Patellar Complications after Total Knee Arthroplasty.

Putman, Sophie; Boureau, Florian; Girard, Julien; Migaud, Henri; Pasquier, Gilles

Document type :

Article dans une revue scientifique: Article de synthèse/Review paper

DOI :

10.1016/j.otsr.2018.04.028

PMID :

29990602

Permalink :

http://hdl.handle.net/20.500.12210/11980

Title :

Patellar Complications after Total Knee Arthroplasty.

Author(s) :

Putman, Sophie [Auteur]

Evaluation des technologies de santé et des pratiques médicales - ULR 2694 [METRICS]
Boureau, Florian [Auteur]
Girard, Julien [Auteur]

Unité de Recherche Pluridisciplinaire Sport, Santé, Société (URePSSS) - ULR 7369
Unité de Recherche Pluridisciplinaire Sport, Santé, Société (URePSSS) - ULR 7369 - ULR 4488 [URePSSS]
Migaud, Henri [Auteur]

Marrow Adiposity & Bone Lab (MABLab) - ULR 4490
Marrow Adiposity & Bone Lab - Adiposité Médullaire et Os - ULR 4490 [MABLab]
Pasquier, Gilles [Auteur]

Marrow Adiposity & Bone Lab (MABLab) - ULR 4490
Marrow Adiposity & Bone Lab - Adiposité Médullaire et Os - ULR 4490 [MABLab]

Journal title :

Orthopaedics & Traumatology: Surgery & Research

Abbreviated title :

Orthop Traumatol Surg Res

Publication date :

2018-07-07

ISSN :

1877-0568

English keyword(s) :

Total knee arthroplasty
Complications
Patella

HAL domain(s) :

Sciences du Vivant [q-bio]

English abstract : [en]

Patellar complications are a source of poor total knee arthroplasty (TKA) outcomes that can require re-operation or prosthetic revision. Complications can occur with or without patellar resurfacing. The objective of this ...
Show more >Patellar complications are a source of poor total knee arthroplasty (TKA) outcomes that can require re-operation or prosthetic revision. Complications can occur with or without patellar resurfacing. The objective of this work is to answer six questions. (1) Have risk factors been identified, and can they help to prevent patellar complications? Patellar complications are associated with valgus, obesity, lateral retinacular release, and a thin patella. Selecting a prosthetic trochlea that will ensure proper patellar tracking is important. Resurfacing is an option if patellar thickness is greater than 12mm. (2) What is the best management of patellar fracture? The answer depends on two factors: (a) is the extensor apparatus disrupted? and (b) is the patellar implant loose? When either factor is present, revision surgery is needed (extensor apparatus reconstruction, prosthetic implant removal). When neither factor is present, non-operative treatment is the rule. (3) What is the best management of patellar instability? Rotational malalignment should be sought. In the event of femoral and/or tibial rotational malalignment, revision surgery should be considered. If not performed, options consist of medial patello-femoral ligament reconstruction and/or medialization tibial tuberosity osteotomy. (4) What is the best management of patellar clunk syndrome? When physiotherapy fails, arthroscopic resection can be considered. Recurrence can be treated by open resection, despite the higher risk of complications with this method. (5) What is the best management of anterior knee pain? The patient should be evaluated for causes amenable to treatment (fracture, instability, clunk, osteonecrosis, bony impingement on the prosthetic trochlea). If patellar resurfacing was performed, loosening should be considered. Otherwise, secondary resurfacing is appropriate only after convincingly ruling out other causes of pain. A painstaking evaluation is mandatory before repeat surgery for anterior knee pain: surgery is not in order in the 10% to 15% of cases that have no identifiable explanation. (6) What can be done to treat patellar defects? Available options include re-implantation (with bone grafting, cement, a biconvex implant, or a metallic frame), bone grafting without re-implantation, patellar reconstruction, patellectomy (best avoided due to the resulting loss of strength), osteotomy, and extensor apparatus allograft reconstruction. LEVEL OF EVIDENCE: V, expert opinion.Show less >

Language :

Anglais

Peer reviewed article :

Oui

Audience :

Internationale

Popular science :

Non

Administrative institution(s) :

CHU Lille
Univ. Littoral Côte d’Opale
Univ. Artois
Université de Lille

Collections :

Research team(s) :

Activité Physique, Muscle, Santé (APMS)

Submission date :

2019-09-24T07:28:03Z
2021-05-20T12:57:24Z
2024-02-26T10:56:44Z

Files

1-s2.0-S1877056818301804-main.pdf
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Version	Link	Modification date
3	20.500.12210/11980*	2024-02-26T10:54:44Z
2	20.500.12210/11980.2	2021-05-20T12:57:00Z
1	20.500.12210/11980.1	2019-09-24T07:28:03Z

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