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[Implantation of a tantalum patella during revision surgery]
E Röhner1, S Böhle2, G Matziolis2
1Deutsches Zentrum für Orthopädie, Professur für Orthopädie des Universitätsklinikum Jena, Waldkliniken Eisenberg, Klosterlausnitzer Str. 81, 07607, Eisenberg, Deutschland. e.roehner@waldkliniken-eisenberg.de.
Objective:
The reconstruction or restoration of a functioning patella for active extension and flexion by implantation of a tantalum patella. In spite of larger osseous defects of the patella, the goal is to achieve sufficient extensor mechanism function.
Indications:
Patients who have such a large bone defect in the area of the patella that implantation of a traditional patella replacement is not possible. In addition, patients with a peri-implant fracture of the patella can be treated with a tantalum patella and additional plate osteosynthesis.
Contraindications:
Absence of a cortical basic structure of the patella. Complete loss of the patella or the extensor mechanism. Periprosthetic infection.
Surgical Technique:
The patella is completely excised. Subsequently, the back surface of the patella is milled to anchor the tantalum structure as accurately as possible without cement. This is fixed circularly after desired positioning by means of nonresorbable suture. Finally, the polyethylene back surface replacement is cemented onto the back surface of the tantalum structure.
Postoperative Management:
The patients have a limitation of flexion of 0-0-90° at 20 kilogram partial weight bearing for 12 weeks after surgery.
Results:
A total of 10 patients who received a tantalum patella between 2013 and 2019 were retrospectively included. A tantalum patella was implanted in 9 patients with a large patellar defect. In one case a tantalum patella with additional plate osteosynthesis was implanted to treat a peri-implant fracture of the patella. Loosening of the tantalum patella was observed in 1 patient, while in another patient postoperative arthrofibrosis was observed. In 2 cases a postoperative superficial wound healing disorder was detected. Two patients had a persistent infection with subsequent complete explantation of the prosthesis.
