Peri-prosthetic patella fracture is the second most common peri-prosthetic fracture after total knee arthroplasty. This report presented the treatment results in 6 patients with peri-prosthetic patella fractures. From January 2015 to February 2019, six patients with peri-prosthetic patella fractures were treated. The mean age at surgery was 64 years (range, 48–72 years). Four patients with displaced fractures were treated surgically, and two patients with non-displaced fractures were treated non-surgically. Outcomes were assessed in terms of motion, functional knee score, and Knee Society score. The mean follow-up period lasted 16 months (range: 12–20 months). The average arc of motion was 110° (range: 80°–130°). The mean functional knee score was 77 (range: 70–87). The mean Knee Society score was 84 (range: 75–89). The non-surgical treatment may be a good choice for non-displaced peri-prosthetic patella fractures. For displaced fractures, surgical treatments yielded good functional outcomes. Level of evidence IVa

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The elderly present with progressive degenerative osteoarthritis of the knee and lumbar spine degeneration (LSD). The coexistent conditions when presented concurrently become challenging for the clinicians and surgeons, as well as determining the predominant source of the underlying pain generation factor. The concurrent presentation of a significant knee and low back pain poses challenges in decision-making for treatment with management being normally individualized. The review narrates the different concepts used for the assessment of knee-spine syndrome. The prime factor for the pain needs to be ascertained by evaluating the deformity of the lumbar spine and the knees to address the causative factor appropriately. A thorough history, detailed examination, and supplemental diagnostic testing will differentiate the clinical entities and guide the treatment. However, a misdiagnosis may need a secondary site surgery and further treatment to alleviate the pain. Clinicians have been challenged while differentiating between the knee and spine pathology to target prime pain generator factors for adequate pain relief, improved functional outcomes, and substantial patient satisfaction. We present our strategy for the management of knee-spine syndrome. The protocols utilized to manage the clinical scenario have been reviewed and discussed. Clinical pearls to identify and treat the symptomatic concurrent knee-spine degeneration are presented. There is still a lack of consensus on the concurrent knee-spine degenerative pathology and its management strategy. The dilemma persists, and a case-based approach needs to be adopted by surgeons.

Unilateral painful swelling of the knee is one of the most common orthopedic presentations. Monoarticular synovitis of the knee may be present due to inflammation, trauma, age-related degeneration, or tumor pathology. Primary synovial chondromatosis (PSC) is an uncommon cause.A 40-year-old female presented with painful swelling of her left knee for around nine months. She had a flexion deformity of her left knee with minimal hydrops. The radiograph showed speckled calcifications and osteopenia with a reduction of medial joint space. MRI imaging confirmed synovitis with calcifications. She underwent an arthroscopic synovectomy for her management. Her biopsy was consistent with synovial chondromatosis. The initial progression was favorable to allowing independent, unsupported, pain-free activities of daily routine. At three months, however, there was disease progression, causing limitation of knee movements and the need for a walker for support.An uncommon cause of synovitis presents at a late stage with a delay in the early diagnosis and early recognition. PSC is considered a benign lesion with good functional outcomes after arthroscopic surgery. Recurrence and poor functional outcome possibly suggest aggressive disease.A delayed diagnosis and late presentation may be susceptible to recurrence and poor functional outcome, even after an adequate arthroscopic debridement and rigorous post-operative rehabilitation program.

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