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Clin Orthop Relat Res. 2012 Jan;470(1):205-10. doi: 10.1007/s11999-011-1995-7.

Restoration of the distal femur impacts patellar height in revision TKA.

Author information

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.

PMID:
21811899
PMCID:
PMC3237988
DOI:
10.1007/s11999-011-1995-7
[Indexed for MEDLINE]
Free PMC Article

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