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Patellar options in revision total knee arthroplasty
Cecil H Rorabeck1, Ramin Mehin, Robert L Barrack
1Division of Orthopaedic Surgery, London Health Sciences Center, University of Western Ontario London, Ontario, Canada. Cecil.Rorabeck@lhsc.on.ca
Clinical Orthopaedics and Related Research
|December 4, 2003
Summary
For revision total knee arthroplasty (TKA), surgeons must evaluate the existing patellar component and bone stock. Retaining well-fixed, non-metal-backed patellar components is often preferred, but replacement with all-polyethylene options may be necessary.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
Background:
- Revision total knee arthroplasty (TKA) presents complex decisions regarding patellar management.
- Key factors include the reason for revision, current patellar implant type, duration of implantation, and bone stock quality.
Purpose of the Study:
- To outline surgical considerations for patellar management during revision TKA.
- To provide guidance on component retention versus replacement based on specific clinical scenarios.
Main Methods:
- Review of clinical decision-making processes in revision TKA.
- Analysis of factors influencing patellar component choice, including bone stock, component fixation, and material.
Main Results:
- Retention of well-fixed, all-polyethylene (PE) cemented patellar buttons is favored if there is minimal PE wear and the component is not metal-backed.
- Metal-backed patellar components typically warrant removal and replacement with an all-PE domed component.
- With >8 mm of patellar bone stock, cementing an all-PE dome is recommended; <8 mm may necessitate patelloplasty or bone stock augmentation.
Conclusions:
- Patellar management in revision TKA requires careful assessment of multiple factors.
- Optimal component selection balances bone preservation with functional outcomes, aiming to minimize risks like anterior knee pain and subluxation.