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Pseudo-patella baja: a minor yet frequent complication of total knee arthroplasty

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

One of the complications in total knee arthroplasty (TKA) is pseudo-patella baja (PPB). PPB is present when there is no shortening of the patellar tendon, but the joint line is elevated. The purpose of this study is to investigate the incidence of PPB after TKA and its clinical effects.

Methods

A case series of 158 patients undergoing TKA surgery between 1999 and 2012 at the 2nd Department of Orthopaedics and Traumatology, Pisa were retrospectively reviewed. Surgeries were performed by three senior surgeons, using the same surgical procedure for the implantation of a cemented posterior stabilized prosthesis. Lateral radiographs at 30° knee flexion were evaluated and the presence of PPB defined as modified Blackburne–Peel Index (mBPI) of < 0.54. All the patients were clinically evaluated using the Knee Society Score (KSS) and the Western Ontario and McMaster Universities Osteoarthritis Index score (WOMAC). Anterior knee pain was evaluated by visual analogue scale (VAS) and range of motion (ROM) was assessed through clinical examination.

Results

The cohort group consisted of 158 patients, 109 (69.0%) female and 49 (31.0%) male. Median age at time of surgery was 74 years (range 36–87) and median follow-up was 66 months (range 12–163 months). Bilateral TKA surgery was performed in 50 patients, resulting in a total of 208 implants for investigation. On radiological evaluation, 139 (66.8%) showed no abnormalities (no joint line elevation and no patellar tendon shortening) and 55 (26.4%) presented joint line elevation with absence of patellar tendon shortening (PPB). No significant differences were found between the groups in terms of the KSS, WOMAC score, VAS or ROM.

Conclusion

Post TKA PPB is a relatively common complication. Careful preoperative planning, adequate soft tissue release, optimal cutting of bone components, on the femoral side in particular, and the use of thin polyethylene inserts can help to avoid this complication.

Level of evidence

IV.

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Authors and Affiliations

  1. Humanitas Clinical and Research Center, Via Manzoni 56, 20089, Rozzano, Milan, Italy

    Giulia Bugelli

  2. Shoulder Surgery Division, Campolongo Hospital, Salerno, Italy

    Francesco Ascione

  3. Orthopedics and Traumatology Department, Ospedale Vito Fazzi, Lecce, Italy

    Niki Cazzella

  4. Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy

    Edoardo Franceschetti & Francesco Franceschi

  5. Orthopedics and Traumatology Department, Ospedale San Luca, Lucca, Italy

    Giacomo Dell’Osso

  6. Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

    Eleonor Svantesson & Kristian Samuelsson

  7. Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden

    Kristian Samuelsson

  8. Orthopedics and Traumatology Department, University of Siena, Siena, Italy

    Stefano Giannotti

Authors
  1. Giulia Bugelli
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  2. Francesco Ascione
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  3. Niki Cazzella
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  4. Edoardo Franceschetti
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  5. Francesco Franceschi
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  6. Giacomo Dell’Osso
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  7. Eleonor Svantesson
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  8. Kristian Samuelsson
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Corresponding author

Correspondence to Giulia Bugelli.

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Conflict of interest

The authors declare that they have no conflicts of interest.

Funding

There has been no financial supports or industry affiliations of all those involved in this project.

Ethical approval

According to Italian laws, ethical approval for this study was not required, because it involved only routine clinical follow-up and radiographic examination.

Informed consent

Written informed consent has been obtained from all the patients participating in the study.

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Bugelli, G., Ascione, F., Cazzella, N. et al. Pseudo-patella baja: a minor yet frequent complication of total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 26, 1831–1837 (2018). https://doi.org/10.1007/s00167-017-4828-8

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  • DOI: https://doi.org/10.1007/s00167-017-4828-8

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