Revision total knee arthroplasty for patellar dislocation in patients with malrotated TKA components

Warschawski, Yaniv; Garceau, Simon; Rutenberg, Tal Frenkel; Dahduli, Omar; Wolfstadt, Jesse; Backstein, David

doi:10.1007/s00402-020-03468-6

Cited by 10 publications

(10 citation statements)

References 24 publications

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“…The results of patients treated with revision arthroplasty of the tibial and femoral components for PFI after TKA were recently described by Warschawski et al. [ 5 ]. In this study, patients underwent revision based on an intraoperative assessment of component positioning.…”

Section: Discussionmentioning

confidence: 99%

“…Aetiology of PFI following TKA is either implant-related, soft-tissue-related, or a combination of the 2. The most frequently cited cause is femoral or tibial component internal rotation (IR) [ [3] , [4] , [5] ], and when present, revision arthroplasty is recommended [ 5 , 6 ]. What defines the threshold for malrotation has not been clearly defined.…”

Section: Introductionmentioning

confidence: 99%

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Can Patella Instability After Total Knee Arthroplasty be Treated With Medial Patellofemoral Ligament Reconstruction?

et al. 2022

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Can Patella Instability After Total Knee Arthroplasty be Treated With Medial Patellofemoral Ligament Reconstruction?

et al. 2022

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“…Surgical management of patella instability after TKA broadly follows one of two pathways [8]. Either revision of components deemed to be malpositioned [9] or patella stabilization with soft-tissue, bony or combined procedures [8,10,11]. Implant positioning limits have not been well defined, and revision of well-fixed implants is a morbid procedure associated with bone loss and soft tissue damage that often requires the use of highly constrained implants that have twice the failure rate of primary implants after 10 years [12].…”

Section: Discussionmentioning

confidence: 99%

Tibial tuberosity osteotomy and medial patellofemoral ligament reconstruction for patella dislocation following total knee arthroplasty: A double fixation technique

Shatrov

Colas

Fournier

et al. 2022

SICOT-J

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Introduction: Patella instability post total knee arthroplasty (TKA) is a rare complication. Tibial tubercle osteotomy (TTO) with medial patellofemoral ligament reconstruction (MPFLr) has not been well described for this indication. This paper describes a surgical technique to address the unique challenges faced when performing TTO and MPFLr in the prosthetic knee. Technique: This technique and video describe a TTO and MPFLr via an extensile incision and medial sub-vastus approach. A 6 cm long TTO is performed, if indicated, to medialise the extensor mechanism up to 1 cm and fixed with ×2 4.5 mm cortical screws. For the MPFLr, a quadriceps tendon autograft is utilized, with the natural insertion to the superior pole of the patella being left undisturbed. The graft is first attached with an interference screw and then reinforced with an endobutton to provide crucial cortical fixation to overcome the problem of low bone mineral density encountered in this area of the femur following TKA. Results: Five patients underwent MPFLr using the described technique. No failures or recurrence of instability occurred at the last follow-up. Pre-operative mean patella tilt and shift were 44° and 3.5 cm, respectively. Post-operatively, mean tilt and shift were 4.1° and 0.4 cm, respectively. There was one wound dehiscence requiring surgical debridement and closure. Conclusion: This paper describes a surgical technique to perform a TTO and MPFLr for patella instability post-TKA. The described method highlights key adaptations to address the unique challenges in this patient population.

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“…Komponent malrotasyonu, uygunsuz patellar hazırlık (malpozisyon veya asimetrik kemik rezeksiyonu), yumuşak doku dengesizliği (medial retinaküler yetmezlik, vastus medialis kasının zayıflığı, kuadriseps kas kontraktürü, iliotibial bant gerginliği), valgus dizilim bozukluğu (Q açısını etkileyerek ekstansör mekanizma üzerinde dengesiz çekme yapar), protez tasarımındaki eksiklikler veya travma gibi problemler patella çıkığına neden olabilmektedirler (Şekil 4). [17] Femoral komponentin iç rotasyonda yerleştirilmesi troklear oluğu mediale yer değiştirtir. Bu lateral retinakulumun gerilimini artırarak patellanın laterale çıkma…”

Section: Patella Subluksasyonu Ve Patella çıKığıunclassified

“…Sonuç olarak her iki komponentin aşırı iç rotasyonda yerleştirilmesi patellar çıkık riskini artırmaktadır. [17,18] Patellar çıkığı olan hastalarda, ambulasyon yeteneğini yeniden kazanmak için genellikle revizyon cerrahisi gereklidir. Komponentlerin malpoziyonu durumlarında tüberositas tibia osteotomisi, lateral retinakuler gevşetme, medial patellofemoral ligament augmentasyonu veya rekonstrüksiyonu gibi cerrahi tedaviler önerilmektedir.…”

Section: Tibiofemoral çıKıkunclassified

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Revision total knee arthroplasty for patellar dislocation in patients with malrotated TKA components

Cited by 10 publications

References 24 publications

Can Patella Instability After Total Knee Arthroplasty be Treated With Medial Patellofemoral Ligament Reconstruction?

Can Patella Instability After Total Knee Arthroplasty be Treated With Medial Patellofemoral Ligament Reconstruction?

Tibial tuberosity osteotomy and medial patellofemoral ligament reconstruction for patella dislocation following total knee arthroplasty: A double fixation technique

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