Radiographic features predictive of patellar maltracking during total knee arthroplasty

2009 ◽  
Vol 17 (10) ◽  
pp. 1217-1224 ◽  
Author(s):  
Shi-Lu Chia ◽  
Azhar M. Merican ◽  
Bernard Devadasan ◽  
Robin K. Strachan ◽  
Andrew A. Amis
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Radiographic Features ◽  
Patellar Maltracking ◽  
Total Knee

scholarly journals Overcoming the Technical Challenges of Total Knee Arthroplasty in Patients Affected by Hereditary Multiple Exostoses: Our Experience Managing the Bone Deformities

2021 ◽  
Author(s):  
Eugenio Cammisa ◽  
Domenico Alesi ◽  
Amit Meena ◽  
Giada Lullini ◽  
Stefano Zaffagnini ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Clinical Results ◽  
Caucasian Woman ◽  
Hereditary Multiple Exostoses ◽  
Patellar Maltracking ◽  
Multiple Exostoses ◽  
Ligament Instability ◽  
Knee Deformity ◽  
Total Knee

Abstract Introduction: Hereditary multiple exostoses (MHE), also known as familiar osteochondromatosis or diaphyseal aclasis, is an autosomal dominant inherited genetic pathology that is characterized by the presence of multiple benign osteochondromas (exostoses). Knee deformity is common in patients with HME, with nearly a third of patients developing genu valgus. Total knee arthroplasty (TKA) has been used to correct valgus deformities with advanced knee osteoarthritis (OA). However concomitant limb deformities and altered anatomy of the knee make this surgery particularly challenging.Case presentation: We present the case of a 50 years old Caucasian woman, affected by multiple hereditary exostoses, who came to our attention for progressive pain in the right knee. Upon further examination the knee had a prominent valgus alignment, concomitant valgus instability and flexion contraction. The patient was treated with one stage total knee arthroplasty using a semi-constrained design. The patient was re-evaluated at 24 months follow-up and there were no signs of implant loosening, the knee function improved significantly and the patient was very satisfiedConclusions: We also present a mini-review of the literature on this topic. Given the recurring technical difficulties of such procedure in these patients, we describe our experience as well as the need for preoperative planning, the use of appropriate constrain when required, the high frequency of ligament instability, bony defects, and patellar maltracking. TKA must be considered when necessary, in these patients, as good to excellent clinical results can be achieved and maintained, allowing for significant improvements in quality of life.

Comparison between Single- and Multi-Radius Prostheses Used in Modified Kinematically Aligned Cruciate-Retaining Total Knee Arthroplasty

2020 ◽  
Author(s):  
Tomoyuki Matsumoto ◽  
Yoshinori Takashima ◽  
Koji Takayama ◽  
Kazunari Ishida ◽  
Naoki Nakano ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Clinical Outcomes ◽  
Knee Arthroplasty ◽  
Simulation Software ◽  
Patellar Tracking ◽  
Trochlear Groove ◽  
Lateral Retinacular Release ◽  
Cruciate Retaining ◽  
Patellar Maltracking ◽  
Total Knee

AbstractKinematically aligned total knee arthroplasty (TKA) has gained interest for achieving more favorable clinical outcomes than mechanically aligned TKA. The present study aimed to compare the clinical outcomes of kinematically aligned TKAs using single-radius (SR) or multi-radius (MR) prostheses. Sixty modified kinematically aligned cruciate-retaining TKAs (30 SR and 30 MR type prostheses) were performed in patients with varus-type osteoarthritis using a navigation system. Intraoperative and postoperative patellar tracking were compared between the two groups. Trochlea shape was also compared between the prostheses and preoperative native anatomy using three-dimensional simulation software. Total 2 years postoperatively, the range of motion and 2011 Knee Society Scores (KSS) were compared between the two groups. There were no differences in patellar maltracking including patellar lateral shift and tilt between the two groups; however, the ratio of intraoperative lateral retinacular release for adjusting patellar tracking was significantly higher in the MR group than in the SR group. Lateral and medial facet heights in both prostheses were understuffed compared with native knee anatomy, while the deepest point of the trochlear groove was significantly more medial in the MR group. The postoperative clinical outcomes showed no significant differences between the two groups. In conclusion, modified kinematically aligned TKAs using a SR or MR prosthesis showed no significant differences in clinical outcomes or patellar tracking when appropriate lateral retinacular release was performed.

scholarly journals Intraoperative patellar maltracking and postoperative radiographic patellar malalignment were more frequent in cases of complete medial collateral ligament release in cruciate-retaining total knee arthroplasty

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Jung Ho Noh ◽  
Nam Yeop Kim ◽  
Ki Ill Song
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Patellar Tracking ◽  
Collateral Ligament ◽  
Cruciate Retaining ◽  
Lateral Tilt ◽  
Patellar Maltracking ◽  
Total Knee ◽  
Group 2 ◽  
Group 1

Abstract Background Patellar maltracking after total knee arthroplasty (TKA) can lead to significant patellofemoral complications such as anterior knee pain, increased component wear, and a higher risk of component loosening, patellar fracture, and instability. This study was to investigate the preoperative and operative variables that significantly affect patellar tracking after cruciate-retaining TKA. Methods We studied 142 knee joints in patients who had undergone TKA: the knees were dichotomized based on postoperative patellar tracking, which was evaluated on patellar skyline, axial-projection radiographs: group 1, normal patellar tracking (lateral tilt ≤ 10° and displacement ≤ 3 mm) and group 2, patellar maltracking (lateral tilt > 10° or displacement > 3 mm). The patients’ demographic data and clinical and radiographic measurements obtained before and after surgery were compared between the two groups. Results Preoperative lateral patellar displacement was greater (4.1 ± 2.6 mm vs. 6.0 ± 3.5 mm), as was the frequency of medial collateral ligament (MCL) release (3/67 vs. 24/75) in group 2 than in group 1 (p < 0.001 and p < 0.001, respectively). The distal femur was cut in a greater degree of valgus in group 1 than in group 2. (6.3 ± 0.8° vs. 6.0 ± 0.8°) (p = 0.034). Conclusions Complete release of the MCL during surgery was associated with patellar maltracking (logistic regression: p = 0.005, odds ratio = 20.592). Surgeons should attend to patellar tracking during surgery in medially tight knees. Level of evidence Retrospective comparative study, level III.

scholarly journals The Effect of Partial Lateral Facetectomy of the Patella on the Radiographic and Clinical Outcome of Unresurfaced Patellar-retaining Total Knee Arthroplasty

2020 ◽  
Vol 7 (1) ◽  
pp. 1-6
Author(s):  
Abolfazl Bagherifard ◽  
◽  
Mahmoud Jabalameli ◽  
Fouad Rahimi ◽  
Mohamad Taher Ghaderi ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Functional Outcome ◽  
Knee Arthroplasty ◽  
Lateral Release ◽  
Patellar Tilt ◽  
Patellar Maltracking ◽  
Patellar Shift ◽  
Total Knee ◽  
The Mean ◽  
Patellar Retaining

Background: Management of patellar maltracking during primary TKA is of considerable importance. Lateral release, which is generally performed for this purpose, is associated with several complications. Objectives: In this study, we aimed to evaluate the role of partial lateral facetectomy in tracking the patella in Total Knee Arthroplasty (TKA). Methods: In a retrospective study, the efficiency of partial lateral facetectomy of the patella in achieving proper tracking of the patella was evaluated in 116 patients who underwent unresurfaced patellar-retaining TKA. The radiographic outcome measures included the patellar tilt and patellar shift. The functional outcome was assessed with Kujala anterior knee pain scale. Results: The Mean±SD age of the patients was 66.3±7.6 years. The mean follow-up of patients was ‎‎20.6±8.9 months. The Mean±SD patellar tilt was ‎‎10.5±7.2‎‎‏°‎‏ before the surgery and ‏‎4.4±5‎‎‏° after ‏the operation ‏‎ (‎P‎<‎‏0.001‏‎). ‎The Mean±SD preoperative patellar shift was ‏‎3.3±4.3‎‏ mm which improved to ‏‎-‎‎0.2±2.8°‎‏ after the surgery ‏‎(‎P‎<‎‏0.001‏‎). ‎The Mean±SD Kujala score of the patients was ‏‎74.6±7.1‎, ‎‏ ‏ranging ‎from 54 ‏to ‎‏89. ‎No complication was recorded during the follow‎-‎up period. Conclusion: Partial lateral facetectomy of the patella provides an acceptable radiographic and ‎functional outcome in patients undergoing primary TKA. Therefore, it could be regarded as a ‎valuable alternative to lateral release in unresurfaced patellar-retaining TKA.‎

Trends in Periprosthetic Knee Infection and Associated Costs: A Population-Based Study Using National Data

2020 ◽  
Author(s):  
Robert Brochin ◽  
Jashvant Poeran ◽  
Khushdeep S. Vig ◽  
Aakash Keswani ◽  
Nicole Zubizarreta ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Length Of Stay ◽  
Knee Arthroplasty ◽  
Trend Test ◽  
Strong Impact ◽  
Hospitalization Costs ◽  
Teaching Status ◽  
Increasing Trend ◽  
Total Knee ◽  
Increasing Trends

AbstractGiven increasing demand for primary knee arthroplasties, revision surgery is also expected to increase, with periprosthetic joint infection (PJI) a main driver of costs. Recent data on national trends is lacking. We aimed to assess trends in PJI in total knee arthroplasty revisions and hospitalization costs. From the National Inpatient Sample (2003–2016), we extracted data on total knee arthroplasty revisions (n = 782,449). We assessed trends in PJI prevalence and (inflation-adjusted) hospitalization costs (total as well as per-day costs) for all revisions and stratified by hospital teaching status (rural/urban by teaching status), hospital bed size (≤299, 300–499, and ≥500 beds), and hospital region (Northeast, Midwest, South, and West). The Cochran–Armitage trend test (PJI prevalence) and linear regression determined significance of trends. PJI prevalence overall was 25.5% (n = 199,818) with a minor increasing trend: 25.3% (n = 7,828) in 2003 to 28.9% (n = 19,275) in 2016; p < 0.0001. Median total hospitalization costs for PJI decreased slightly ($23,247 in 2003–$20,273 in 2016; p < 0.0001) while median per-day costs slightly increased ($3,452 in 2003–$3,727 in 2016; p < 0.0001), likely as a function of decreasing length of stay. With small differences between hospitals, the lowest and highest PJI prevalences were seen in small (≤299 beds; 22.9%) and urban teaching hospitals (27.3%), respectively. In stratification analyses, an increasing trend in PJI prevalence was particularly seen in larger (≥500 beds) hospitals (24.4% in 2003–30.7% in 2016; p < 0.0001), while a decreasing trend was seen in small-sized hospitals. Overall, PJI in knee arthroplasty revisions appears to be slightly increasing. Moreover, increasing trends in large hospitals and decreasing trends in small-sized hospitals suggest a shift in patients from small to large volume hospitals. Decreasing trends in total costs, alongside increasing trends in per-day costs, suggest a strong impact of length of stay trends and a more efficient approach to PJI over the years (in terms of shorter length of stay).

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