An unusual complication affecting an unresurfaced patella after total knee arthroplasty

Deshmukh, R. G.; Noble, J.

doi:10.1016/s0883-5403(99)90046-3

Cited by 3 publications

(6 citation statements)

References 11 publications

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“…Patellar fractures without trauma are rare in unresurfaced patella following TKA. Disruption of blood supply has been one of the important reasons causing devascularisation of patella, nevertheless some studies suggest routine patellar resurfacing [1,3,6]. However, the complications increase manifold with resurfacing which can be due to incorrect patellar tracking, metal component, uncemented component and patellar clunk syndrome; that too can cause fracture of patella or patellofemoral problems after TKA the percentage of which is quite high [1].…”

Section: Discussionmentioning

confidence: 99%

“…However patellar fractures without replacement of patellar component are rare and occur in only 0.05% patients [2,3]. Medial parapatellar arthrotomy combined with lateral release and excision of Hoffas' fat pad compromise the patellar blood supply by division of geniculate and infrapatellar arteries [4,5] and this factor has usually been ascribed to causing devascularisation of patella and pathological fracture.…”

Section: Introductionmentioning

confidence: 99%

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Insufficiency fracture of the unresurfaced patella following total knee arthroplasty

Schuh¹,

Schuh²,

Fujak³

et al. 2018

Glob Med Therap

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Atraumatic patellar fractures after Total Knee Arthroplasty (TKA) are rare in unresurfaced patella. Previous reports are few and have highlighted association of these fractures with rheumatoid arthritis and gout along with interference with patellar blood flow after lateral release and Hoffas' fat pad excision. We report a case of insufficiency fracture of patella in a patient following TKA after post-operative haematoma and arthrofibrosis that was managed conservatively.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Insufficiency fracture of the unresurfaced patella following total knee arthroplasty

Schuh¹,

Schuh²,

Fujak³

et al. 2018

Glob Med Therap

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“…3,4 The rate increases to between 0.2 and 21% when the knee prosthesis includes a patellar replacement. 3,5 Patellar fractures can be caused by direct injury or a stress fracture, 1,6,7 mostly in TKAs. 5,[8][9][10] In TKAs without patellar resurfacing, patellar fractures are usually caused by rheumatoid arthritis or degenerative osteoarthritis.…”

Section: Discussionmentioning

confidence: 99%

“…Only 0.05% patients undergoing TKA without a patellar component sustain a patellar fracture. 3,4 The rate increases to between 0.2 and 21% when the knee prosthesis includes a patellar replacement. 3,5 Patellar fractures can be caused by direct injury or a stress fracture, 1,6,7 mostly in TKAs.…”

Section: Discussionmentioning

confidence: 99%

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Fracture of the Unresurfaced Patella after Total Knee Arthroplasty: A Report of Two Cases

Seijas

Orduña

Castro

et al. 2009

J Orthop Surg (Hong Kong)

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Safe Zone for the Descending Genicular Artery in the Midvastus Approach to the Knee

Başarır

Erdemli²,

Tüccar³

et al. 2006

Clinical Orthopaedics and Related Research

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Minimally invasive total knee arthroplasty is performed using a modified version of the standard total knee arthroplasty without complete knee exposure. Traditional medial parapatellar arthrotomy has been criticized because it may disturb patellar blood flow and the extensor mechanism. Devascularization of the patella leading to osteonecrosis places the patella at risk for fracture. Alternative vastus-orientated approaches have the potential to preserve the descending genicular artery. Although this arterial supply to the patella potentially can be compromised throughout surgery, it is particularly vulnerable during deep dissection and arthrotomy. Knowledge of the anatomic course of the descending genicular artery would likely be helpful in its preservation. We investigated the course of the descending genicular artery and its entry angle to peripatellar network to determine the distance between the artery and superomedial patella during medial parapatellar arthrotomy and proximal capsular release. We dissected the descending genicular artery in 15 cadaveric knees. The average entry angle was 32.6 degrees , and the average distance between the descending genicular artery and superomedial pole of the patella during parapatellar arthrotomy was 13.5 mm. The safest distance for splitting the vastus medialis during median parapatellar arthrotomy was 15 mm from the superior pole of the patella because of the course of the descending genicular artery.

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An unusual complication affecting an unresurfaced patella after total knee arthroplasty

Cited by 3 publications

References 11 publications

Insufficiency fracture of the unresurfaced patella following total knee arthroplasty

Insufficiency fracture of the unresurfaced patella following total knee arthroplasty

Fracture of the Unresurfaced Patella after Total Knee Arthroplasty: A Report of Two Cases

Safe Zone for the Descending Genicular Artery in the Midvastus Approach to the Knee

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