Alteration of the patellar height following total knee arthroplasty

Patellofemoral related complications after total knee arthroplasty (TKA) remain clinically relevant. The hypothesis of the present study was that the patellar height changes more than 10% of its preoperative height after TKA. Possible influences of age, gender, side and navigation system on patellar height were evaluated separately in subgroups.

A total of 107 knees were enrolled after primary TKA. The patellar height was determined for each patient preoperatively, 1 week and 1 year postoperatively on routinely performed standing lateral view radiographs at 30° knee flexion. Insall-Salvati index (ISI), modified Insall-Salvati index (MIS) as well as Miura-Kawamura index (MKI) were determined for the whole cohort.

One week after TKA the ISI, MIS and MKI changed by more than 10% in 24 (22%), 33 (30%) and 54 (50%) cases, respectively. Moreover, the 1 year follow-up revealed a decrease or increase of ISI in 30 (28%), MIS in 47 (44 %) and MK in 65 (61%) knees. The frequency of patella alta, norma and baja preoperatively as well as 1 week and 1 year postoperatively were not significantly different. Significant differences of patellar height changes were not noted between the defined subgroups.

The present study demonstrates that TKA leads, at 1 week and 1 year follow-up, to patellar height alteration more than 10% in a significant number of knee joints. However, with the use of ISI and MIS the changes of patellar height did not exceed the defined thresholds to be classified as patella alta or baja.