Ortiguera, J Bone Joint Surg Am 2002 - Patellar Fracture after Total Knee Arthroplasty

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Patellar Fracture after Total Knee Arthroplasty

Ortiguera, Berry·J Bone Joint Surg Am·2002·298 citations·Retrospective cohort

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Background

Patellar fracture can occur as a complication following total knee arthroplasty. The purpose of this study was to evaluate a large series of patellar fractures to determine the results of different forms of treatment of specific fracture types.

Methods

A retrospective review identified 85 fractures (in 77 patients) following 12,464 consecutive total knee arthroplasties performed between 1985 and 1998.
78 fractures occurred after primary total knee arthroplasty and 7, after revision total knee arthroplasty.
5 fractures were treated elsewhere, and 2 others were lost to follow-up.
The results of treatment of the remaining 78 fractures were reviewed.
Fractures were classified according to 3 main criteria: integrity of the extensor mechanism, fixation status of the patellar implant, and quality of the remaining bone stock.
The mean duration of follow-up was 3.6 years.

Results

The prevalence of patellar fracture after total knee arthroplasty was 0.68%; fractures were significantly more prevalent among men (1.01%) than among women (0.40%) (p = 0.0004).
38 fractured patellae had a stable implant and an intact extensor mechanism (Type I).
All but one were treated nonoperatively, and there was only one late failure of nonoperative treatment, which required operative intervention.
12 fractures were associated with disruption of the extensor mechanism (Type II).
11 were treated operatively; 6 knees had complications and 5 had a reoperation.
28 fractures occurred in association with a loose patellar component (Type III).
20 were treated operatively; 9 knees had complications, and 4 had a reoperation.

Conclusions

Patellar fractures after total knee arthroplasty are infrequent. Treatment can be guided by three main criteria: integrity of the extensor mechanism, fixation status of the patellar implant, and quality of the remaining bone. Fractures associated with a stable implant and an intact extensor mechanism were usually treated successfully with nonoperative means, with minimal complications. When operative treatment was required, it was associated with a high rate of complications and reoperations.

Copyright remains with the authors and publisher.

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Patellar Fracture after Total Knee Arthroplasty

Ortiguera, Berry·J Bone Joint Surg Am·2002·298 citations·Retrospective cohort

|

Background

Patellar fracture can occur as a complication following total knee arthroplasty. The purpose of this study was to evaluate a large series of patellar fractures to determine the results of different forms of treatment of specific fracture types.

Methods

A retrospective review identified 85 fractures (in 77 patients) following 12,464 consecutive total knee arthroplasties performed between 1985 and 1998.
78 fractures occurred after primary total knee arthroplasty and 7, after revision total knee arthroplasty.
5 fractures were treated elsewhere, and 2 others were lost to follow-up.
The results of treatment of the remaining 78 fractures were reviewed.
Fractures were classified according to 3 main criteria: integrity of the extensor mechanism, fixation status of the patellar implant, and quality of the remaining bone stock.
The mean duration of follow-up was 3.6 years.

Results

The prevalence of patellar fracture after total knee arthroplasty was 0.68%; fractures were significantly more prevalent among men (1.01%) than among women (0.40%) (p = 0.0004).
38 fractured patellae had a stable implant and an intact extensor mechanism (Type I).
All but one were treated nonoperatively, and there was only one late failure of nonoperative treatment, which required operative intervention.
12 fractures were associated with disruption of the extensor mechanism (Type II).
11 were treated operatively; 6 knees had complications and 5 had a reoperation.
28 fractures occurred in association with a loose patellar component (Type III).
20 were treated operatively; 9 knees had complications, and 4 had a reoperation.

Conclusions

Patellar fractures after total knee arthroplasty are infrequent. Treatment can be guided by three main criteria: integrity of the extensor mechanism, fixation status of the patellar implant, and quality of the remaining bone. Fractures associated with a stable implant and an intact extensor mechanism were usually treated successfully with nonoperative means, with minimal complications. When operative treatment was required, it was associated with a high rate of complications and reoperations.

Copyright remains with the authors and publisher.

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