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J Knee Surg
DOI: 10.1055/a-2509-3388
Special Focus Section

Patellar Instability after Total Knee Arthroplasty

Gabrielle Swartz
1   Department of Orthopaedics, LifeBridge Health, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
,
Zuhdi E. Abdo 
2   Department of Orthopedic Surgery, Zucker School of Medicine at Hofstra/Northwell, Northwell Health, New York, New York
,
Sandeep S. Bains
1   Department of Orthopaedics, LifeBridge Health, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
,
Jeremy A. Dubin
1   Department of Orthopaedics, LifeBridge Health, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
,
Daniel Hameed
1   Department of Orthopaedics, LifeBridge Health, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
,
Sumon Nandi
3   Department of Orthopaedic Surgery, University of Maryland Medical Center, Baltimore, Maryland
,
Michael A. Mont
1   Department of Orthopaedics, LifeBridge Health, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
,
Ronald E. Delanois 
1   Department of Orthopaedics, LifeBridge Health, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
,
Giles R. Scuderi
2   Department of Orthopedic Surgery, Zucker School of Medicine at Hofstra/Northwell, Northwell Health, New York, New York
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Abstract

Patellar instability following total knee arthroplasty (TKA) is a rare, yet serious complication, potentially requiring revision surgery or resulting in chronic dysfunction. When encountered, it is paramount to understand the etiologies, diagnostic approaches, treatment options, and outcomes of the selected treatment. The most common cause of patella instability is improper positioning of components, leading to lateral maltracking of the patella. Factors such as internal rotation and/or medialization of femoral or tibial components and lateralization of the patellar button have been identified as factors that contribute to instability. Additionally, a longstanding valgus deformity of the knee may exacerbate patella maltracking. Patients typically present with anterior knee pain, worsened by activities like stair climbing, and may report sensations of giving way. Radiographs and computed tomography scans aid in evaluating component positioning and rotation. Operative intervention is often necessary, with options ranging from soft tissue realignment to component revision. Lateral retinacular release is a common approach, although it is associated with complications such as osteonecrosis of the patella. Proximal or distal realignment procedures may be required if instability persists. Some recent case reports have also described medial patellofemoral ligament reconstruction as a treatment modality, but more investigation on the topic is still pending. It is important that the treatment strategy address the underlying cause, as failure to do so may result in recurrent instability. The best way to avoid patella instability is to pay attention to all the details of component position and soft tissue balance during the index procedure.

Keywords

total knee arthroplasty - complications - management


Publication History

Received: 07 May 2024

Accepted: 01 January 2025

Accepted Manuscript online:
03 January 2025

Article published online:
27 January 2025

© 2025. Thieme. All rights reserved.

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333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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