Abstract
Patellectomized knees often perform poorly with respect to extensor mechanism function. Reconstruction options and literature reports are limited. The purpose of this study was to describe and review bone graft patella reconstruction in TKA.
Material_e_Methods: Since 1990 nine previously patel-lectomized patients underwent cementless Low-Contact-Stress TKA with autologous patella reconstruction. One patient died 5 years post surgery. Mean follow-up was 8.0 years (6 to 12). Autologous bonegraft was taken in five cases from the iliac crest, in two cases from the posterior femoral condyle and in two cases from the opposite patella at time of simultaneous bilateral TKA. Postoperative evaluation included clinical and radiographic analysis and bilateral comparative isokinetic strength measurement at 60 degrees per second (Biodex).
Clinical scores had a mean of 27 points (max: 30) and mean isokinetic extension strength of 71Nm (81 percent) compared with the opposite healthy patella site. One patient with bilateral patellectomy and unilateral patella reconstruction showed a 50 percent increase of strength on the grafted side. Radiographs showed minor signs of neopatella bone resorption, but a maintained leaver arm.
Reconstruction of a neo-patella in TKA with autograft provides marked improvement of isokinetic extensor strength, little evidence of autograft resorption, excellent or good clinical outcome and high patients satisfaction after a mean of 8 years. The results of this study indicate encouraging data for reconstructing a new patella and lever arm in patellectomized knees during primary or revision TKA. Cosmetic improvement in females is another subjective advantage.
Correspondence should be addressed to Richard Komistek, PhD, International Society for Technology in Arthroplasty, PO Box 6564, Auburn, CA 95604, USA. E-mail: ista@pacbell.net
