Recent improvements in total knee arthroplasty (TKA) surgical technique, instrumentation, and prosthetic design have decreased the incidence of extensor mechanism complications following TKA. The majority of these complications continue to be secondary to errors in surgical technique. Extensor mechanism complications following TKA include soft-tissue impingement, instability, patellar fractures, patellar component failures, and extensor mechanism rupture. Both nonsurgical and surgical treatment may be used in the management of these complications. However, the majority of these complications are avoidable with attention to proper surgical technique and selection of appropriate patellar components in TKA.
[Show abstract][Hide abstract] ABSTRACT: A retrospective study was done to determine the incidence, clinical function, and complications of treatment in a large series of patella fractures after total knee replacement (TKR). Between 1983 and 1996, 4583 primary AGC TKRs done at our institution. One hundred seventy-seven fractures were identified in 135 patients for a fracture incidence of 3.8%. Twenty-two fractures were vertical and had a stable implant and intact extension mechanism (Type 1). Twenty-one fractures had disruption of the extensor mechanism of less than 1 cm (Type 2A). Seventeen fractures had disruption of the extensor mechanism of 1 cm or more (Type 2B). One hundred fourteen fractures had a loose component and an intact extension mechanism (Type 3). Patients treated nonoperatively generally had no extensor lag and had adequate pain and function scores. Patients treated operatively had a high complication rate. Four of nine patients treated with excision of an extruded patella button developed a deep infection. Both patients treated with open reduction internal fixation (ORIF)had a nonunion develop. Surgery on patients with patella fractures has a high complication rate and should be avoided if possible.
Clinical Orthopaedics and Related Research 12/2003; 416(416):93-7. DOI:10.1097/01.blo.0000092992.90435.20 · 2.77 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Knee replacement surgery, either with unicompartmental or total systems, is common. The purpose of this manuscript is to review the appearance of normal knee arthroplasty and the appearances of complications such as infection, polyethylene wear, aseptic loosening and particle-induced osteolysis, patellofemoral abnormalities, axial instability, and periprosthetic and component fracture. Knowledge of the potential complications and their imaging appearances will help the radiologist in the diagnostic evaluation of the patient with a painful knee arthroplasty.
European Journal of Radiology 06/2005; 54(2):164-77. DOI:10.1016/j.ejrad.2005.01.020 · 2.37 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Extensor disruptions of the knee following the total knee replacements are uncommon. We describe a case of postoperative bilateral simultaneous extensor mechanism disruption following simultaneous bilateral total knee replacement. On both sides, the patient sustained open wounds. The extensor mechanism was successfully repaired on both sides, but the outcome is less than satisfactory.
Archives of Orthopaedic and Trauma Surgery 08/2005; 125(6):396-8. DOI:10.1007/s00402-005-0826-2 · 1.60 Impact Factor
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