Saurabh Khakharia1, Giles R Scuderi. 1. Insall Scott Kelly Institute for Orthopaedics and Sports Medicine, 210 East 64th Street, 4th Floor, New York, NY 10065, USA.
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.
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.
Authors: Arnaud Clavé; Goulven Le Henaff; Thomas Roger; Paul Maisongrosse; Christian Mabit; Frédéric Dubrana Journal: Int Orthop Date: 2016-01-08 Impact factor: 3.075
Authors: Annie Arteau; Valerae O Lewis; Bryan S Moon; Robert L Satcher; Justin E Bird; Patrick P Lin Journal: J Bone Joint Surg Am Date: 2015-11-18 Impact factor: 5.284