Patellar Component Failure in Cementless Total Knee Arthroplasty

Rosenberg, Aaron G.; Andriacchi, Thomas P.; Barden, Regina M.; Galante, Jorge O.

doi:10.1097/00003086-198811000-00012

Cited by 150 publications

(65 citation statements)

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“…Patellofemoral failures have been noted in other investigations [3,24,28,32,33,46]. These failures have been associated with poorly designed metal-backed components, patellar complications such as fracture or subluxation, and more subtle problems such as patellar "clunk."…”

Section: Discussionmentioning

confidence: 93%

International multi-centre survivorship analysis of mobile bearing total knee arthroplasty

Stiehl

Hamelynck

Voorhorst³

2006

International Orthopaedics (SICO

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We retrospectively reviewed the experience of a large international multi-centre study of primary total knee arthroplasty with mobile bearing design and modifications of the tibial component to allow for bicruciate preservation, posterior cruciate retention, or sacrifice. Twenty-seven surgeons performed 4,743 total knee replacements between 1981 and 1997. Implants inserted were 324 that retained both cruciate ligaments, 2,165 that retained the posterior cruciate, and 2,254 that sacrificed both cruciates. The patella was resurfaced in 2,838 and unresurfaced in 1,905. With failure defined as revision or reoperation for any reason, the overall survivorship was 79% at 16 years' follow-up. Revision occurred in 259 (5.4%) knees out of the entire cohort. The risk adjusted rates of failure were higher in females, younger patients, osteoarthritis, posttraumatic arthritis, and in patients who had a meniscal bearing prosthesis or patellar resurfacing. The most common cause of revision was bearing-related issues including chronic instability, bearing subluxation, bearing dislocation, or bearing wear in 2.3%.Résumé Nous avons revu rétrospectivement une série multicentrique de prothèses totales primaires de genoux avec plateaux mobiles et pièce tibiale permettant le sacrifice ou la conservation d'un ou des deux ligaments croisés. Entre 1981Entre et 1997 prothèses ont été faite par 27 chirugiens. Les implants utilisés étaient pour 2254 sans ligaments croisés, pour 2165 avec croisé postérieur et pour 324 avec conservation des 2 croisés. La rotule a été resurfacée 2838 fois. Avec l'échec défini par la reprise chirurgicale, la survie était de 79% à 16 ans de recul. Une reprise a été faite 259 fois (5,4%). Le risque d'échec était plus grand chez les femmes, les patients jeunes, en cas d'arthrose primaire ou post traumatique et chez les patients avec une prothèse à ménisques mobiles ou avec une rotule prothèsée. Les causes les plus fréquentes de révision étaient l'instabilité chronique, la subluxation ou la luxation des plateaux mobiles et leur usure.

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Section: Discussionmentioning

confidence: 93%

International multi-centre survivorship analysis of mobile bearing total knee arthroplasty

Stiehl

Hamelynck

Voorhorst³

2006

International Orthopaedics (SICO

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“…Although a well-fixed and stable metal-backed patellar component can be retained, we recommend revising all metal-backed patellar components to a cemented all-polyethylene patellar component because of the high incidence of catastrophic failures associated with metal-backed implants of many designs [1,5,7,25,28,39]. Rorabeck et al [38] similarly suggested surgeons should consider the revision of all metal-backed patellar components regardless of patellar component fixation, damage, or positioning.…”

Section: Retaining the Existing Patellar Componentmentioning

confidence: 99%

Management of the Deficient Patella in Revision Total Knee Arthroplasty

Garcia

Kraay

Conroy-Smith

et al. 2008

Clinical Orthopaedics &Amp; Related Research

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There are a number of options available to manage the patella when revising a failed total knee arthroplasty. If the previous patellar component is wellfixed, undamaged, not worn, and compatible with the femoral revision component, then it can be retained. When a patellar component necessitates revision and is removed with adequate remaining patellar bone stock, an onlay-type all-polyethylene cemented implant can be used. Management of the patella with severe bony deficiency remains controversial. Treatment options for the severely deficient patella include the use of a cemented all-polyethylene biconvex patellar prosthesis, patellar bone grafting and augmentation, patellar resection arthroplasty (patelloplasty), performing a gull-wing osteotomy, patellectomy, or the use of newer technology such as a tantalum (trabecular metal) patellar prosthesis. Severe patellar bone deficiency is a challenging situation because restoration of the extensor mechanism, proper patellar tracking, and satisfactory anatomic relationships with the femoral and tibial components are critical for an optimal clinical outcome.

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“…The same benefits were expected to exist for the metal-backed patellar component; but recently, mechanical failures have been reported (Bayley et al 1988, Rosenberg et al 1988, Stulberg et al 1988, Felmet et al 1989). …”

Section: Tel+45-75181900mentioning

confidence: 83%