Total knee arthroplasty in patients with permanent patella dislocation. Report of two cases and literature review

Abstract

The occurrence of permanent patellar dislocation associated with severe osteoarthritis is considered rare and difficult to treat. Literature: The literature is quite controversial on the subject. The objective of the study is to report two rare cases of severe osteoarthritis with permanent dislocation of the patella that underwent total knee arthroplasty, in addition to a review of the literature on the subject and related surgical technique. Total knee arthroplasty with using the medial parapatellar approach associated with lateral release was a good surgical option in patients with permanent patellar dislocation associated with advanced osteoarthritis.

Transposition of the medial synovial flap to repair the lateral joint capsule in total knee arthroplasty for knee osteoarthritis with permanent patellar dislocation

“…It has been reported that several surgical techniques can restore the trajectory of the patella: release the lateral articular capsule and retinaculum of contracture, rearrange the knee extension device, reconstruct the medial retinaculum, etc. 8,12,25,[27][28][29][30][31] . According to the conditions during the operation, the patellar trajectory can be restored by the combination of one or more surgical techniques.…”

“…At present, only a few studies have reported the effect of knee osteoarthritis with permanent dislocation of the patella on the repair of the joint capsule in TKA; most are case reports, and the number of patients included is small 8, 12,25,30,31 because knee osteoarthritis with permanent patellar dislocation is a complex deformity with a relatively low incidence 8,12,25,30,31 . Due to the different follow-up times of each study, the functional scores used are also different, and most studies do not record speci c pain scores 8,12,25,30,31 . Therefore, prospective studies with larger sample sizes are needed to compare the differences between different methods of joint capsule repair.…”

Combined Total Knee Arthroplasty and Medial Patellofemoral Ligament Reconstruction for Chronic Patellar Dislocation and Severe Osteoarthritis

“…Chronic patellar dislocation is recognized as a rare entity that can be due to congenital conditions but can also be acquired secondary to trauma. In the setting of severe osteoarthritis (OA), a fixed patellar dislocation represents a challenge to the orthopedic surgeon, and there is no consensus regarding treatment of these patients [ [1] , [2] , [3] ]. Realignment of the extensor mechanism is mandatory to restore the biomechanics of the knee and recover active extension.…”

“…Various approaches have been proposed to address fixed patellar dislocations in the setting of knee OA, and literature regarding this topic consists mainly of case reports that describe varying realignment techniques combined with TKA [ 1 , 3 , [11] , [12] , [13] , [14] , [15] , [16] ]. This technique article describes the utilization of a soft tissue allograft to reconstruct the medial patellofemoral ligament (MPFL) along with an extensive lateral release to achieve soft tissue balancing for a patient with a fixed patellar dislocation and knee OA.…”