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Patellar complications after total knee arthroplasty.

Sophie Putman1, Florian Boureau1, Julien Girard1

  • 1Université de Lille Nord de France, 59037 Lille, France; Service d'orthopédie, hôpital Roger-Salengro, centre hospitalier régional universitaire de Lille, place de Verdun, 59037 Lille, France.

Orthopaedics & Traumatology, Surgery & Research : OTSR
|July 11, 2018
PubMed
Summary

Patellar complications after total knee arthroplasty (TKA) can be prevented by identifying risk factors and managing them proactively. This expert opinion guides the best treatment for various patellar issues, from fractures to pain, aiming to improve TKA outcomes.

Keywords:
ComplicationsPatellaTotal knee arthroplasty

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Area of Science:

  • Orthopedic Surgery
  • Arthroplasty
  • Biomechanics

Background:

  • Patellar complications significantly impact total knee arthroplasty (TKA) outcomes, often necessitating revision surgery.
  • These complications can arise with or without patellar resurfacing, highlighting the complexity of patellofemoral joint management in TKA.

Purpose of the Study:

  • To address key questions regarding the prevention and management of patellar complications following total knee arthroplasty (TKA).
  • To provide expert-level guidance on identifying risk factors, treating patellar fractures, instability, clunk syndrome, anterior knee pain, and patellar defects.

Main Methods:

  • This work is based on expert opinion (Level of Evidence V).
  • It synthesizes current knowledge to answer specific clinical questions concerning patellar complications in TKA.
  • Management strategies are discussed based on clinical presentation, including surgical and non-operative options.

Main Results:

  • Risk factors for patellar complications include valgus, obesity, lateral retinacular release, and thin patella; proper prosthetic trochlea selection and patellar thickness (>12mm) are crucial.
  • Management of patellar fractures, instability, clunk syndrome, and anterior knee pain varies based on extensor apparatus integrity, implant fixation, rotational alignment, and identifiable causes.
  • Treatment options for patellar defects range from re-implantation and bone grafting to reconstruction and, cautiously, patellectomy.

Conclusions:

  • Proactive identification and management of risk factors are essential for preventing patellar complications in TKA.
  • Tailored treatment strategies, considering factors like extensor mechanism status and rotational alignment, are critical for optimizing outcomes.
  • A thorough evaluation is paramount before considering repeat surgery for persistent anterior knee pain after TKA.