0
Articles   |    
Bone-Grafting for Severe Patellar Bone Loss During Revision Knee Arthroplasty
Arlen D. Hanssen, MD
View Disclosures and Other Information
Investigation performed at the Department of Orthopedic Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota
Arlen D. Hanssen, MD Department of Orthopedic Surgery, Mayo Clinic and Mayo Foundation, 200 First Street S.W., Rochester, MN 55905
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 article. No funds were received in support of this study.

J Bone Joint Surg Am, 2001 Feb 01;83(2):171-171
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case

Abstract

Background: Severe patellar bone loss may preclude adequate fixation of another patellar prosthesis as a part of revision knee replacement. The purpose of this study was to describe the surgical technique and early clinical results of an alternative to the conventional treatment options of either patellectomy or retention of the remaining patellar osseous shell. The goals of this procedure are to restore patellar bone stock and potentially to improve the functional outcome.

Methods: Severe patellar bone loss had left a "patellar shell" that precluded insertion of another patellar implant in nine of 100 consecutive knees undergoing revision total knee arthroplasty. Rather than performing a patellectomy or simply retaining the patellar osseous shell in these nine knees (eight patients), I performed a surgical procedure in which a tissue flap was secured to the patellar rim to contain cancellous bone graft inserted into the patellar bone defect. Final follow-up was at a mean of 36.7 months (range, twenty-four to fifty-five months) after the patellar bone-grafting procedure.

Results: The mean preoperative Knee Society scores for function and pain were 39 points (range, 18 to 82 points) and 40 points (range, 20 to 80 points), respectively. At the time of final follow-up, the Knee Society function and pain scores had improved significantly, to a mean function score of 91 points (range, 80 to 98 points) and a mean pain score of 84 points (range, 65 to 100 points) (p < 0.05). The point of greatest patellar thickness measured intraoperatively ranged from 7 to 9 mm. Patellar thickness on immediate postoperative Merchant radiographs averaged 22 mm (range, 20 to 25 mm) whereas, at the time of final follow-up, patellar thickness averaged 19.7 mm (range, 17 to 22.5 mm).

Conclusions: In contrast with other treatment alternatives, this surgical procedure imparts the potential for restoring patellar bone stock and may improve functional outcome by facilitating patellar tracking and improving quadriceps leverage. On the basis of satisfactory short-term to mid-term clinical results, this technique of patellar bone-grafting appears to be an important addition to the armamentarium of surgeons performing revision knee arthroplasties.

Figures in this Article
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

     
    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org

    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe





    Related Content
    The Journal of Bone & Joint Surgery
    JBJS Case Connector
    Topic Collections
    Related Audio and Videos
    PubMed Articles
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    02/05/2014
    Oregon - The Center - Orthopedic and Neurosurgical Care and Research
    04/16/2014
    Ohio - OhioHealth Research and Innovation Institute (OHRI)