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Is Further Treatment Necessary for Patellar Crepitus After Total Knee Arthroplasty?

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Patellar crepitus may occur with posterior-stabilized (PS) TKAs. Several studies have suggested numerous etiologies of patellar crepitus after PS-TKA with patellar resurfacing. However, it is unclear whether and to what degree crepitus influences pain and function without or with patellar resurfacing.

Questions/purposes

We therefore determined (1) the frequency of crepitus; (2) which factors predicted the occurrence of crepitus; and (3) whether crepitus influenced pain and function.

Methods

We retrospectively reviewed 41 patients (54 knees) with painful or painless patellar crepitus after primary PS-TKAs without patellar resurfacing performed from 2007 to 2008. These patients were compared with a group of 73 patients (94 knees) without patellar crepitus matched for age, sex, and BMI. The minimum followup was 2 years (mean, 2.8 years; range, 2–4.5 years).

Results

Five (9%) of the 54 knees with patellar crepitus also had peripatellar pain. Mean time from primary TKA to the onset of patellar crepitus was 4 months. All patients in the patellar crepitus group were asymptomatic within 1 year of onset of symptoms without additional surgical treatment. The development of patellar crepitus was associated with an Outerbridge patellar cartilage Grade 4 (odds ratio [OR], 11.9; 95% CI, 2.2–65.3) and joint line elevation (OR, 5.1; 95% CI, 1.9–8.6).

Conclusions

Patellar crepitus is typically benign and self-limited. We continue not to resurface arthritic patellae and counsel patients with patellar crepitus that their symptoms will improve without intervention.

Level of Evidence

Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Hye-Sun Ahn MS and Ji-Won Park RS for help in collecting and organizing the data analyzed in this study.

Author information

Authors and Affiliations

  1. Joint & Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, 404-3, Mok-dong, Yangcheon-gu, Seoul, 158-806, Republic of Korea

    Bo-Hyun Hwang MD, Chang-Hyun Nam MD, PhD, Kwang-Am Jung MD & Su-Chan Lee MD

  2. Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea

    Bo-Hyun Hwang MD

  3. Rothman Institute of Orthopedics, Thomas Jefferson University Hospital, Philadelphia, PA, USA

    Alvin Ong MD

Authors
  1. Bo-Hyun Hwang MD
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  2. Chang-Hyun Nam MD, PhD
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  3. Kwang-Am Jung MD
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  5. Su-Chan Lee MD
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Corresponding author

Correspondence to Su-Chan Lee MD.

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Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.”

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at Himchan Hospital, Seoul, Korea.

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Hwang, BH., Nam, CH., Jung, KA. et al. Is Further Treatment Necessary for Patellar Crepitus After Total Knee Arthroplasty?. Clin Orthop Relat Res 471, 606–612 (2013). https://doi.org/10.1007/s11999-012-2634-7

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  • DOI: https://doi.org/10.1007/s11999-012-2634-7

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