THE OUTCOME OF PRIMARY TOTAL KNEE ARTHROPLASTY WITH POSTERIOR STABILISED IMPLANT AFTER A PREVIOUS PATELLECTOMY

Abstract

In patients with previous patellectomy the optimal constrained implant is not well understood. Previous outcome studies have shown contradictory results. There interpretation is limited by small number of patients, included primary and revision implants or involved a heterogeneous group of different constraint implants.

We performed retrospective match controlled analysis of a posterior stabilised primary total knee arthroplasty in forty-two patients who had previous patellectomy. There were nineteen male and twenty-three female patients. The average age of patients at the time of surgery was fifty-nine years (range from forty-one to seventy-four years). The average time from patellectomy to total knee arthroplasty was seventeen years (range from one to thirty-four years). The average duration of follow-up was 5.3 years with minimum two years follow up (range from two to sixteen years). The control group was matched by age, sex, prosthesis type and surgeon. We used the student-t test to compare the outcome measurement.

Preoperatively, the patellectomy and control groups were not significantly different in terms of Knee Society clinical and functional scores or range of motion. Postoperatively clinical component of the knee society score had a significant difference (p< 0.05) however the functional part of the knee society score didn’t (p> 0.05). In patellectomy group the postoperative clinical and functional score were equal to seventy and fifty-eight respectively. The average clinical component of knee society score in the patellectomy group was twelve points (SE=4.8) lower compare to the knee with intact patella. The patellectomy group also had higher extension lag and poorer extension (higher flexion contracture) at the most recent follow up (p< 0.05).

This study demonstrated the outcome of the largest series of primary total knee arthroplasty with posterior stabilised implant in patient with previous patellectomy. The outcome of surgery was significantly improved but not as good as the knee with intact patella especially the function of the extensor mechanism.