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Clinical Orthopaedics and Related Research®

Published in:

01-01-2012 | Symposium: Papers Presented at the Annual Meetings of The Knee Society

Restoration of the Distal Femur Impacts Patellar Height in Revision TKA

Authors: Saurabh Khakharia, MD, Giles R. Scuderi, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 1/2012

Abstract

Background

Restoring patellar height is important in revision TKA for normal knee function and kinematics. Alteration in patellar height after revision TKA is associated with inferior extensor mechanism function.

Questions/purposes

We determined whether gap balancing with bone preservation and distal femoral augmentation would restore patellar height and patellar height changed in patients undergoing septic and aseptic revision TKA.

Patients and Methods

We retrospectively reviewed 76 patients who had revision TKA between 2006 and 2009; 12 had two-stage revisions for infected TKA, and 64 had revision for aseptic failure. We compared preoperative and postoperative radiographs and measured the patellar height using the Insall-Salvati ratio in both groups. We reviewed operative records to determine type of exposure and amount of distal femoral augmentation used to restore the joint line.

Results

Overall mean preoperative and postoperative Insall-Salvati ratios were 1.02 and 1.04, respectively. In the septic group, mean preoperative and postoperative Insall-Salvati ratios were 1.07 and 0.99, respectively. In the aseptic group, mean preoperative and postoperative Insall-Salvati ratios were 1.01 and 1.05, respectively. Overall, nine patients had preoperative patella baja; seven of these had an improvement to normal height. There was little difference in preoperative and postoperative Insall-Salvati ratios in patients with patella alta. Distal augmentation was used in 10 of 12 patients in the septic group and 48 of 64 patients in the aseptic group.

Conclusions

Surgeons can maintain normal patellar height and improve patella baja by preserving bone stock and using distal femoral augments to restore the distal joint line during revision TKA.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Bellemans J. Restoring the joint line in revision TKA: does it matter? Knee. 2004;11:3–5.PubMedCrossRef

Clatworthy MG, Gross AE. Management of bony defects in revision total knee replacement. In: Callaghan JJ, Rosenberg AG, Rubash HE, Simonian PT, Wickiewicz TL, eds. The Adult Knee. Philadelphia, PA: Lippincott Williams & Wilkins; 2003:1455–1463.

Figgie HE, Goldberg VM, Heiple KG, Moller HS, Gordon NH. The influence of tibial-patellofemoral location on function of the knee in patients with the posterior stabilized condylar knee prosthesis. J Bone Joint Surg Am. 1986;68:1035–1040.PubMed

Floren M, Davis J, Peterson MG, Laskin RS. A mini-midvastus capsular approach with patellar displacement decreases the prevalence of patella baja. J Arthroplasty. 2007;22:51–57.PubMedCrossRef

Hsu CS, Hsu CC, Wang JW, Lin PC. Two-stage revision of infected total knee arthroplasty using an antibiotic-impregnated static cement-spacer. Chang Gung Med J. 2008;31:583–591.PubMed

Insall J, Goldberg V, Salvati E. Recurrent dislocation and the high-riding patella. Clin Orthop Relat Res. 1972;88:67–69.PubMedCrossRef

Insall JN, Salvati E. Patella position in the normal knee joint. Radiology. 1971;101:101–104.PubMed

Koshino T, Ejima M, Okamoto R, Morii T. Gradual low riding of the patella during postoperative course after total knee arthroplasty in osteoarthritis and rheumatoid arthritis. J Arthroplasty. 1990;5:323–327.PubMedCrossRef

Kurtz S, Mowat F, Ong K, Chan N, Lau E, Halpern M. Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002. J Bone Joint Surg Am. 2005;87:1487–1497.PubMedCrossRef

10.

Lancourt JE, Cristini JA. Patella alta and patella infera: their etiological role in patellar dislocation, chondromalacia, and apophysitis of the tibial tubercle. J Bone Joint Surg Am. 1975;57:1112–1115.PubMed

11.

Laskin RS. Management of the patella during revision total knee replacement arthroplasty. Orthop Clin North Am. 1998;29:355–360.PubMedCrossRef

12.

Laskin RS. Joint line position restoration during revision total knee replacement. Clin Orthop Relat Res. 2002;404:169–171.PubMedCrossRef

13.

Lavernia C, Lee DJ, Hernandez VH. The increasing financial burden of knee revision surgery in the United States. Clin Orthop Relat Res. 2006;446:221–226.PubMedCrossRef

14.

Lucey SD, Scuderi GR, Kelly MA, Insall JN. A practical approach to dealing with bone loss in revision total knee arthroplasty. Orthopedics. 2000;23:1036–1041.PubMed

15.

Meneghini RM, Ritter MA, Pierson JL, Meding JB, Berend ME, Faris PM. The effect of the Insall-Salvati ratio on outcome after total knee arthroplasty. J Arthroplasty. 2006;21:116–120.PubMedCrossRef

16.

Partington PF, Sawhney J, Rorabeck CH, Barrack RL, Moore J. Joint line restoration after revision total knee arthroplasty. Clin Orthop Relat Res. 1999;367:165–171.PubMedCrossRef

17.

Porteous AJ, Hassaballa MA, Newman JH. Does the joint line matter in revision total knee replacement? J Bone Joint Surg Br. 2008;90:879–884.PubMedCrossRef

18.

Radnay CS, Scuderi GR. Management of bone loss: augments, cones, offset stems. Clin Orthop Relat Res. 2006;446:83–92.PubMedCrossRef

19.

Scuderi GR. Revision total knee arthroplasty: how much constraint is enough? Clin Orthop Relat Res. 2001;392:300–305.PubMedCrossRef

20.

Scuderi GR, Windsor RE, Insall JN. Observations on patellar height after proximal tibial osteotomy. J Bone Joint Surg Am. 1989;71:245–248.PubMed

21.

Singerman R, Davy DT, Goldberg VM. Effects of patella alta and patella infera on patellofemoral contact forces. J Biomech. 1994;27:1059–1065.PubMedCrossRef

22.

Whittaker JP, Dharmarajan R, Toms AD. The management of bone loss in revision total knee replacement. J Bone Joint Surg Br. 2008;90:981–987.PubMedCrossRef

23.

Yoshii I, Whiteside LA, White SE, Milliano MT. Influence of prosthetic joint line position on knee kinematics and patellar position. J Arthroplasty. 1991;6:169–177.PubMedCrossRef

Title: Restoration of the Distal Femur Impacts Patellar Height in Revision TKA
Authors: Saurabh Khakharia, MD
Giles R. Scuderi, MD
Publication date: 01-01-2012
Publisher: Springer-Verlag
Published in: Clinical Orthopaedics and Related Research® / Issue 1/2012
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-011-1995-7

At a glance: The STEP trials

Springer Medicine

Restoration of the Distal Femur Impacts Patellar Height in Revision TKA

Abstract

Background

Questions/purposes

Patients and Methods

Results

Conclusions

Level of Evidence

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Questions/purposes

Patients and Methods

Results

Conclusions

Level of Evidence

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