Should total prosthetization of the patella be used in knee surgery? A review of the literature and personal experience.
Based on an analysis of patellar complications during total knee arthroplasty, the authors report the conclusions of the most important studies in the literature as to whether or not the patella should be prosthetized. In particular, several important parameters to be taken into consideration before performing patellar prosthetization are discussed: the conditions of the cartilage and of the patellar bone, preoperative clinical symptoms, age, habits, body weight of the patient. The results of 50 Miller-Galante prostheses implanted between January 1989 and September 1993 is reported. The patella was prosthetized in 40% of the cases; there were no fractures or vascular necroses, nor was there breakage or detachment of the prosthetic button. Patellar pain was manifested in 5 cases (10%), 2 of which with a prosthetized patella, including 1 case of external dislocation and 1 case of breakage of the patellar tendon; another case of external dislocation, in a non-prosthetized patella, was clinically asymptomatic; pain was manifested after delay in wound healing in 2 cases. Only one patient with breakage of the patellar tendon was submitted to further surgery. The authors conclude that in light of the numerous studies published prosthetization of the patella may offer overall better clinical results, but they advise that indications should be carefully evaluated for each individual case, and that details in surgical technique should be observed (correct execution of bone resection and of lateral release when necessary, preservation of Hoffa pad, accurate hemostasis).
Murena
P F
PF
Divisione di Ortopedia e Traumatologia, Ospedale San Daniele del Friuli.
Pasqualini
M
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007720:Knee Prosthesis; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000601:surgery*; D010329:Patella; D011183:Postoperative Complications; D019736:Prostheses and Implants; D013997:Time Factors