Skip to main content

Advertisement

SpringerLink
Log in

Resection arthroplasty for failed patellar components

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

A total of 1,401 primary total knee arthroplasties (TKA) were reviewed; 44 (3.2%) had at least the patellar component revised. Nine of these knees (eight patients) had insufficient bone stock to allow reimplantation of another patellar component. Clinical data on the nine knees were obtained with recent follow-up evaluation, review of their medical records and radiographs. Evaluation included Hospital for Special Surgery (HSS) scores. Average follow-up was 4 years and 7 months, 2-year range (2 months to 8 years and 4 months). Common factors found in these nine knees included: thin patella after primary TKR status, osteoarthritis, good range of motion and patella alta. Results were good to excellent in seven knees and fair in two. The untoward associations with patellectomy such as quadriceps lag, extension weakness and anterior knee pain were not experienced. Resection of the patellar component, without reimplantation, is an acceptable alternative in revision TKA lacking adequate remaining bone stock.

Résumé

Objectif: Analyser les reprises des prothèses totales de genou avec ablation de l’insert rotulien. 1401 prothèses totales du genou ont été revues. 44 genoux (3,2%) ont eu une révision du composant rotulien. 9 de ces genoux (8 patients) n’avaient pas un stock osseux suffisant pour permettre une réimplantation d’une prothèse rotulienne. Méthodes: les données cliniques de ces 9 patients ont été analysées ainsi que leur suivi clinique et radiographique et une évaluation selon le score HSS. Résultats: le suivi moyen a été de 4 ans et 7 mois (de 2 mois à 8 ans, 4 mois). Ces malades présentaient en commun une épaisseur patellaire très mince après la prothèse primaire avec une bonne mobilité et une rotule haute. Les résultats ont été excellents et bons dans 7 cas et médiocres dans 2 cas. Nous n’avons pas évalué la force du quadriceps et les douleurs antérieures. En conclusion: l’ablation du composant patellaire sans réimplantation est une alternative acceptable dans les révisions de prothèses totales du genoux qui n’ont pas un stock osseux suffisant.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Aglietti P, Baldini A, Buzzi R, Indelli PF (2001) Patella resurfacing in total knee replacement: functional evaluation and complications. Knee Surg Sports Traumatol Arthrosc 9(Suppl 1):S27–S33

    Article  PubMed  Google Scholar 

  2. Burke WV, Ammeen DJ, Engh GA (2005) Isolated revision of failed metal-backed patellar components: outcome with minimum 4-year follow-up. J Arthroplasty 20:998–1001

    Article  PubMed  Google Scholar 

  3. Chalidis BE, Tsiridis E, Tragas AA, Stavrou Z, Giannoudis PV (2007) Management of periprosthetic patellar fractures. A systematic review of literature. Injury 38:714–724

    Article  PubMed  Google Scholar 

  4. Chun KA, Ohashi K, Bennett DL, El-Khoury GY (2005) Patellar fractures after total knee replacement. AJR Am J Roentgenol 185:655–660

    PubMed  Google Scholar 

  5. Gonzalez MH, Mekhail AO (2004) The failed total knee arthroplasty: evaluation and etiology. J Am Acad Orthop Surg 12:436–446

    PubMed  Google Scholar 

  6. Günal I, Karatosun V (2001) Patellectomy: an overview with reconstructive procedures. Clin Orthop Relat Res 389:74–78

    Article  PubMed  Google Scholar 

  7. Hanssen AD, Pagnano MW (2004) Revision of failed patellar components. Instr Course Lect 53:201–206

    PubMed  Google Scholar 

  8. Hsu HC, Luo ZP, Rand JA, An KN (1996) Influence of patellar thickness on patellar tracking and patellofemoral contact characteristics after total knee arthroplasty. J Arthroplasty 11:69–80

    Article  CAS  PubMed  Google Scholar 

  9. Keating EM, Haas G, Meding JB (2003) Patella fracture after post total knee replacements. Clin Orthop Relat Res 416:93–97

    Article  PubMed  Google Scholar 

  10. Kim YH, Yoon SH, Kim JS (2007) The long-term results of simultaneous fixed-bearing and mobile-bearing total knee replacements performed in the same patient. J Bone Joint Surg Br 89:1317–1323

    Article  PubMed  Google Scholar 

  11. Kooijman HJ, Driessen AP, van Horn JR (2003) Long-term results of patellofemoral arthroplasty. A report of 56 arthroplasties with 17 years of follow-up. J Bone Joint Surg Br 85:836–840

    CAS  PubMed  Google Scholar 

  12. Kraay MJ, Darr OJ, Salata MJ, Goldberg VM (2001) Outcome of metal-backed cementless patellar components: the effect of implant design. Clin Orthop Relat Res 392:239–244

    Article  PubMed  Google Scholar 

  13. Lonner JH, Mont MA, Sharkey PF, Siliski JM, Rajadhyaksha AD, Lotke PA (2003) Fate of the unrevised all-polyethylene patellar component in revision total knee arthroplasty. J Bone Joint Surg Am 85-A:56–59

    PubMed  Google Scholar 

  14. Martin SD, Haas SB, Insall JN (1995) Primary total knee arthroplasty after patellectomy. J Bone Joint Surg Am 77:1323–1330

    CAS  PubMed  Google Scholar 

  15. Meneghini RM, Ritter MA, Pierson JL, Meding JB, Berend ME, Faris PM (2006) The effect of the Insall-Salvati ratio on outcome after total knee arthroplasty. J Arthroplasty 21:116–120

    Article  PubMed  Google Scholar 

  16. Musil D, Stehlik J, Starek M (2005) Our experience with revision total knee arthroplasty (in Czech). Acta Chir Orthop Traumatol Cech 72:6–15

    CAS  PubMed  Google Scholar 

  17. Oh IS, Kim MK, You DS, Kang SB, Lee KH (2006) Total knee arthroplasty without patellar resurfacing. Int Orthop 30:415–419

    Article  PubMed  Google Scholar 

  18. Paletta GA Jr, Laskin RS (1995) Total knee arthroplasty after a previous patellectomy. J Bone Joint Surg Am 77:1708–1712

    PubMed  Google Scholar 

  19. Parvizi J, Kim KI, Oliashirazi A, Ong A, Sharkey PF (2006) Periprosthetic patellar fractures. Clin Orthop Relat Res 446:161–166

    Article  PubMed  Google Scholar 

  20. Reuben JD, McDonald CL, Woodard PL, Hennington LJ (1991) Effect of patella thickness on patella strain following total knee arthroplasty. J Arthroplasty 6:251–258

    Article  CAS  PubMed  Google Scholar 

  21. Rosenberg AG, Jacobs JJ, Saleh KJ, Kassim RA, Christie MJ et al (2003) The patella in revision total knee arthroplasty. J Bone Joint Surg Am 85-A(Suppl 1):S63–S70

    PubMed  Google Scholar 

  22. Rousseau MA, Lazennec JY, Catonne Y (2008) Early mechanical failure in total knee arthroplasty. Int Orthop 32:53–56

    Article  PubMed  Google Scholar 

  23. Sharkey PF, Hozack WJ, Rothman RH, Shastri S, Jacoby SM (2002) Insall Award paper. Why are total knee arthroplasties failing today? Clin Orthop Relat Res 404:7–13

    Article  PubMed  Google Scholar 

  24. Slupik A, Bialoszewski D (2007) Comparative analysis of clinical usefulness of the Staffelstein Score and the Hospital for Special Surgery Knee Score (HSS) for evaluation of early results of total knee arthroplasties. Preliminary report. Ortop Traumatol Rehabil 9:627–635

    PubMed  Google Scholar 

  25. Smith AJ, Wood DJ, Li MG (2008) Total knee replacement with and without patellar resurfacing: a prospective, randomised trial using the profix total knee system. J Bone Joint Surg Br 90:43–49

    CAS  PubMed  Google Scholar 

  26. Worland RL, Johnson GV, Alemparte J, Jessup DE, Keenan J, Norambuena N (2002) Ten to fourteen year survival and functional analysis of the AGC total knee replacement system. Knee 9:133–137

    Article  PubMed  Google Scholar 

  27. Wulff W, Incavo SJ (2000) The effect of patella preparation for total knee arthroplasty on patellar strain: a comparison of resurfacing versus inset implants. J Arthroplasty 15:778–782

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgement

We would like to acknowledge the financial support of Mercy Hospital and Arthritis Surgery and Research Foundation.

Author information

Authors and Affiliations

  1. Orthopaedic Institute at Mercy Hospital, 3659 South Miami Avenue Suite 4008, Miami, FL, 33133, USA

    Carlos J. Lavernia

  2. Arthritis Surgery & Research, 3661 South Miami Avenue, Suite 610, Miami, FL, 33133, USA

    Jose C. Alcerro

  3. Palmetto Orthopaedic & Sports Medicine Center, 595 W Wesmark Blvd, Sumter, SC, 29150–1969, USA

    Michael K. Drakeford

  4. Sun Valley Orthopedic Surgeons, 12361 W Bola Dr Ste 100, Surprise, AZ, 85374–9021, USA

    Audrey K. Tsao

  5. Department of Orthopaedics, Buffalo General Hospital, 100 High St Ste B-276, Buffalo, NY, 14203–1126, USA

    Kenneth A. Krackow

  6. Johns Hopkins Orthopaedics at Good Samaritan Hospital, 5601 Loch Raven Blvd, Professional Office Building, Suite G1, Baltimore, MD, 21239, USA

    David S. Hungerford

Authors
  1. Carlos J. Lavernia
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jose C. Alcerro
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael K. Drakeford
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Audrey K. Tsao
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kenneth A. Krackow
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. David S. Hungerford
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Carlos J. Lavernia.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lavernia, C.J., Alcerro, J.C., Drakeford, M.K. et al. Resection arthroplasty for failed patellar components. International Orthopaedics (SICOT) 33, 1591–1596 (2009). https://doi.org/10.1007/s00264-008-0674-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-008-0674-0

Keywords

Search

Navigation