Patellar Clunk Syndrome in Fixed-Bearing Posterior-Stabilised versus Cruciate-Substituting Prostheses

Abstract

Purpose.To compare the outcome of fixed-bearing posterior-stabilised versus cruciate-substituting prostheses in 46 patients who underwent primary bilateral total knee replacement (TKR). Methods. Records of 35 women and 11 men aged 54 to 78 (mean, 67) years who underwent primary bilateral TKR for osteoarthritis (n=44) and rheumatoid arthritis (n=2) were retrospectively reviewed. A fixed-bearing posterior-stabilised prosthesis (Zimmer NexGen Legacy flex [LPS-Flex]) was used in one knee, and a fixed-bearing cruciate-substituting prosthesis (Depuy Press Fit Condylar Sigma CS [PFC CS]) was used in the contralateral knee. The mean time interval between the 2 operations was 34 (range, 4-60) months. All operations were performed by the same group of surgeons using standardised techniques. The medial parapatellar approach was used, and the patella was resurfaced. Rehabilitation was also standardised. Outcome measures included the pre-and post-operative active range of movement Patellar clunk syndrome in fixed-bearing posterior-stabilised versus cruciate-substituting prostheses

Anterior knee pain following primary total knee arthroplasty

“…It is due to the formation of a fibrous nodule between the superior pole of the patellar and femoral component and the quadriceps tendon, which causes pain and displaces (clunks) with extension of the knee from approximately 30 to 45 degrees of flexion [46][47][48] . The etiology is multifactorial with the femoral component considered to be one of the contributors leading to the development of this syndrome [45,47] .…”

“…Several design flaws of the femoral prosthesis have been proposed including: a sharp anterior edge at the superior aspect of the intercondylar box, a high intercondylar box ratio, an increased posterior condyle offset, and the use of smaller femoral components [45,47,48] . In addition, specific total knee systems, most notable posteriorly-stabilized TKA, have been associated with a higher incidence of patellar clunk [44,46,48] . While treatment for this syndrome is accomplished by either open or arthroscopic correction, prevention is always preferred [45] .…”

“…While treatment for this syndrome is accomplished by either open or arthroscopic correction, prevention is always preferred [45] . Attempts of reducing this postoperative complication have included the following modifications to the femoral components: smoothing the transition from the notch to the anterior flange, raising the lateral flange, deepening the trochlear groove, and incorporating a more posterior intercondylar box [45][46][47][48] . To minimize the occurrence of patellar clunk syndrome, both manufactures and surgeons must continue to assess the advantages of altering the current designs of femoral components.…”

Patello-femoral clunk syndrome-current concepts

“…5 The Press Fit Condylar Cruciate sacrificing prosthesis is more likely to be associated with the patellar clunk syndrome. 6 The formation of peripatellar inflammatory scar tissue is related to implant design and surgical technique. In patients with more disabling symptoms such as catching, early intervention with open scar excision should be considered.…”

Assessment of standardization in surgical skin preparation: does a compliance-culture exist?

“…1 With the current trends of unsustainable growth and increasing cost, healthcare facilities are faced with a crucial need to improve quality and decrease expenses while continuing to deliver patient-centered care. 2 Each year, 1.7 million patients develop a healthcare-associated infection (HAI), 3 leading to $40 billion in added annual costs. 4 The most common types of HAI were pneumonia (21.8%), surgical-site infections (21.8%), and gastrointestinal infections (17.1%).…”