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Cruciate-retaining TKA Is an Option in Patients With Prior Patellectomy

  • Symposium: 2014 Knee Society Proceedings
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

The recommendation for using posterior-stabilized (PS) implants in patellectomy patients undergoing total knee arthroplasty (TKA) is based on older case series with heterogeneous patient populations. The use of cruciate-retaining implants in these patients has not been evaluated with more contemporary implant designs.

Questions/purposes

The purpose of this study was to evaluate the survivorship and functional outcomes (Knee Society score, presence of an extensor lag, and range of motion) of cruciate-retaining (CR) TKA in patients with prior patellectomy.

Methods

Between 1986 and 2012, we performed 27 CR TKAs in 25 patients after patellectomy. Of those, 23 CR TKAs in 21 patients were available for followup at a minimum of 2 years (mean, 11.2 years; range, 2.3–25.1 years). In this retrospective study, we queried a prospectively maintained database to assess functional outcomes and survivorship.

Results

Aseptic loosening-free survival was 100% at 5 and 10 years, and survival with revision for any reason as the outcome was 96% at 5 years (95% confidence interval [CI], 87.7%–100%) and 84% at 10 years (95% CI, 69.5%–100%). One patient was revised for aseptic loosening at 10.2 years postoperatively. Mean Knee Society scores improved from 36 ± 13 preoperatively to 92 ± 9.6 at followup. Extensor lag was present in seven patients preoperatively and only three at followup. Average knee flexion at followup was 112° ± 12.5°.

Conclusions

In this study we found good long-term survivorship and functional outcomes with a CR implant design in patients following patellectomy. Earlier studies have favored PS over CR implants for patients with patellectomies. We believe this series suggests that CR TKA is indeed an option in patients with patellectomy.

Level of Evidence

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

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Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, North Shore LIJ Orthopaedic Institute at Southside Hospital, 301 East Main Street, Bayshore, NY, 11706, USA

    Keith R. Reinhardt MD

  2. Harvard Combined Orthopedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA

    Stephen J. Huffaker MD, PhD, Thomas S. Thornhill MD & Richard D. Scott MD

Authors
  1. Keith R. Reinhardt MD
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  2. Stephen J. Huffaker MD, PhD
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  3. Thomas S. Thornhill MD
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  4. Richard D. Scott MD
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Corresponding author

Correspondence to Keith R. Reinhardt MD.

Additional information

Two of the authors certify that he (TST, RDS), or a member of his immediate family, has or may receive payments or benefits, during the study period, an amount of more than USD 1,000,001 from DePuy (Warsaw, IN, USA).

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 Brigham and Women’s Hospital, Boston, MA, USA.

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Reinhardt, K.R., Huffaker, S.J., Thornhill, T.S. et al. Cruciate-retaining TKA Is an Option in Patients With Prior Patellectomy. Clin Orthop Relat Res 473, 111–114 (2015). https://doi.org/10.1007/s11999-014-3758-8

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  • DOI: https://doi.org/10.1007/s11999-014-3758-8

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