title: Spontaneous patella fracture associated with anterior tibial tubercle pseudarthrosis in a revised knee replacement following knee arthrodesis.
abstract: BACKGROUND
  Conversion of a knee arthrodesis to a Total Knee Arthroplasty is an uncommon procedure. Revision Total Knee Arthroplasty in this setting presents the surgeon with a number of challenges including the management of the extensor mechanism and patella.
  
  
  METHODS
  We describe a unique case of a 69 years old Caucasian man who underwent a revision Total Knee Arthroplasty using a tibial tubercle osteotomy after a previous conversion of a knee arthrodesis without patella resurfacing. Unfortunately 9 months following surgery a tibial tubercle pseudarthrosis and spontaneous patella fracture occurred. Both were managed with open reduction and internal fixation. At 30 months follow-up the tibial tubercle osteotomy had completely consolidated while the patella fracture was still evident but with no signs of further displacement. The patient was completely satisfied with the outcome and had a painless range of knee flexion between 0-95°.
  
  
  CONCLUSIONS
  We believe that patients undergoing this type of surgery require careful counseling regarding the risk of complications both during and after surgery despite strong evidence supporting improved functional outcomes.
authors.affiliation: 1st Orthopaedic Department, C,T,O, Hospital, Via S, Pertini 21,Via Bignami 1, 20040, Cambiago Milan, Italy. alf.manzotti@libero.it.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Manzotti
authors.forename: Simone
authors.initials: S
authors.lastname: Aldè
authors.forename: Chris
authors.initials: C
authors.lastname: Pullen
authors.forename: Pietro
authors.initials: P
authors.lastname: Cerveri
authors.forename: Norberto
authors.initials: N
authors.lastname: Confalonieri
mesh_terms: D000368:Aged; D001174:Arthrodesis; D019645:Arthroplasty, Replacement, Knee; D005598:Fractures, Spontaneous; D006801:Humans; D008297:Male; D010329:Patella / Q000293:injuries*; D011183:Postoperative Complications / Q000601:surgery*; D012086:Reoperation