Patella recurrent dislocation and patellofemoral pain syndrome instability many young people and especially athletes. In the present study we present the results of the extension mechanism realignment through the Fulkerson oblique osteotomy of the tibial tuberosity and soft tissue balancing. During the last two years 10 patients (7 men, 3 women, mean age 29.3/ range 20–39) were treated operatively for recurrent dislocation of the patella using the Fulkerson procedure. All patients underwent knee arthroscopy for the treatment of potential chondral damage or loose bodies and for lateral retinacular release. After that we performed oblique tibial tuberosity osteotomy, medialization and internal fixation with 2 cortical screws. This oblique osteotomy allows also the anteriorization of tibial tuberosity as we move it medially. In addition, we performed medial placation. All the patients used functional knee brace locked to 0° right after the operation and with gradual ROM increase till the 8th p.o. week. The patients had no initial or long term complication. During their last follow up examination had a painless knee with full ROM and marked improvement of the patella tracking. The mean Lysholm score was 90.5. No patella dislocation was referred. Our findings show that the Fulkerson osteotomy procedure, with an additional intervention on the lateral and medial patella retinacular, is an excellent option for the treatment of recurrent patella instability and relief of the patellofemoral pain.
Failure of a TKA is caused many times from the polyethylene debris or the mechanical forces which lead to loosening mostly to tibial component. The mobile meniscal knee prosthesis could provide solution as it simulates better normal knee function. The aim of our study is to present the midterm results of TKA using mobile bearing platform Rotaglide. During the period 2000–2004 we performed 261 TKA with the Rotaglide mobile polyethylene prosthesis (Corin Medical, UK). They are 235 women and 26 men, mean age 76.33 years, and the 93.7% of them (N=245) with primary osteoarthritis. The tibial component was cemented for all them, and for the femur was cementless for 146 cases (hybrid) and cemented for 115. None of them had patella replacement. One hundred five patients (59 hybrid and 46 cemented) were examined clinically and radiologically and the minimum follow-up time was 5 years (mean 6,6 /range 5–8 years). We use the Knee injury and Osteoarthritis Outcome Score (KOOS- range of scale for each subscore 0–100). There was significant improvement of knee function and the majority of our patients were satisfied from the result. Specifically, the score for general symptoms and joint stiffness was 89.1, for pain was 83.3, for daily activities was 75.6 and for the quality of life was 72.5. One patient had revision TKA for femur component aseptic loosening. Our results indicate that the Rotaglide total knee arthroplasty is a great choice for primary knee OA with excellent functional result.
