The Effect of Partial Lateral Facetectomy of the Patella on the Radiographic and Clinical Outcome of Unresurfaced Patellar-retaining Total Knee Arthroplasty (original) (raw)
Related papers
The Journal of arthroplasty, 2014
This study presents the selective use of partial patellar lateral facetectomy for maltracking during primary TKA, as an alternative to lateral release. Twenty three partial facetectomies were performed out of 191 TKAs (12%). Balanced tracking was achieved in 22 knees. At follow-up 2 patients had persistent anterior knee pain. Mean Knee Society score (KSS) was 94 and mean functional KSS was 86. Mean patellar score was 28. Patellar tilt angles were within 2 degrees in all but one knee. Patellar translation was within 2 mm in all cases. No complications were recorded. A control group of 46 matched patients had similar functional and radiographic results. If tracking is not satisfactory at the conclusion of TKA, our method of choice would be partial lateral facetectomy.
Radiographic features predictive of patellar maltracking during total knee arthroplasty
Knee Surgery, Sports Traumatology, Arthroscopy, 2009
Despite improvements in component design and surgical technique, some patients still require lateral retinacular release during TKA to improve patella tracking. We studied 148 fixed-bearing TKAs to identify parameters in pre-operative knee radiographs that would predict intraoperative patellar maltracking. Digital radiographs and software were used to measure coronal alignment, distal femoral valgus angle, proximal tibia varus angle, patellar tilt, patellar shift, Insall-Salvati ratio, and patellar component placement and alignment. Patellar tracking was assessed after all components had been cemented, using both no-touch and modified ''towel clip'' techniques. The only radiographic parameter independently associated with maltracking was patellar shift. The median pre-operative patellar lateral shift in patients who had maltracking was 4.1 mm compared to 0.0 mm in those who did not. Patients who had a patellar shift of more than 3.0 mm had a high likelihood of maltracking, with estimated positive and negative predictive values of 78 and 95%, respectively. Pre-operative patellar shift may thus be clinically relevant for identifying osteoarthritic patients who have a higher likelihood for patellar maltracking during TKA. Variations in the intrinsic risk for maltracking within patient study populations may account for the widely differing reported rates of patellar maltracking, and our data suggest that information on pre-operative patellar shift may be helpful in stratifying these sample populations.
Interventional Medicine and Applied Science
Background: In this study, the results of the partial lateral facetectomy of the patella to better patellofemoral motion and congruence are compared with the results of the osteophyte removal of the patella and neurectomy only in total knee arthroplasty (TKA). Methods: Data from 55 patients undergoing TKA with osteophytes removal of the patella and neurectomy only, and those undergoing osteophytes removal of the patella and neurectomy and partial lateral facetectomy were reviewed retrospectively. Clinical outcomes were evaluated by knee society score (KSS) and functional score of knee. Clinical anterior knee pain (AKP) rating and knee range of motion and extension lag were assessed for each patient. Results: There was significant difference between two groups in AKP (p < 0.05), and the mean range of motion of the knee in groups 1 and 2 was 117°± 9°a nd 116.6°± 8.2°, respectively. Three (13%) patients of the reshaped patella group and three (11%) patients of the non-reshaped patella group had extension lag <10°, respectively. The mean KSS and knee functional scores showed no statistical difference between groups (p > 0.05). Conclusion: Partial lateral facetectomy of the patella can decrease AKP and can be used routinely for every patient that surgeon does not decide to resurface the patella.
Medialization of the patella in total knee arthroplasty
The Journal of Arthroplasty, 1997
Patellar complications of total knee arthroplasty remain the most common cause of pain and reoperation. Laboratory studies have suggested that medialization of the patella will improve tracking of the patella on the trochlea of the femoral component. The purpose of this study was to determine if clinical medialization of the patellar component on the patellar bone would improve tracking of the patella as demonstrated radiographically. Sixty-two knees were randomized so that 31 knees had a centrally placed patellar component and 31 had the patellar component placed on the medial two thirds of the patellar bone. There was no difference between the two groups with respect to either clinical or radiographic results in the first year after surgery. There was no improvement compared with previous reports in the incidence of tilt and displacement. The one improvement was a reduction in the incidence of lateral release. Thus, consequences of lateral release such as postoperative morbidity, avascular necrosis of the patella, and stress fracture of the patella can be avoided. It is recommended that the patellar component be placed on the medial two thirds of the patella to reduce the occurrence of lateral release. Tracking of the patella during surgery can be assessed using a single suture placed at the superior pole of the patella, and this technique in combination with the no-thumbs test provides an additional means of evaluation for patellar tracking.
A Technique of Staged Lateral Release to Correct Patellar Tracking in Total Knee Arthroplasty
The Journal of Arthroplasty, 2009
Optimal patellar tracking and component alignment are important in achieving a well-functioning total knee arthroplasty (TKA). The patella is constrained partly by design of the prosthetic trochlear groove, and patellar tracking is governed by a combination of static and dynamic factors. Maltracking may result from excessive or unbalanced tension in the surrounding soft tissues. This article describes a staged progressive lateral release of the patellar retinaculum in TKA, which is classified into 6 stages. Stage 1 transects the deep lateral patellofemoral ligament; stages 2 to 6 extend the lateral patellar incision distally from vastus lateralis to the tibial tubercle. This technique was used in a series of 96 primary TKAs. We report the rates of the various stages of lateral release and the variables that might affect the decision to perform such a release.
Patellar malalignment treatment in total knee arthroplasty
Joints, 2013
The patella, with or without resurfacing, plays a fundamental role in the success of a total knee arthroplasty (TKA). Patellofemoral joint complications are due to problems related to the patient, to the surgical technique, or to the design of the components. Patellar tracking is influenced by several factors: a severe preoperative valgus, the presence of pre-existing patellofemoral dysplasia, the design of the femoral component, the surgical approach, the Q angle, the mechanical alignment of the limb, the tightness of the lateral retinaculum, the positioning of the patellar component in the proximal-distal and medial-lateral directions, the patella height, the patella (native or resurfaced) thickness, the size of the femoral and the tibial components, and the alignment and rotation of the components. Several factors are crucial to prevent patellar maltracking in TKA: the use of an anatomical femoral component, a meticulous surgical technique, careful dynamic intraoperative assessme...
Short Term Outcomes of Non-Surfacing Patelloplasty in Primary Total Knee Arthroplasty
The Egyptian Journal of Hospital Medicine, 2019
Background: The management of the patella during primary total knee arthroplasty (TKA) is controversial. The most common methods of treating the patella in TKA are patellar resurfacing and non-surfacing patelloplasty. Objectives: The aim of this study was to assess short term outcomes of non-surfacing patelloplasty in primary total knee arthroplasty. Patient and methods: This study included a total of twenty patients who had primary total knee arthroplasty for degenerative or inflammatory arthritis accompanied with moderate to severe patellofemoral arthritis attending at Al-Azhar University Hospitals. Patelloplasty was done in the form of excision of peripatellar synovial tissues, osteophytectomy and denervation of patellar rim using electro-cautery and smoothing of the articular surface by oscillating saw. Results: All patients were examined using a new patellofemoral scoring system,after one year follow up after total knee arthroplasty (TKA) the end result was: 14 patients were very satisfied, while 5 patients had mild to moderate anterior knee pain, tolerated by analgesics on demand and physiotherapy. Only one case had severe pain and secondary resurfacing was done about 6 months postoperatively, the patient was satisfied, and the pain became mild. Discussion: Total knee arthroplasty (TKA) is one of the most commonly performed operations in adult reconstructive surgery. The management of the patella in primary TKA remains controversial. The approaches available for patellar management in TKA are non-resurfacing patelloplasty, and selective resurfacing. Conclusion: It is recommended to do patelloplasty without resurfacing of the patella as this technique has fewer hazards and complications.
Knee Surgery, Sports Traumatology, Arthroscopy, 2013
Purpose To assess the long-term results of lateral facetectomy plus Insall's realignment procedure to treat isolated patellofemoral osteoarthritis. Methods All consecutive patients undergoing this procedure with a follow-up between 10 and 14 years were included in this study. Subjects were excluded if they had previous patellar dislocation, patellar fracture, tibiofemoral osteoarthritis (except mild cases) or follow-up \10 or [14 years. Failure cases (need for total knee arthroplasty) of this surgical procedure before 10 years of followup were considered in the overall failure rate. Clinical, functional and radiographic outcomes were obtained at baseline and compared to postoperative values. Results Forty-three patients (mean (SD) age 59.7 (8.1) years) had a follow-up between 10 and 14 years and were finally included in this study. The failure rate in the whole series and included patients was 26.4 and 16.3 %, respectively, for a mean (SD) follow-up of 9.2 (3.2) years and 11.7 (1.4) years, respectively. Patellofemoral pain (p \ 0.0001), need for NSAIDs (p \ 0.0001), longitudinal (p \ 0.0001) and transversal (p \ 0.0001) patellar glide tests, Zholen's sign (p = 0.0007) and knee effusion (p = 0.02) significantly improved in the follow-up. Postoperative Knee Society Score (KSS) anatomical (p \ 0.0001), functional (p \ 0.0001) and total (p \ 0.0001) scores and Kujala's score (p = 0.001) were significantly higher compared to preoperative values. The patellar tilt (p = 0.001) and shift (p = 0.04) significantly improved postoperatively, whereas the patellofemoral osteoarthritis was not modified (n.s.) with respect to preoperative assessment. Conclusions The lateral facetectomy plus Insall's realignment procedure was a successful treatment for isolated patellofemoral osteoarthritis from a clinical, functional and radiographic point of view in the long-term follow-up. Level of evidence Prospective case series, Level IV.
Knee Surgery, Sports Traumatology, Arthroscopy, 2012
Purpose The purpose of this study was to report the survival analysis of partial lateral facetectomy and Insall's procedure in patients with isolated patellofemoral osteoarthritis, and to assess the risk and protective factors for failure of this procedure. Methods From 1992 to 2004, all subjects with isolated patellofemoral osteoarthritis who met the inclusion criteria and underwent this procedure were enrolled. Risk and protective factors for failure (failure considered as the need for total knee arthroplasty) were assessed by comparing obtained baseline data between failed and non-failed cases. Eighty-seven cases (mean (SD) age 61.8 (7.7) years, mean (SD) follow-up 9.6 (3.2) years) were included. Results Twenty-three failed cases were found. Mean (SD) survival time was 13.6 (0.5) years. At 13 years (last failure case), the cumulative survival was 59.3 %. Baseline medial tibiofemoral pain, genu flexum, and worst grade of tibiofemoral osteoarthritis were significant risk factors for failure (p \ 0.0001, p = 0.02, p \ 0.0001, respectively). In contrast, higher anatomical (p = 0.02) and total (p = 0.03) knee society score (KSS) scores, absence of knee effusion (p = 0.03), higher value of the Caton-Deschamps index (p = 0.03), and lateral position of the patella (p = 0.01) were all protective factors against failure. Conclusion The treatment for isolated patellofemoral osteoarthritis through partial lateral facetectomy and Insall's procedure demonstrated good long-term survival. The presence of preoperative medial tibiofemoral pain, genu flexum, and incipient tibiofemoral osteoarthritis increased the risk of failure of this procedure. In contrast, higher anatomical and total KSS scores, absence of knee effusion, higher value of the Caton-Deschamps index, and lateral position of the patella were found to protect against failure. Level of evidence Prospective case series, Level IV.
Journal of Bone and Joint Surgery, 2014
Background: Patellar mobilization technique during total knee arthroplasty has been debated, with some suggesting that lateral retraction, rather than eversion, of the patella may be beneficial. We hypothesized that patients with knees surgically exposed using patellar lateral retraction would have comparable outcomes with patients with knees surgically exposed using patellar eversion. Methods: After an a priori power analysis, 120 patients with degenerative arthrosis were prospectively enrolled and were randomized to one of two patellar exposure techniques during the primary total knee arthroplasty: lateral retraction or eversion. The primary outcome measure was one-year, dynamometer-measured quadriceps strength. The secondary outcome measures evaluated during hospital stay included the ability to straight-leg raise, visual analog scale in pain, walking distance, and length of stay. The secondary outcome measures that were evaluated preoperatively and through a one-year follow-up included the Short Form-36 Physical Component Summary and Mental Component Summary scores, range of motion, quadriceps strength, and radiographic rate of patella baja and tilt. Results: A mixed-model analysis of variance showed no significant differences between the two groups in the one-year outcome measures. At one year postoperatively, quadriceps strength was not different between groups (p = 0.77), and the range of motion significantly improved (p < 0.01) from preoperative values by a mean value (and standard deviation) of 6°± 17°, with no significant difference (p = 0.60) between groups. The Short Form-36 Physical Component Summary score and Mental Component Summary score significantly improved (p < 0.01) for both study groups from preoperatively to one year postoperatively with no significantly different effects between groups (time • group, p = 0.85 for the Physical Component Summary score and p = 0.71 for the Mental Component Summary score), and the scores were not different at one year after surgery. There were no significant differences between groups in the change in frequency of the radiographic patella baja (p = 0.99) or the radiographic patellar tilt (p = 0.77) from before surgery to one year after surgery. Conclusions: Lateral retraction of the patella did not lead to superior postoperative results compared with eversion of the patella during total knee arthroplasty as evaluated using our primary outcome measure of one-year, dynamometermeasured quadriceps strength or our secondary outcome measures. Level of-Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence. S urgical exposure of the knee during total knee arthroplasty requires mobilization of the patella. Eversion of the patella by twisting it on the axis of the extensor mechanism can augment surgical exposure and has been a routine part of surgical technique 1. Lateral retraction of the patella is an additional technique 2 whereby the patella is subluxed without eversion.