Primary Total Knee Arthroplasty in Knees with Old Neglected dislocation of Patella

Transcription

1 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

2 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

3 Introduction Total knee arthroplasty (TKA) Effective method of treating end-stage knee osteoarthritis (OA) 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 Although the management of these patients are still unclear, primary TKA can be a useful treatment option

4 Purpose To report Clinical and radiological outcomes using our surgical technique

5 Material and Methods Retrospectively reviewed 12 knees of 8 patients Demographic and preoperative data are summarized in Table 1 Primary TKA with extensive lateral release were done in all cases 10 patellas, including 7 hypoplastic patellas, were resurfaced V-Y quadricepsplasty was required due to the contracture in case No. 2

6 Material and Methods Table 1. Demographic and preop associated problems of 12 cases *TT-TG : Tibial tuberosity Trochlear groove *VY-Q : VY quadricepsplasty *Q-snip : Quadriceps snip

7 Results Significant improvements in all clinical scores at the mean 37.8 months follow-up (all p < 0.05) (Table 2) No complication during f/u period Table 2. Results of clinical and radiological assessment (*: valgus)

8 Results

9 Discussions Valgus deformity Overcome by precise bone cutting and soft tissue balancing Lateral extension gap narrowing after bone resection (A) Release for ITB, PLC, LCL, and popliteus tendon Determine the femoral component rotation angle while holding the leg in the position of 90 knee flexion with gravity gap tension(b) JI Kim & MC Lee et al, Knee, 2017 JK Lee & MC Lee et al, Musculoskeletal Discord, 2017 External rotation of tibia & Lateralization of tibial tuberosity Corrected by tibial component positioning Anterior tibial curved cortex was found to be the most reliable and useful anatomical landmark (C) Lateralizing the tibial component JI kim & MC Lee et al, BMC Musculoskeletal Discord, 2017

10 Discussions Patellofemoral(PF) problems Lateralizing the femoral and the tibial component and medializing the patella component in accordance with the basic principles of TKA Reduce Q-angle, improve extensor mechanism, correct the patellar hypoplasia, and correct the subluxation of the tibia All hypoplastic patellas were resurfaced without any surgical complication Recent design concept of the femoral component allows the dysplasia of the trochlear groove to be overcome Extensive lateral release in all cases d/t PF maltracting (additional medial plication in two cases) (D) In case No. 2, CCK prosthesis was used to solve extensive flexion gap and V-Y quadricepsplasty was done for limited

11 Limitations Discussions Retrospective design, not able to conduct comparison with control groups The number of cases is relatively small, not experience more diverse pathology More long term f/u is needed

12 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 were extensive lateral release in all cases, medial plication in 2 knees, and quadriceps lengthening in 3 knees with shortened quadriceps tendon. All The outcome of these patients is satisfactory without any complication during mean 37.8 months follow-up

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