Patellar Complications (Total Knee Arthroplasty) Effect of Lateral Release and Thickness

Ritter, Merrill A.; Pierce, Michael; Zhou, Hongling; Meding, John B.; Faris, Philip M.; Keating, E. Michael

doi:10.1097/00003086-199910000-00018

Cited by 83 publications

(55 citation statements)

References 9 publications

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“…Our study indicates either of these two options can be chosen without causing adverse clinical or radiographic effects, providing postoperative overall thickness remains within 3 mm of the original thickness and residual bony thickness is between 10 mm and 15 mm. Our findings concur with those of several clinical studies [6,10,17]. A study comparing the incidence of lateral retinacular release in TKA found knees with a residual bony thickness less than 15 mm had a lower incidence of lateral retinacular release than knees with a residual thickness of 15 mm or greater [6].…”

Section: Discussionsupporting

confidence: 92%

“…Moreover, a study of 112 Chinese patients showed no differences in the maximum flexion and function scores (as described by the American Knee Society) between the knees with a residual bony thickness greater than 12 mm and 12 mm or less [10]. Another study of 1146 TKAs in which postoperative overall thickness deviations were ± 6 mm found no association between thickness change and several clinical parameters (patellar fracture, component loosening, the need for lateral retinacular release, and maximum flexion) [17]. The above findings and ours indicate no adverse clinical findings are likely to occur if overall and residual bony thicknesses are maintained in a reasonable range, despite the possibility that postoperative patella thickness may affect patellofemoral contact pressures in an experimental setting [8,13,16].…”

Section: Discussionmentioning

confidence: 97%

“…Patella-related problems are among the issues of concern after TKA [8,13,17,18]. To prevent complications related to the patella, the use of appropriately designed prostheses and proper surgical techniques are mandatory.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Clinical Implications of Anthropometric Patellar Dimensions for TKA in Asians

Kim

Chung

Kang

et al. 2008

Clin Orthop Relat Res

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Anthropometric patellar dimensions can influence implant design and surgical techniques in patellar resurfacing for TKA. We measured anthropometric patellar dimensions in 752 osteoarthritic knees (713 in females and 39 in males) treated with TKA in 466 Korean patients and compared them with reported dimensions for Western patients. We investigated the effects of postoperative overall thickness deviations, residual bony thickness after bone resection, and postoperative deviations of component center positions from median ridge positions versus clinical and radiographic outcomes evaluated 1 year after surgery. Korean patients undergoing TKA had thinner and smaller patellae than Western patients. We found no associations between preoperative to postoperative overall thickness differences and clinical and radiographic outcomes and no differences between knees with a residual bony thickness 12 mm or greater and knees with a residual thickness less than 12 mm, with the exception of WOMAC pain scores. We found no associations between postoperative deviations of component center position and clinical or radiographic outcomes. Our findings indicate bone resection for patellar resurfacing can be flexible without jeopardizing clinical outcome.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 97%

See 1 more Smart Citation

Clinical Implications of Anthropometric Patellar Dimensions for TKA in Asians

Kim

Chung

Kang

et al. 2008

Clin Orthop Relat Res

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“…Most studies do not distinguish between fractures associated with a clear history of trauma and spontaneous events, or between fractures following revision as opposed to those following primary TKR. 2,11,[16][17][18][19] The purpose of this study was to conduct a retrospective case-control analysis identifying clinical, radiological and surgical factors that increase the risk of developing a spontaneous fracture of the patella after resurfacing as part of primary TKR.…”

mentioning

confidence: 99%

A case-control study of spontaneous patellar fractures following primary total knee replacement

Seo

Moon

Park

et al. 2012

The Journal of Bone and Joint Surgery. British volume

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Peri-prosthetic patellar fracture following resurfacing as part of total knee replacement (TKR) is an infrequent yet challenging complication. This case-control study was performed to identify clinical, radiological and surgical factors that increase the risk of developing a spontaneous patellar fracture after TKR. Patellar fractures were identified in 74 patients (88 knees) from a series of 7866 consecutive TKRs conducted between 1998 and 2009. After excluding those with a previous history of extensor mechanism realignment or a clear traumatic event, a metal-backed patella, any uncemented component or subsequent infection, the remaining 64 fractures were compared with a matched group of TKRs with an excellent outcome defined by the Knee Society score. The mean age of patients with a fracture was 70 years (51 to 81) at the time of TKR. Patellar fractures were detected at a mean of 13.4 months (2 to 84) after surgery. The incidence of patellar fracture was found to be strongly associated with the number of previous knee operations, greater pre-operative mechanical malalignment, smaller post-operative patellar tendon length, thinner post-resection patellar thickness, and a lower post-operative Insall-Salvati ratio. An understanding of the risk factors associated with spontaneous patellar fracture following TKR provides a valuable insight into prevention of this challenging complication.

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“…In Kombination mit korrekter Rotation der Implantate [1] und Medialisierung des Patellarückflächenersatzes [21] reduziert er das Auftreten patellofemoraler Komplikationen. Durch die verminderte Notwendigkeit eines lateralen Release können Komplikationen wie Osteonekrosen und Frakturen der Kniescheibe weitgehend vermieden werden[24]. Funktioneller Score der American Knee Society.…”

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