Knee osteoarthritis with patellar dislocation treated by total knee arthroplasty using a lateral parapatellar approach—ingenuity of exposure and closure

Abstract

Knee osteoarthritis with patellar dislocation is a rare and difficult-to-treat condition. Several reports of total knee arthroplasty (TKA) combined with various realignment procedures have been published. A 77-year-old man with knee pain was referred to our hospital. Plain radiography revealed a laterally dislocated patella, with osteoarthritic changes in the femorotibial joint. He simply underwent TKA via a lateral parapatellar approach without realignment. We devised methods of exposure and closure to maximize the effect of lateral release by the lateral parapatellar approach. TKA using the lateral parapatellar approach might be effective in treating knee osteoarthritis with patellar dislocation.

Transposition of the medial synovial flap to repair the lateral joint capsule in total knee arthroplasty for knee osteoarthritis with permanent patellar dislocation

“…Untimely and ineffective treatment often results in permanent patellar dislocation. Permanent patellar dislocation means that the patella cannot be reduced during knee straightening and exion 10,12 . The abnormal soft tissue structure around the knee joint is the leading cause of permanent dislocation of the patella: lengthening and relaxation of the medial joint capsule and retinaculum of the knee joint, contracture of the lateral joint capsule and retinaculum, contracture of the lateral part of the quadriceps tendon, and contracture of the iliotibial band.…”

“…In addition to pain, knee osteoarthritis can also lead to muscle contracture around the joint, exion deformity, valgus deformity, patellar dislocation, and so on 4,5 . Knee osteoarthritis with patellar dislocation will increase the di culty of TKA, especially in patients with permanent patellar dislocation [6][7][8][9][10][11] .…”

“…At present, only a few studies have reported the clinical effect of TKA in the treatment of knee osteoarthritis with permanent patellar dislocation 8, 10,12,13 . Revision of lateral capsular defects after restoring the patellar trajectory is a di cult procedure for patients with permanent patellar dislocation undergoing TKA 10,12,17,18 .…”

“…At present, only a few studies have reported the clinical effect of TKA in the treatment of knee osteoarthritis with permanent patellar dislocation 8, 10,12,13 . Revision of lateral capsular defects after restoring the patellar trajectory is a di cult procedure for patients with permanent patellar dislocation undergoing TKA 10,12,17,18 . At present, there are two main ways to repair the defect of the lateral articular capsule of the knee joint: the rst is to cut the lateral articular capsule in layers and then stagger and suture it to repair the articular capsule; and the second is to repair the defect of the joint capsule with an iliotibial band, infrapatellar fat pad, meniscus or subcutaneous fat 10,12,17,18 .…”

“…At present, there are two main ways to repair the defect of the lateral articular capsule of the knee joint: the rst is to cut the lateral articular capsule in layers and then stagger and suture it to repair the articular capsule; and the second is to repair the defect of the joint capsule with an iliotibial band, infrapatellar fat pad, meniscus or subcutaneous fat 10,12,17,18 . However, these methods have many disadvantages, such as the limited scope of repair, di culty in closing large joint capsule defects, leakage of articular uid after TKA, and limitations in performing functional exercise after TKA 10,12,17,18 . We used a medial synovial ap to repair the lateral joint capsule in TKA patients with osteoarthritis with permanent patellar dislocation.…”