Patellar resection during total knee arthroplasty: effect on bone strain and fracture risk.

Patellae in small knees, or after severe patellar erosion, may be vulnerable to fracture after resection during arthroplasty. The patellar remnant may be thin, while the polyethylene component has a standard thickness. Anterior patellar bone strain was measured in cadaver knees loaded via the quadriceps, from 0 to 90 degrees flexion, with the patella intact, and after resections to 16, 13 and 11 mm thick and replacement by an 8-mm-thick polyethylene component. Strain increased significantly with knee flexion with constant 500 N quadriceps tension. Resection caused significant changes from intact values in knee flexion and extension and no significant effect at 30 degrees flexion. In flexion, bending caused the anterior surface to become more convex, with high tensile bone strains. In extension, resection caused negative anterior strains, representing bending in the opposite direction, with large tensile strains on the cut posterior surface. For normal activities, such as rising from a chair (1.8 kN quadriceps tension) the patella appears safe against fracture with a minimal resection to 16 mm thick. An eroded patella resected to 11 mm thickness may be at risk of fracture with that loading.

Prospective trial of resurfaced patellaversus non-resurfaced patella in simultaneous bilateral total knee replacement.

INTRODUCTION: A prospective trial was carried out in simultaneous bilateral total knee replacement to compare the outcome of resurfaced versus non-surfaced patella. METHODS: Thirty-five patients between 1997 and 2002 had simultaneous bilateral total knee replacement with resurfaced patella on the left and non-resurfaced patella on the right knee using the same implant in both. RESULTS: There were 29 females and six males with a mean age of 65.3 years. Mean follow-up was 3.18 years. There was no significant difference between the resurfaced and non-resurfaced knees with respect to the overall Knee Society clinical score (p = 0.093 preoperative, 0.310 postoperative) or the pain (p = 0.715 preoperative, 0.395 postoperative) or function subscores (p = 0.126 preoperative, 0.317 postoperative). The postoperative range of motion was 109 and 110 degrees for the resurfaced patella and non-resurfaced patella respectively (p = 0.894). The post-operative knee scores between patients with or without pre-operative anterior knee pain (p = 0.238) and between those who were obese and non-obese (p = 0.387) were not significantly different. 82.9% of patients felt that the resurfaced knee and 80% felt that the non-resurfaced knee were much better than before. There was no major preference for either knee for climbing stairs and getting out of chair. CONCLUSION: The functional and symptomatic outcome of total knee replacement with or without patella resurfacing is the same in the local population. Also, the present study demonstrated no evidence that the weight of the patient or the presence of preoperative anterior knee pain should be considered as factors in the decision to resurface the patella.

Influence of patellar thickness on results of total knee arthroplasty: does a residual bony patellar thickness of

With patellar thickness averaging 24.0 mm and 21.9 mm in Singapore men and women undergoing total knee arthroplasty, achievement of precut thickness is difficult if the recommended residual bony thickness of 15 mm is maintained. We retrospectively compared the clinical outcome of 56 patellae resurfaced 12 mm (mean residual thickness, 13.7 mm). Both groups were comparable in terms of demographic characteristics, presentation, precut patellar thickness, and operative details (P> .05). Knee scores (P= .627), extensor mechanism function (P= .625), and postoperative range of motion (P= .344) were comparable. Differences in the overall (P= .167) and patellar (P= .061) complication rates as determined by chi-square test on the SPSS 10.0 program were not significant, although there were 4 patella-related complications in group 2. Increased patella-related complications may be associated with an excessive patellar composite of the patellofemoral articulation. A residual patellar thickness of <12 mm did not appear to affect the clinical outcome in this series.