Abstract
Management of the patella with poor bone stock remains a challenge in revision total knee arthroplasty (TKA). The purpose of this study was to evaluate the results of a novel surgical technique in which widely available wires and acrylic bone cement are used in the reconstruction of a deficient patella.
Twenty-eight patients (30 knees) underwent revision TKA in which a deficient patella was treated with an onlay-type prosthesis and bone-augmenting procedure, using transcortical wiring. The technique was indicated when the thickness of remnant patella was less than 8mm with variable amounts of the peripheral rim. The remaining patellar height ranged from 3.2mm to 7.3mm. Follow-up was available for all patients with a mean of 36.6 months (range, 24 to 55 months).
The respective mean Knee Society scores for knee and function improved from 34.2 points (range, 18 to 65 points) and 23 points (range, 18 to 46 points) preoperatively to 73.5 points (range, 30 to 88 points) and 61points (range, 34 to 80 points) at final follow-up. The mean thickness of the patellar construct was 14.6mm (range, 12.2 – 18.3mm). One patient experienced patellar fracture during knee flexion one week after surgery. There were no complications associated with implanted hardware.
A patellar bone-augmenting procedure using transcortical wiring is a straightforward technique that potentially allows firm fixation. Considering the satisfactory short- to mid-term results, we believe that this technique provides a good alternative option in addressing this challenging problem in revision TKA.
