Skip to main content

Extensor Mechanism Complications After Total Knee Arthroplasty

  • Chapter
  • First Online:
Anterior Knee Pain and Patellar Instability

Abstract

Extensor mechanism problems in total knee arthroplasty account for 12% of complications (Parker et al. in J Am Acad Orthop Surg 11:238–247, 2003). Manifestations are broad both in terms of etiology and impact on the patient. The most commonly encountered complications knee arthroplasty are patella tendon rupture, quadriceps tendon injury, periprosthetic patella fracture, patellofemoral instability, soft tissue impingement and osteonecrosis of the patella.

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

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Akagi M, Matsusue Y, Mata T, Asada Y, Horiguchi M, Iida H, et al. Effect of rotational alignment on patellar tracking in total knee arthroplasty. Clin Orthop Relat Res. 1999. https://doi.org/10.1097/00003086-199909000-00019155-163.

  2. Anouchi YS, Whiteside LA, Kaiser AD, Milliano MT. The effects of axial rotational alignment of the femoral component on knee stability and patellar tracking in total knee arthroplasty demonstrated on autopsy specimens. Clin Orthop Relat Res. 1993:170–177.

    Google Scholar 

  3. Astur DC, Gouveia GB, Borges JH, Astur N, Arliani GG, Kaleka CC, et al. Medial patellofemoral ligament reconstruction: a longitudinal study comparison of 2 techniques with 2 and 5-years follow-up. Open Orthop J. 2015;9:198–203.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Basso O, Johnson DP, Amis AA. The anatomy of the patellar tendon. Knee Surg Sports Traumatol Arthrosc. 2001;9:2–5.

    Article  CAS  PubMed  Google Scholar 

  5. Berger RA, Crossett LS, Jacobs JJ, Rubash HE. Malrotation causing patellofemoral complications after total knee arthroplasty. Clin Orthop Relat Res. 1998. https://doi.org/10.1097/00003086-199811000-00021144-153.

  6. Berger RA, Rubash HE, Seel MJ, Thompson WH, Crossett LS. Determining the rotational alignment of the femoral component in total knee arthroplasty using the epicondylar axis. Clin Orthop Relat Res. 1993:40–47.

    Google Scholar 

  7. Bouras TUE, Brown A, Gallacher P, Barnett A. Isolated medial patellofemoral ligament reconstruction significantly improved quality of life in patients with recurrent patella dislocation. Knee Surg Sports Traumatol Arthrosc. 2019;27:3513–3517.

    Google Scholar 

  8. Brown NM, Murray T, Sporer SM, Wetters N, Berger RA, Della Valle CJ. Extensor mechanism allograft reconstruction for extensor mechanism failure following total knee arthroplasty. J Bone Joint Surg Am. 2015;97:279–83.

    Article  PubMed  Google Scholar 

  9. Burnett RS, Butler RA, Barrack RL. Extensor mechanism allograft reconstruction in TKA at a mean of 56 months. Clin Orthop Relat Res. 2006;452:159–65.

    Article  CAS  PubMed  Google Scholar 

  10. Cadambi A, Engh GA. Use of a semitendinosus tendon autogenous graft for rupture of the patellar ligament after total knee arthroplasty. A report of seven cases. J Bone Joint Surg Am. 1992;74:974–9.

    Article  CAS  PubMed  Google Scholar 

  11. Chalidis BE, Tsiridis E, Tragas AA, Stavrou Z, Giannoudis PV. Management of periprosthetic patellar fractures. A systematic review of literature Injury. 2007;38:714–24.

    PubMed  Google Scholar 

  12. Chan JY, Giori NJ. Uncemented metal-backed tantalum patellar components in total knee arthroplasty have a high fracture rate at midterm follow-up. J Arthroplasty. 2017;32:2427–30.

    Article  PubMed  Google Scholar 

  13. Chang MA, Rand JA, Trousdale RT. Patellectomy after total knee arthroplasty. Clin Orthop Relat Res. 2005;440:175–7.

    Article  PubMed  Google Scholar 

  14. Chauhan SK, Clark GW, Lloyd S, Scott RG, Breidahl W, Sikorski JM. Computer-assisted total knee replacement. A controlled cadaver study using a multi-parameter quantitative CT assessment of alignment (the Perth CT Protocol). J Bone Joint Surg Br. 2004;86:818–23.

    Article  CAS  PubMed  Google Scholar 

  15. Clarke HD, Fuchs R, Scuderi GR, Mills EL, Scott WN, Insall JN. The influence of femoral component design in the elimination of patellar clunk in posterior-stabilized total knee arthroplasty. J Arthroplasty. 2006;21:167–71.

    Article  PubMed  Google Scholar 

  16. Cobb JP, Dixon H, Dandachli W, Iranpour F. The anatomical tibial axis: reliable rotational orientation in knee replacement. J Bone Joint Surg Br. 2008;90:1032–8.

    Article  CAS  PubMed  Google Scholar 

  17. Conrad DN, Dennis DA. Patellofemoral crepitus after total knee arthroplasty: etiology and preventive measures. Clin Orthop Surg. 2014;6:9–19.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Dandy DJ. Chronic patellofemoral instability. J Bone Joint Surg Br. 1996;78:328–35.

    Article  CAS  PubMed  Google Scholar 

  19. Deie M, Ochi M, Sumen Y, Adachi N, Kobayashi K, Yasumoto M. A long-term follow-up study after medial patellofemoral ligament reconstruction using the transferred semitendinosus tendon for patellar dislocation. Knee Surg Sports Traumatol Arthrosc. 2005;13:522–8.

    Article  PubMed  Google Scholar 

  20. Dobbs RE, Hanssen AD, Lewallen DG, Pagnano MW. Quadriceps tendon rupture after total knee arthroplasty. Prevalence, complications, and outcomes. J Bone Joint Surg Am. 2005;87:37–45.

    PubMed  Google Scholar 

  21. Figgie HE 3rd, Goldberg VM, Heiple KG, Moller HS 3rd, Gordon NH. 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. 1986;68:1035–40.

    Article  PubMed  Google Scholar 

  22. Fiquet C, Schneider A, Ballis R, Servien E, Neyret P, Lustig S. Reconstructing the chronically disrupted knee extensor mechanism after total knee arthroplasty: hourglass variant of the original partial allograft technique. Orthop Traumatol Surg Res. 2017;103:1197–200.

    Article  CAS  PubMed  Google Scholar 

  23. Fukunaga K, Kobayashi A, Minoda Y, Iwaki H, Hashimoto Y, Takaoka K. The incidence of the patellar clunk syndrome in a recently designed mobile-bearing posteriorly stabilised total knee replacement. J Bone Joint Surg Br. 2009;91:463–8.

    Article  CAS  PubMed  Google Scholar 

  24. Hamilton WG, Ammeen DJ, Parks NL, Goyal N, Engh GA, Engh CA Jr. Patellar cut and composite thickness: the influence on postoperative motion and complications in total knee arthroplasty. J Arthroplasty. 2017;32:1803–7.

    Article  PubMed  Google Scholar 

  25. Healy WL, Wasilewski SA, Takei R, Oberlander M. Patellofemoral complications following total knee arthroplasty. Correlation with implant design and patient risk factors. J Arthroplasty. 1995;10:197–201.

    Article  CAS  PubMed  Google Scholar 

  26. Hozack WJ, Rothman RH, Booth RE, Jr., Balderston RA. The patellar clunk syndrome. A complication of posterior stabilized total knee arthroplasty. Clin Orthop Relat Res. 1989:203–208.

    Google Scholar 

  27. Indelli PF, Graceffa A, Marcucci M, Baldini A. Rotational alignment of the tibial component in total knee arthroplasty. Ann Transl Med. 2016;4:3.

    PubMed  PubMed Central  Google Scholar 

  28. Ip D, Ko PS, Lee OB, Wu WC, Lam JJ. Natural history and pathogenesis of the patella clunk syndrome. Arch Orthop Trauma Surg. 2004;124:597–602.

    Article  CAS  PubMed  Google Scholar 

  29. Jarvela T, Halonen P, Jarvela K, Moilanen T. Reconstruction of ruptured patellar tendon after total knee arthroplasty: a case report and a description of an alternative fixation method. Knee. 2005;12:139–43.

    Article  PubMed  Google Scholar 

  30. Kirschner MH, Menck J, Nerlich A, Walser R, Buhren V, Hofmann GO. The arterial blood supply of the human patella. Its clinical importance for the operating technique in vascularized knee joint transplantations. Surg Radiol Anat. 1997;19:345–51.

    Article  CAS  PubMed  Google Scholar 

  31. Konig C, Sharenkov A, Matziolis G, Taylor WR, Perka C, Duda GN, et al. Joint line elevation in revision TKA leads to increased patellofemoral contact forces. J Orthop Res. 2010;28:1–5.

    PubMed  Google Scholar 

  32. Lucas TS, DeLuca PF, Nazarian DG, Bartolozzi AR, Booth RE, Jr. Arthroscopic treatment of patellar clunk. Clin Orthop Relat Res. 1999;226–229.

    Google Scholar 

  33. Lynch AF, Rorabeck CH, Bourne RB. Extensor mechanism complications following total knee arthroplasty. J Arthroplasty. 1987;2:135–40.

    Article  CAS  PubMed  Google Scholar 

  34. Malo M, Vince KG. The unstable patella after total knee arthroplasty: etiology, prevention, and management. J Am Acad Orthop Surg. 2003;11:364–71.

    Article  PubMed  Google Scholar 

  35. Meding JB, Fish MD, Berend ME, Ritter MA, Keating EM. Predicting patellar failure after total knee arthroplasty. Clin Orthop Relat Res. 2008;466:2769–74.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Nam D, Abdel MP, Cross MB, LaMont LE, Reinhardt KR, McArthur BA, et al. The management of extensor mechanism complications in total knee arthroplasty. AAOS exhibit selection. J Bone Joint Surg Am. 2014;96:e47.

    Google Scholar 

  37. Ng J, Balcells-Nolla P, James PJ, Bloch BV. Extensor mechanism failure in total knee arthroplasty. EFORT Open Rev. 2021;6:181–8.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Nicholls RL, Green D, Kuster MS. Patella intraosseous blood flow disturbance during a medial or lateral arthrotomy in total knee arthroplasty: a laser Doppler flowmetry study. Knee Surg Sports Traumatol Arthrosc. 2006;14:411–6.

    Article  PubMed  Google Scholar 

  39. Noh JH, Roh YH. Osteonecrosis of bipartite patella following total knee arthroplasty without lateral release. Acta Orthop Traumatol Turc. 2019;53:74–6.

    Article  PubMed  Google Scholar 

  40. Ortiguera CJ, Berry DJ. Patellar fracture after total knee arthroplasty. J Bone Joint Surg Am. 2002;84:532–40.

    Article  PubMed  Google Scholar 

  41. Parker DA, Dunbar MJ, Rorabeck CH. Extensor mechanism failure associated with total knee arthroplasty: prevention and management. J Am Acad Orthop Surg. 2003;11:238–47.

    Article  PubMed  Google Scholar 

  42. Pawar U, Rao KN, Sundaram PS, Thilak J, Varghese J. Scintigraphic assessment of patellar viability in total knee arthroplasty after lateral release. J Arthroplasty. 2009;24:636–40.

    Article  PubMed  Google Scholar 

  43. Rand JA. The patellofemoral joint in total knee arthroplasty. J Bone Joint Surg Am. 1994;76:612–20.

    Article  CAS  PubMed  Google Scholar 

  44. Rand JA, Morrey BF, Bryan RS. Patellar tendon rupture after total knee arthroplasty. Clin Orthop Relat Res. 1989;233–238.

    Google Scholar 

  45. Scuderi GR, Insall JN, Scott NW. Patellofemoral pain after total knee arthroplasty. J Am Acad Orthop Surg. 1994;2:239–46.

    Article  CAS  PubMed  Google Scholar 

  46. Servien E, Fritsch B, Lustig S, Demey G, Debarge R, Lapra C, et al. In vivo positioning analysis of medial patellofemoral ligament reconstruction. Am J Sports Med. 2011;39:134–9.

    Article  PubMed  Google Scholar 

  47. Theodorou DJ, Theodorou SJ, Farooki S, Kakitsubata Y, Resnick D. Osteonecrosis of the patella: imaging features. Clin Imaging. 2001;25:60–5.

    Article  CAS  PubMed  Google Scholar 

  48. Warschawski Y, Garceau S, Frenkel Rutenberg T, Dahduli O, Wolfstadt J, Backstein D. Revision total knee arthroplasty for patellar dislocation in patients with malrotated TKA components. Arch Orthop Trauma Surg. 2020;140:777–83.

    Article  PubMed  Google Scholar 

  49. Watkins MP, Harris BA, Wender S, Zarins B, Rowe CR. Effect of patellectomy on the function of the quadriceps and hamstrings. J Bone Joint Surg Am. 1983;65:390–5.

    Article  CAS  PubMed  Google Scholar 

  50. Whiteside LA. Surgical technique: Muscle transfer restores extensor function after failed patella-patellar tendon allograft. Clin Orthop Relat Res. 2014;472:218–26.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jobe Shatrov .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Shatrov, J., Batailler, C., Fournier, G., Servien, E., Lustig, S. (2023). Extensor Mechanism Complications After Total Knee Arthroplasty. In: Sanchis-Alfonso, V. (eds) Anterior Knee Pain and Patellar Instability. Springer, Cham. https://doi.org/10.1007/978-3-031-09767-6_25

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-09767-6_25

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-09766-9

  • Online ISBN: 978-3-031-09767-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics