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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