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Transcript of Primary Total Knee Arthroplasty in Knees with Old ... · Discussion •Problems of OA with old...
Primary Total Knee Arthroplasty in Knees with
Old Neglected dislocation of Patella
Seung Bin Im, Min Ku Song, Woo Cheol Shin, Joonhee
Lee, Taehoon Kang, Du Hyun Ro, Hyuk soo Han, Myung
Chul Lee
Department of Orthopaedic Surgery
Seoul National University College of Medicine
Disclosure
• No benefits in any form have been received or will
be received from a commercial party related directly
or indirectly to the subject of this presentation
Introduction
• Total knee arthroplasty (TKA)
▪ Effective method of treating end-stage knee osteoarthritis
▪ Some abnormal deformities can affect the outcome
• Old neglected dislocation of patella
▪ Patella is located lateral without being reduced
▪ Valgus malalignment, lateral dislocated patella, and
weakness of knee extensor with OA
• Management of these patients are still unclear, but
primary TKA can be a useful treatment option
Mullaji A et al, J Arthroplasty, 2009
Berend KR et al, CORR, 2006
Baldini A et al, Bone Joint J, 2015
Green JP et al, JBJS Br, 1968
Purpose
• To report
▪ Clinical and radiological outcomes
▪ Additional surgical procedures needed
Material and Methods
• Retrospectively reviewed 12 knees of 8 patients (6F, 2M)
• Demographic data
▪ Mean age at TKA : 67.6 years (range 57~76)
▪ Mean follow-up : 37.8 months (range 16~56)
• Pre & Postoperative scores
▪ Knee Society knee and functional Score (KSS), WOMAC index
▪ Range of motion (ROM)
• Serial radiologic assessment
▪ Full-length standing AP, Knee standing AP, knee 30° flexion lateral,
Merchant view
▪ Before surgery, 4weeks after surgery, 3months, 12months, yearly
thereafter
Results
*TT-TG : Tibial tuberosity – Trochlear groove *VY-Q : VY quadricepsplasty *Q-snip : Quadriceps snip
Results
*VY-Q : VY quadricepsplasty *Q-snip : Quadriceps snip
• Lateral release were done in all cases
▪ 10 patellas, including all 7 hypo-
plastic patellas, were resurfaced
▪ V-Y quadricepsplasty was required
due to the contracture in one case
F/68
valgus 21° valgus 1°
• Left knee
▪ Extensive lateral release
• Right knee
▪ Extensive lateral release
▪ Medial plication
▪ V-Y quadricepsplasty
Postoperative image
Results
• Significant improvements in all clinical scores
at the mean 37.8 months follow-up (all p < 0.05)
▪ No complication during f/u period
Discussion
• Problems of OA with old neglected patella dislocation
▪ Genu valgum – bone cutting, soft tissue balance
▪ Subluxation of tibia – lateralization of prosthesis
▪ External rotation of tibia – rotation of prosthesis
▪ Lateralization of tibial tubercle – position of prosthesis
▪ Flattening of trochlea – position & design of prosthesis
▪ Patella hypoplasia – medialization of prosthesis
▪ Tight & loose retinaculum – (extensive) lateral release
▪ Shortened quadriceps - lengthening
Other methods besides lateral release were not necessary
Conclusion
• Primary TKA is an effective surgical procedure to
correct the various pathologies in end-stage OA with
old neglected dislocation of patella
• Additional procedures
▪ Extensive lateral release in all cases, medial plication in 2
knees, and quadriceps lengthening in 3 knees with
shortened quadriceps tendon
• All the outcomes were satisfactory without any
complication during mean 37.8 months follow-up
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