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Functional outcomes after removal of hardware in patellar fracture: are we helping our patients?

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Purpose

Functional outcomes after Open Reduction Internal Fixation (ORIF) of the patella are variable. Common complications of patella ORIF include persistent anterior knee pain, limited range of motion and symptomatic hardware. The purpose of this study was to evaluate if removal of hardware is beneficial to symptomatic patients after patellar fracture fixation.

Methods

Patients who presented to our institution between December 2006 and November 2014 with patella fractures treated with ORIF were eligible for inclusion. Patella ORIF was performed using (1) K-wires (KW) with a tension band construct or (2) Cannulated Screws (CS) with a tension band construct. Radiological analyses included (1) AO classification and (2) measurements of prominent hardware length. Patient medical charts were reviewed for demographic and intraoperative data as well as peri/postoperative complications. All patients completed the SF-12 score, visual analog scale, Kujala score, Lysholm score and questionaries’ regarding return to previous activity levels.

Results

Forty-seven patients met the inclusion criteria. The average time from fracture fixation to removal of hardware was 15.8 (SD ± 14.9) months. The mean follow-up was 43.1 (SD ± 27.1) months. Patella fixation was accomplished using tension band constructs with KW in 28 patients (59.5%) or with CS in 19 patients (40.5%). Patient reported quality of life and pain outcomes improved significantly after removal of hardware (p = 0.001, and p = 0.002 respectively). Functional outcome scores (Kujala and Lysholm) did not improve significantly after hardware removal in the KW or CS groups. Significantly more patients in the KW group returned to pre-injury activity (p = 0.005).

Conclusions

Hardware removal after patella ORIF significantly improves patient reported pain and quality of life outcomes but not functional outcomes. Patients should be counseled regarding the expected outcome of hardware removal following patella ORIF and diabetic patients should be given special consideration before undergoing this procedure.

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Authors and Affiliations

  1. Joint Arthroplasty and Sports Medicine Department, Tel Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, 6 Weitzman Street, 6423906, Tel-Aviv, Israel

    Arieh Greenberg, Assaf Kadar, Michael Drexler, Zachary T. Sharfman, Ofir Chechik, Ely L. Steinberg & Nimrod Snir

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  1. Arieh Greenberg
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  2. Assaf Kadar
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  3. Michael Drexler
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  4. Zachary T. Sharfman
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  5. Ofir Chechik
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  6. Ely L. Steinberg
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  7. Nimrod Snir
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Correspondence to Nimrod Snir.

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The authors declare that they have no conflict of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Greenberg, A., Kadar, A., Drexler, M. et al. Functional outcomes after removal of hardware in patellar fracture: are we helping our patients?. Arch Orthop Trauma Surg 138, 325–330 (2018). https://doi.org/10.1007/s00402-017-2852-2

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  • DOI: https://doi.org/10.1007/s00402-017-2852-2

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