arthroplasty. J Arthroplasty 24:1099–1102
Seo JG, Moon YW, Lim JS, Park SJ, Kim SM (2012) Mechanical axis-derived femoral component rotation in extramedullary total knee arthroplasty: a comparison between femoral transverse axis and transepicondylar axis. Knee Surg Sports Traumatol Arthrosc 20:538–545
Wyss TF, Schuster AJ, Munger P, Pfluger D, Wehrli U (2006) Does total knee joint replacement with the soft tissue balancing surgical technique maintain the natural joint line? Arch Orthop Trauma Surg 126:480–486
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Seo, JG., Moon, YW., Kim, SM. et al. Prevention of pseudo-patella baja during total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 23, 3601–3606 (2015). https://doi.org/10.1007/s00167-014-3257-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00167-014-3257-1