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Journal of Orthopaedic Surgery and... Mar 2021The decision to resurface the patella as part of total knee arthroplasty may be influenced by the surgeon's preference, education, training, tradition and geographic... (Comparative Study)
Comparative Study Review
BACKGROUND
The decision to resurface the patella as part of total knee arthroplasty may be influenced by the surgeon's preference, education, training, tradition and geographic location. Advocates for non-resurfacing or selectively resurfacing may claim no difference in patient reported outcomes, and that resurfacing is associated with increased risks such as extensor mechanism injury or malalignment, problems with the design of the patella component and technical issues intraoperatively.
AIMS
To critically examine factors that should be considered in addition to patient reported outcomes in the decision process of resurfacing or non-resurfacing of the patella in total knee arthroplasty.
METHOD
A comprehensive literature search was conducted to identify factors that may influence decision making in addition to knee specific patient reported outcome measures such as surgical risks, patient quality of life, procedure cost, re-operation rate, implant design, surgeons learning curve and the fate of remaining cartilage in native patellae.
RESULTS
Patient-reported outcomes are equivocal for resurfacing and non-resurfacing. Critical analysis of the available literature suggests that the complications of resurfacing the patella are historic, which is now lower with improved implant design and surgical technique. Routine resurfacing was cost-effective in the long term (potential saving £104 per case) and has lower rates of revision (absolute risk reduction 4%). Finally, surgical judgment in selective resurfacing was prone to errors.
CONCLUSION
Patella resurfacing and non-resurfacing had similar patient-reported outcomes. However, patella resurfacing was cost-effective and was associated with a lower rate of re-operation compared to non-resurfacing.
Topics: Arthroplasty, Replacement, Knee; Cost-Benefit Analysis; Humans; Patella; Reoperation
PubMed: 33706779
DOI: 10.1186/s13018-021-02295-8 -
Musculoskeletal Surgery Jun 2023Patella maltracking is among the most frequent causes of poor outcomes and early failure after total knee arthroplasty (TKA), with an incidence that ranges from 1 to... (Review)
Review
PURPOSE
Patella maltracking is among the most frequent causes of poor outcomes and early failure after total knee arthroplasty (TKA), with an incidence that ranges from 1 to 20%. Even if there is agreement between authors regarding the preoperative and intraoperative management of patella maltracking in TKA, less clear are postoperative conducts. The purpose of this systematic review is to summarize and compare surgical techniques used to treat patella maltracking after TKA.
METHODS
A systematic review of the literature was performed with a primary search on Medline through PubMed. The PRISMA 2009 flowchart and checklist were used to edit the review. Screened studies had to provide clinical, functional and radiological results and complications of the proposed treatment to be included in the review.
RESULTS
A total of 21 articles were finally included. Three main types of surgical procedures and other minor techniques have been identified to manage patella maltracking after TKA. The choice of the proper technique to use in the specific case depends on several factors, first of all the malpositioning of the prosthetic components.
CONCLUSION
Patella maltracking after TKA represents a frequent and challenging problem for orthopedic surgeons. Treatments described in the literature are often able to correct an abnormal patellar tracking; nevertheless, authors report variable percentages of residual knee pain and dissatisfaction in re-treated patients. Therefore, it would be desirable to prevent the maltracking condition at the time of primary arthroplasty, using proper surgical precautions.
Topics: Humans; Arthroplasty, Replacement, Knee; Patella; Knee Joint; Radiography
PubMed: 36197592
DOI: 10.1007/s12306-022-00764-9 -
JBJS Reviews Jan 2019
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Journal of Long-term Effects of Medical... 2015The absence or dysfunction of the knee extensor mechanism accelerates degenerative joint disease and complicates knee arthroplasty. Various treatment strategies have... (Review)
Review
The absence or dysfunction of the knee extensor mechanism accelerates degenerative joint disease and complicates knee arthroplasty. Various treatment strategies have been suggested to improve outcomes in total knee arthroplasties after patellectomy (semi- or constrained components, autograft, allograft, prosthetic reconstruction), but the optimal management of this condition is not known. The purpose of this report is to review the relevant basic biology and biomechanics of the patella and the extensor mechanism, and to review the current literature on the management of complete patellectomy during total knee arthroplasty. Tissue engineered heart valves, BMMSCs, oscillatory shear stress, nicotine, F-actin filaments, cell differentiation, endothelial cells.
Topics: Arthroplasty, Replacement, Knee; Biomechanical Phenomena; Biomedical and Dental Materials; Bone Transplantation; Humans; Knee Joint; Patella; Prostheses and Implants; Range of Motion, Articular; Reoperation
PubMed: 26756555
DOI: 10.1615/jlongtermeffmedimplants.2014010499 -
The Journal of Arthroplasty Sep 2019Currently, the decision to resurface the patella is often made irrespective of the presence of patellar arthritis. The purpose of this study is to utilize the existing... (Review)
Review
BACKGROUND
Currently, the decision to resurface the patella is often made irrespective of the presence of patellar arthritis. The purpose of this study is to utilize the existing literature to assess cost-utility of routinely vs selectively resurfacing the patella.
METHODS
Prospective randomized studies of patella resurfacing vs non-resurfacing in total knee arthroplasty (TKA) were identified through literature review. Data from these studies represented probabilities of varied outcomes following TKA dependent upon patella resurfacing. Using previously validated utility scores from the McKnee modified Health Utilities Index, endpoint utility values were provided for each potential outcome.
RESULTS
Literature review yielded a total of 14 studies with 3,562 patients receiving 3,823 TKAs, of which 1,873 (49.0%) patellae were resurfaced. Persistent postoperative anterior knee pain occurred in 20.9% vs 13.2% (P < .001) and patella reoperation was performed in 3.7% vs 1.6% (P < .001) of unresurfaced and resurfaced patella, respectively. In studies excluding those with arthritic patellae, the incidence of anterior knee pain was equivalent between groups and reoperation decreased to 1.2% vs 0% (P = .06). Patella resurfacing provided marginally improved quality-adjusted life-years (QALY) for both selective and indiscriminate patella resurfacing. When including all studies, the incremental cost per QALY was $3,032. However, when analyzing only those studies with nonarthritic patellae, the incremental cost per QALY to resurface the patella increased to $183,584.
CONCLUSION
Patellar resurfacing remains a controversial issue in TKA. Utilizing data from new prospective randomized studies, this analysis finds that routinely resurfacing arthritis-free patellae in TKA are not cost-effective.
Topics: Arthroplasty, Replacement, Knee; Cost-Benefit Analysis; Decision Trees; Humans; Knee Joint; Osteoarthritis, Knee; Patella; Probability; Prospective Studies; Quality-Adjusted Life Years; Randomized Controlled Trials as Topic; Reoperation; Treatment Outcome
PubMed: 31104838
DOI: 10.1016/j.arth.2019.04.040 -
European Journal of Orthopaedic Surgery... Dec 2019Early patellar failures in tricompartmental total knee arthroplasty (TKA) have been related to universal designing of implants. Establishing the appropriate patellar...
INTRODUCTION
Early patellar failures in tricompartmental total knee arthroplasty (TKA) have been related to universal designing of implants. Establishing the appropriate patellar bone-prosthesis composite thickness is one of the important steps in ensuring functional success in arthroplasty. Since there is a paucity of data concerning the anthropometric measurements of Indian patella, the objective of this study was to obtain anatomic information of the patella of the northern Indian population and to analyze how it differs from western patellae that will improve patellar component design and implantation in TKA.
MATERIALS AND METHODS
A total of 266 consecutive knee radiographs were evaluated. All data were collected by a single doctor using X-ray console, where height (mm) and breadth (mm) were taken in anteroposterior views and thickness (mm) in lateral view.
RESULTS
The mean, standard deviation, 95% confidence interval and P value of the measurements were calculated. It was found that Indians had thinner and smaller patella as compared to westerners and also males had significantly (P < .001) larger patella as compared to females.
CONCLUSION
Anthropometric patellar dimensions can influence implant design and surgical outcomes and can be used as a guideline for future designing of more regional and gender-specific patellar component and patellar plate.
Topics: Adolescent; Adult; Anthropometry; Arthroplasty, Replacement, Knee; Female; Humans; India; Knee Prosthesis; Male; Middle Aged; Patella; Prosthesis Design; Prosthesis Failure; Radiography; Sex Factors; White People; Young Adult
PubMed: 31286219
DOI: 10.1007/s00590-019-02490-8 -
Seminars in Musculoskeletal Radiology Feb 2018We discuss the pediatric patella, with an emphasis on diagnostic imaging. Topics include normal patellar development, anatomical variants and their physiologic... (Review)
Review
We discuss the pediatric patella, with an emphasis on diagnostic imaging. Topics include normal patellar development, anatomical variants and their physiologic significance, genetic syndromes that alter the appearance of the patella, physiology of patellar tracking and stability, patellofemoral instability, and injury patterns and classification. Recognition of appropriate development on imaging prevents diagnostic error and unnecessary evaluation. Knowledge of the pertinent features of syndromes associated with morphological patellar abnormalities can aid in generating a succinct and relevant differential diagnosis. In patellofemoral instability, the patient's baseline anatomy, factors that predispose to instability, and the specific injuries that occur as a result are critical considerations for determining the course of treatment. Patellar sleeve fractures are unique to pediatric patients, and timely identification is critical to achieving an optimal treatment outcome.
Topics: Anatomic Variation; Child; Humans; Knee Injuries; Knee Joint; Patella; Risk Factors; Syndrome
PubMed: 29409075
DOI: 10.1055/s-0037-1608004 -
Clinics in Sports Medicine Jan 2022Patella alta is described as abnormally high-riding patella in relation to the femur, the trochlear groove, or the tibia with decreased bony stability. Patella alta... (Review)
Review
Patella alta is described as abnormally high-riding patella in relation to the femur, the trochlear groove, or the tibia with decreased bony stability. Patella alta represents an important predisposing factor for patellofemoral instability. Different measurement methods are used to define patella alta. Despite the clinical importance of patella alta, there is only limited consensus on cutoff values, indications for treatment, and ideal correction. In addition, the impact of patella alta on other risk factors for lateral patellar instability is significant. This must be considered when assessing clinical complaints and choosing the best individual treatment. Combined surgical interventions may be necessary.
Topics: Humans; Joint Instability; Patella; Patellar Dislocation; Patellofemoral Joint; Risk Factors
PubMed: 34782076
DOI: 10.1016/j.csm.2021.07.002 -
Injury Jun 2022
Topics: Fractures, Bone; Humans; Knee Injuries; Patella
PubMed: 35643733
DOI: 10.1016/j.injury.2022.03.035 -
Knee Surgery, Sports Traumatology,... Oct 2022To evaluate the inter-observer and inter-method reliability for patellar height measurements between conventional radiographs (CR) and magnetic resonance imaging (MRI)...
PURPOSE
To evaluate the inter-observer and inter-method reliability for patellar height measurements between conventional radiographs (CR) and magnetic resonance imaging (MRI) using one or two slices.
METHODS
This was a reliability study, with 60 patients divided in two groups: 30 patients with patellar instability (patella group) and 30 patients with anterior cruciate ligament or meniscus injury (control group). CR and MRI were evaluated by two independent observers. Insall-Salvati index (IS) and Caton-Deschamps index (CD) were measured using three different methods: CR, one-slice MRI or two-slice MRI. Intra-class correlation coefficients (ICC) were calculated for inter-observer reliability and inter-method reliability. Bland-Altman agreement was also calculated.
RESULTS
The inter-observer reliability was very good for the IS with ICCs of 0.93, 0.84 and 0.82, for the CR, one-slice MRI and two-slice MRI, respectively. Similarly, for the CD the ICCs were good, 0.76, 0.80 and 0.75 for the CR, one-slice MRI and two-slice MRI, respectively. No differences were found between the patella and the control group. The inter-method analysis results were: ICCs for IS (0.83, 0.86, 0.93) and CD (0.72, 0.82, 0.83), for the comparisons of CR/one-slice MR, CR/two-slice MRI and one-slice MRI/two-slice MRI, respectively. The Bland-Altman mean differences showed an 8% and a 7% increase on IS values with one-slice MRI and two-slice MRI compared to CR results, while the increase was of 9% and 1% in CD for the respective comparisons with CR.
CONCLUSION
MRI can overestimate patellar height compared to CR, as much as an 8% increase in Insall-Salvati values when using one- or two-slice MRI measurements, and up to a 9% increase in Caton-Deschamps value when using the one-slice MRI method. It is recommended to use the CR as the preferred method when measuring patellar height.
LEVEL OF EVIDENCE
III.
Topics: Humans; Joint Instability; Magnetic Resonance Imaging; Patella; Patellofemoral Joint; Reproducibility of Results
PubMed: 35357529
DOI: 10.1007/s00167-022-06953-0