Knowledge of diet and blood pressure among African Americans: use of focus groups for questionnaire development

The long-term results were reviewed for seventy-two patients (seventy-five knees) who had had a bone-patellar ligament-bone intra-articular reconstruction of the anterior cruciate ligament between August 1984 and May 1992. The mean age of the patients at the time of the operation was forty-five years (range, forty to sixty years). Three patients had a bilateral procedure. The primary mechanisms of injury were accidents that occurred during skiing (thirty-two knees), tennis (fourteen knees), and soccer (five knees). We analyzed the responses to subjective questionnaires, the functional results, and the objective clinical data. The clinical examination included assessment of the range of motion, performance of Lachman and pivot-shift tests, and measurements with use of a KT-1000 arthrometer. All knees were evaluated with use of three common rating scales: that of Lysholm and Gillquist; that of The Hospital for Special Surgery, as modified by Insall et al.; and the International Knee Ligament Standard Evaluation Form. At the latest follow-up evaluation, at a mean of fifty-five months (range, twenty-six to 117 months), three patients reported pain or swelling. No patient reported giving-way or symptoms related to the patellofemoral joint. The mean range of extension was -12 to 6 degrees, compared with -8 to 42 degrees preoperatively, and the mean range of flexion was 112 to 150 degrees, compared with 52 to 154 degrees preoperatively. Flexion was limited to 112 degrees in one patient, but this was 5 degrees greater than that of the uninvolved knee. Sixty knees (80 per cent) had a negative pivot-shift test, and ten knees (13 per cent) had a grade of 1+. On testing with the KT-1000 device at maximum manual pressure, the mean difference between the injured and uninjured knees was found to have improved by 5.1 millimeters, from 6.4 millimeters preoperatively to 1.4 millimeters postoperatively (p < 0.01). The grade on the International Knee Ligament Standard Evaluation Form improved markedly; seventy-two knees (96 per cent) had a grade of C or D preoperatively, whereas seventy knees (93 per cent) had a grade of A or B postoperatively. The Hospital for Special Surgery score improved from a mean of 69 points preoperatively to a mean of 92 points postoperatively (p < 0.01). The mean score according to the scale of Lysholm and Gillquist increased from a mean of 63 points preoperatively to a mean of 94 points postoperatively (p < 0.01). All patients indicated that they were pleased with the result of the procedure. Bicycling was resumed at a mean of four months; jogging, at a mean of nine months; skiing, at a mean of ten months; and tennis, at a mean of twelve months.     

Characteristics of impaired awareness after traumatic brain injury

The condylar constrained total knee arthroplasty was performed on 29 patients undergoing 33 procedures and were reviewed clinically and radiographically at an average follow-up of 5 years (range, 2-10 years). There were 21 women and 8 men. The average age at the time of surgery was 70 years (range, 32-84). Of the 16 knees that were revision total knee arthroplasties, 8 had a previous infected total knee arthroplasty, and 17 knees had severe deformities requiring the use of the condylar constrained prosthesis. The patients were rated according to the Knee Society clinical and radiological evaluation protocol. Measurements of femoral and tibial component position were obtained as well as femoral tibial angle, patella position, and cement bone radiolucencies. All clinical measurements were made by an independent physical therapist. Clinical results revealed an improvement from an average preoperative knee score of 38 points to an average postoperative score of 86 points. The clinical results for 19 (58%) knees were excellent, 8 (24%) had a good result, 1 (3%) was fair, 2 (6%) were poor, and 3 (9%) were failures. The patients' average functional levels increased from 24 to 58. The final average flexion was 96 degrees. Three knees have been revised (9%). One was revised for recurrent infection, one for periprosthetic fracture, and one for mechanical loosening of the tibial component. There were no other knees with evidence of radiologic loosening. We conclude that the condylar constrained total knee prosthesis provides an acceptable solution for revision and complex primary total knee replacements at an intermediate follow-up term of 5 years.     

A comparison of isokinetic strength testing and gait analysis in patients with posterior cruciate-retaining and substituting knee arthroplasties

Fourteen patients with a posterior-stabilized prosthesis in one knee and a posterior cruciate-retaining prosthesis in the contralateral knee and both scoring good or excellent on the Hospital for Special Surgery (HSS) knee scale were evaluated by isokinetic muscle testing and comprehensive gait analysis at a mean follow-up of 98 months after arthroplasty. The average HSS knee score (93 points) and the average Knee Society score (94 points) were the same for the cruciate-retaining and posterior-stabilized knees. No differences were noted between the cruciate-retaining and the posterior stabilized knees with respect to isokinetic muscle testing parameters (peak torque, endurance, angle of peak torque, and torque acceleration energy) for both quadriceps and hamstrings. No significant differences were found between the cruciate-retaining and the posterior-stabilized knees with regard to gait parameters, knee range of motion, and electromyographic waveforms during level walking and stair climbing. Cruciate-retaining and posterior-stabilized total knee prostheses perform equally well during level gait and stair climbing.     

Distal realignment of the patellar tendon to correct abnormal patellar tracking

Between January 1980 and January 1994, 31 knees required distal realignment of the extensor mechanism to treat lateral patellar subluxation that could not be corrected with lateral patellar release and vastus medialis advancement during total knee arthroplasty. Fifteen had a preoperative valgus angle of more than 12 degrees, and 16 were undergoing revision total knee arthroplasty. Ten knees had a modified Roux-Goldthwait procedure, 18 had medial tibial tubercle transfer, and three had medial transfer of the medial 1/2 of the patellar tendon. The length of followup ranged from 2 to 16 years. No late patellar subluxations or dislocations have occurred in any of these cases. Three cases of medial tibial tubercle transfer had hematomas develop, with two requiring surgical evacuation; one of these developed a late infection. No fractures or displacements of the tubercle fragment have occurred. No significant patellar complications have occurred in those patients who underwent the modified Roux-Goldthwait procedure or the medial transfer of the medial 1/2 of the patellar tendon. One year after surgery, the mean knee flexion was 113 degrees, four knees had a flexion contracture of 5 degrees, and none had a quadriceps lag.     

Anterior knee laxity and loss of extension after anterior cruciate ligament injury

This study was performed to examine the relationship between knee extension loss and the length of time after injury. We also wanted to compare anterior laxity in anterior cruciate ligament-injured knees in the early and late stages of injury. Loss of knee extension was measured in 81 patients with anterior cruciate ligament injury using lateral radiography with the injured leg relaxed and elevated. Extension loss was defined as the difference in maximal extension angle between the injured and uninjured knees. Average loss of extension was 3.6 degrees in the 17 knees in which the anterior cruciate ligament had been torn 3 weeks or less before examination (the acute injury group) and 0.6 degree in the 64 knees in which the anterior cruciate ligament had been torn more than 3 weeks before examination (the chronic injury group). The extension loss in the acutely injured knees was significantly greater compared with that in the uninjured knees and in the chronically injured knees. Arthrometric measurements using the KT-1000 arthrometer were reliable to diagnose an acute tear. There was no correlation between the degree of extension loss and arthrometric anterior knee laxity measurements. In 12 patients, the initial extension deficit in the early stage of injury significantly resolved with time, and manual maximum arthrometric measurements of anterior knee laxity improved spontaneously with time.     

A quantitative pharmacological study of the cholinergic depolarization of hippocampal pyramidal cells in rat brain slices

Twenty-eight unicompartmental knee arthroplasties performed as an alternative to high tibial osteotomy or tricompartmental knee arthroplasty in patients under 60 years of age were reviewed after 2 to 6 years of follow-up. The patient's age at the time of operation averaged 52 years. Using the Knee Society Score, 90% were rated good or excellent results in terms of function and pain relief. The average flexion angle obtained was 124 degrees, and the average postoperative alignment was 4 degrees of anatomic valgus for varus deformities and 8 degrees for valgus deformities. The average activity level according to the Tegner and Lysholm score slightly improved (preoperative, 2.3; follow-up, 2.7 points). Of the 28 knees, 9 (32%) presented radiolucent lines about the tibial component and two had incomplete radiolucent lines at the bone-cement interface on the femoral side. There was no correlation between activity level and tibial radiolucent lines. Two revisions were performed because of loosening of the femoral component at the prosthesis-cement interface. One was converted to another unicompartmental arthroplasty and the other to a tricompartmental arthroplasty. One tibial component exhibited an asymptomatic slowly progressive radiolucency. Unicompartmental knee arthroplasty in middle-aged patients yields 2- to 6-year results competitive with osteotomy but inferior to tricompartmental arthroplasty in terms of revision. The specific prosthetic design used in this series appeared to be vulnerable to femoral component loosening possibly because of constrained tibial topography and smooth tapered femoral fixation lugs.     

In vitro activities of antimicrobial agents against Candida species

A single surgeon's consecutive series of 50 arthroscopically repaired meniscal tears in 48 patients was retrospectively reviewed. None of these patients had concomitant ligament damage to the knee. The average follow-up period was 10 years, 9 months. Criteria for clinical success included 1) history of pain of grade 1 or less and absence of locking, catching, or giving way; 2) a physical examination demonstrating no significant effusion and a painless and negative jump sign; and 3) no subsequent surgical procedures on the repaired meniscus. Patient satisfaction was quite high, although clinical confirmation was possible in only 38 knees, indicating a clinical success rate of 76%. Bilateral standing radiographs were obtained on these 38 operated knees and were evaluated using Fairbank's classification. Evaluation of the radiographs revealed that 8% of the operated knees had minimal joint changes, as compared with 3% in the contralateral, nonoperated knee. This study demonstrates that arthroscopic meniscal repair in knees with isolated meniscal tears has the potential for a long-term successful clinical and radiographic outcome.     

Sagittal plane translations of the knee in anterior cruciate deficient subjects and controls

Static anterior-posterior (AP) laxity is one of the commonly used criteria in selecting patients for cruciate ligament reconstructions, but in reality dynamic AP laxity plays a more important role. The aim of this in vivo study was to compare the sagittal translation of the knee during active and passive motion, signifying dynamic AP laxity, with static AP laxity in healthy subjects (controls) and patients with anterior cruciate ligament deficiency. The sagittal plane knee translations were recorded and compared in both knees of nine healthy subjects (Controls) and seven patients with confirmed unilateral ACL deficiency during dynamic and static situations with an electrogoniometer system. In all groups during the ascents the tibia moved anteriorly in relation to the femur, whereas during the descents it moved posteriorly. The static anterior-posterior translation was significantly smaller in the control knee than in both healthy and injured knees of the ACL deficient group (P < 0.05). The injured knee showed the same laxity (92%) as the uninjured knee during dynamic activities, but it was 46% of static laxity. Also in the injured knees, the dynamic active laxity was larger during descents than ascents (P < 0.05). The results indicate that there is also a change in mechanics of the noninjured knee following injury to the contralateral knee and that this population of patients with ACL deficiency had good control over their abnormal anterior-posterior laxity.     

Intracerebral hemorrhage more than twice as common as subarachnoid hemorrhage

A review of pre- and postoperative prone knee flexion (PKF) data after isolated hamstring tenotomy for 52 patients with cerebral palsy (CP) at an average follow-up of 3 years 4 months showed the frequency of diminished knee flexion to be 71%. Twenty-three percent of the knees actually had improved flexion, whereas 6% were unchanged. On the average, patients' flexion decreased 14.4 degrees from a preoperative PKF of 131.5 degrees to 117.1 degrees postoperatively (p < 0.0001). Only 11.5% of patients had PKF < 90 degrees at most recent follow-up, however; only 1.9% had PKF < 60 degrees. Thirteen percent of ambulators eventually required a rectus femoris transfer to correct "stiff-legged gait."     

Arthroscopic-assisted anterior cruciate ligament reconstruction with the central third patellar tendon. A 5-8-year follow-up

We reviewed 89 arthroscopically assisted patellar tendon anterior cruciate ligament (ACL) reconstructions for chronic isolated injuries with an average follow-up of 7 years (range 5.4 to 8.6 years). Pain was present in 7 knees (8%). Giving-way symptoms were reported by 7 patients (8%). A KT-2000 side-to-side difference over 5 mm at 30 lbs was recorded in 12 cases (16%). The pivot shift was glide in 17 cases (19%) and clunk in 10 (11%). A 3 degrees-5 degrees extension loss compared with the normal side was present in 20 knees (22%) and 6 degrees-10 degrees in 4 knees (4%). The intra-articular exit of the femoral tunnel was misplaced in the anterior 50% of the condyles along the roof of the notch in 10% of the knees. This positioning significantly (P = 0.003) increased the frequency of graft failure (62.5%) compared with the cases with a more posterior placement (graft failure 12%). An anterior position of the intra-articular exit of the tibial tunnel (in the anterior 15% of the sagittal width of the tibia) significantly (P = 0.01) increased the frequency of extension loss > 5 degrees. Medial meniscectomy was associated with a 35% incidence of narrowing of the medial joint space, which was significantly higher compared with knees with normal menisci (9%; P = 0.04) or with medial meniscal repair (7%; P = 0.05). In conclusion this study showed satisfactory anterior stability (KT-2000 side-to-side difference up to 5 mm and pivot absent or glide) in 83% of the knees. This percentage increases to 88% in the knees with a correct posterior and proximal femoral tunnel placement. Accuracy in tunnel positioning is essential for the success of ACL surgery. Meniscal repair was effective in decreasing joint space narrowing and should be attempted when possible.     

Complications from the hinged GUEPAR prosthesis after resection of knee tumor. 102 cases

PURPOSE: The purpose of this study was to present the complications which occurred in knee replacement with the GUEPAR prosthesis, after bone tumor resection. We tried to point out complications in relation to prosthetic design and surgical technique. MATERIAL AND METHOD: Between 1972 and 1993, 90 patients had a knee resection, for 80 malignant and 10 benign tumors. There were 51 males and 49 females, aged 12 to 75 years (mean age 35). Fifty-six distal femur resections and 34 proximal tibial resections were performed. Length of resection averaged 16 cm (9 to 30). The reconstruction was always achieved with a cemented, custom-made GUEPAR prosthesis. Including revisions, there was a total of 102 prostheses in 90 patients. A patellar resurfacing was performed in 64 cases. An allograft reconstruction was associated in 39 knees. In all tibial resections and in two extra-articular femoral resections, the extensor mechanism had to be reconstructed. Several reconstruction techniques were associated, in which 19 medial gastrocnemius transfers. The prosthesis design was slightly modified with time. Ten patients received radiotherapy, and 55 had chemotherapy. RESULTS: Results and complications were retrospectively assessed, with an average follow-up of 4.3 years (1 to 22). Six patients were lost for follow-up, 62 patients were alive, with no evolutive disease, 13 had an evolutive disease and 10 were deceased from disease. Nineteen patients had distant metastasis and 17 had local recurrences. Apart from intraoperative complications, late mechanical complications included: 13 aseptic loosening, 2 femoral shaft fractures, 18 knee contractures, 5 femoral stem fractures and, 18 intra-articular instabilities related to wear of the hinge-axis. In the 39 allograft-composite prostheses, only 15 had a favorable evolution. There were 15 extensor mechanism failures and 13 knees had persistent infection. There was a total of 94 reoperations in the 90 patients. In 28 cases, the initially implanted prosthesis was removed. There were also 18 revisions, 7 amputations and 3 arthrodeses. Survivorship analysis showed a 60 per cent probability for the initial prosthesis not to be revised at 10 year-follow-up, apart from oncologic complications. DISCUSSION: Results with allograft-composite reconstruction were not better than with massive prosthesis. When needed, soft tissue coverage and patellar tendon augmentation would better be performed with gastrocnemius plasty. Polyethylene and steel bushes were not solution for hinge axis wear.     

Small wire external fixation of high energy tibial plateau fractures

Open plate osteosynthesis for high energy tibial plateau fractures with dissociation between the metaphysis and diaphysis has been plagued with frequent soft tissue complications. The Harbor-University of California at Los Angeles Medical Center's experience with small wire external fixation supplemented by limited internal fixation is examined. This alternative method of adequate stable fixation offers the advantage of minimal soft tissue compromise. Twenty-four patients with Schatzker Type VI tibial fractures were treated with small wire external fixation. Supplementary limited internal fixation was used with percutaneous screws in 10 patients and with open reduction in one patient. Sixteen patients had isolated fractures, and eight others suffered multiple injuries. Minimum followup was 12 months. All fractures healed. Complications included one septic knee, two infections at screw sites, and one 10 degrees knee flexion contracture. One knee had Grade 3 radiographic arthrosis, five had Grade 2, 10 had Grade 1, and eight showed no arthrosis. The outcomes (Knee Society clinical rating system) of this study compare favorably with outcomes described in reports published previously for this type of fracture, despite inclusion of eight multiply injured patients. This technique preserves the goals of early range of motion and stable fixation for these devastating injuries, while decreasing the observed major wound complications and nonunion rates. However, longer followup may reveal higher arthrosis rates, specifically in those fractures that were not anatomically reduced.     

Treatment of tibial plateau fractures by limited internal fixation

Seventy-five adults who sustained 76 tibial plateau fractures were treated according to a prospective protocol using instability in extension as the principal indication for operative fixation. Patients showing instability underwent closed manipulative reduction under fluoroscopic guidance. If significant joint depression persisted after reduction, elevation of the fracture was performed either from below using bone punches through a cortical window or via limited arthrotomy. Iliac crest bone graft was used to buttress depressed fractures. Fixation was then secured using 7-mm cannulated screws with washers or buttress plates and screws. Postoperatively, 58 of 76 knees were managed in a hinged knee brace, allowing the patient early range of motion and protected weightbearing for 8 weeks. Patients who were found to have a stable knee were treated with Bledsoe braces according to the postoperative protocol. In the 75 patients, 18 of the 76 knees were unsuitable for percutaneous screw fixation because of fracture complexity requiring plates, severe open injuries, or inadequate reductions with limited fixation had been done. A minimum followup of 12 months was obtained in 55 patients (range, 12-59 months). All fractures had healed at the time of followup. Eighty-seven percent of the patients at followup had a successful outcome using Rasmussen's criteria. Fourteen of these patients had arthroscopic assisted reduction or evaluation. All seven patients who had poor outcomes had AO Type C3 fracture patterns. Severely depressed or comminuted fractures or fractures with significant metaphyseal diaphyseal extension may not be suitable for this technique and require the addition of an external fixation device or buttress plate to maintain the reduction and allow for early range of motion.     

Management of late induced abortions in France

OBJECTIVE: To evaluate the clinical results of comminuted patella fracture fixation after an extensile surgical approach by using a tibial tuberosity osteotomy. DESIGN: Prospective, clinical. PATIENTS: Six knees with displaced comminuted patella fractures had stable internal fixation after an osteotomy of the tibial tubercle. All had immediate postoperative continuous knee motion and were followed for an average of thirty-one months (minimum of eighteen months). OUTCOME MEASURES: Time to clinical and radiographic union, Hospital for Special Surgery (HSS) Knee Scores and comparisons with literature cohort studies. RESULTS: Clinical union of the osteotomy occurred at an average of eight weeks (range 6 to 12 weeks) and of the patella fractures at an average of eleven weeks (range 8 to 21 weeks). There was no radiographic evidence of osteotomy displacement, fracture implant loosening, migration, or failure. All patients had clinical residua, which included loss of motion, thigh muscle atrophy, and barometric complaints. HSS Knee Scores averaged 75 points with four good, one fair, and one poor result. These results were comparable to those of previously published reports of ablative surgery for this type of fracture. CONCLUSION: Comminuted patella fractures are severe injuries that usually result in some lingering morbidity. Internal fixation preserves bone stock, which facilitates future reconstructive procedures. The described tibial tuberosity osteotomy, patella eversion technique of fracture exposure improved visualization and reduction of the articular surface. The osteotomy healed in all cases and did not adversely affect the clinical results.     

Operative treatment of hip fractures in patients with renal failure

The conditions of a hip fracture and renal failure cause particularly high mortality. Eight patients (average age, 63 years) who had operative treatment for nine hip fractures were studied retrospectively. Three had intertrochanteric fractures fixed with sliding compression screws, and five had femoral neck fractures (bilateral in one patient): two nondisplaced femoral neck fractures were fixed with percutaneous screws, and four displaced femoral neck fractures were treated with arthroplasties in three and percutaneous screws in one. Operative treatment was done when the patient was in medically stable condition (average, 8 days). Full weightbearing was allowed on the injured limb after surgery. Early morbidity analysis showed no wound infections, thromboembolic events, or hemorrhagic complications. The first year mortality was three (38%). Late morbidity included one nonunion and one sliding screw penetration. Total mortality at 6 years was seven (88%) patients, with an average postoperative survival time of 28 months. Preoperative ambulation was preserved in five of seven (71%) patients. One the basis of this study, it appears that a team approach to operative management including nephrologist and surgeon helps to reduce short term complications and mortality and allows such patients to be mobilized and regain ambulation.     

Placental restriction alters adrenal medullary development in the midgestation sheep fetus

This is a retrospective study of 10 patients with combined cruciate ligament and posterolateral instability who underwent surgical reconstruction between 1991 and 1994. All knees had at least 20 degrees increased external rotation at 30 degrees of knee flexion and from 1+ to 3+ varus instability. Five knees with posterior cruciate ligament ruptures had at least a 2+ Lachman test result. (One knee had both anterior and posterior cruciate ligament injuries). In all cases the lateral collateral ligament was reconstructed with a bone-patellar tendon-bone allograft secured with interference screws. Fixation tunnels were placed in the fibular head and at the isometric point on the femur. The cruciate ligaments were reconstructed with autograft or allograft material. The average follow-up was 28 months. Excessive external rotation at 30 degrees of flexion was corrected in all but one knee. Six patients had no varus laxity, and four patients had 1+ varus laxity at 30 degrees of flexion. The posterior drawer test result decreased, on average, to 1+, and the Lachman test result decreased to between 0 and 1+. The average Tegner score was 4.6, with five patients returning to their preinjury level of activity and four returning to one level lower. These results indicate that this is a promising new procedure for patients with instability resulting from lateral ligament injuries of the knee.     

Fracture of the metal tibial tray after Kinematic total knee replacement. A common cause of early aseptic failure

We reviewed 1567 elective knee replacements performed between 1980 and 1990, using either the Total Condylar prosthesis with an all-plastic tibial component, or the Kinematic prosthesis which has a metal tibial tray. The ten-year probability of survival was 92.1% for the Total Condylar design and 87.9% for the Kinematic. The difference was mainly due to 16 revisions required in the Kinematic series for fracture of the metal base-plate. This was the most common cause of aseptic failure in this group. These fractures were strongly associated with a preoperative varus deformity (hazard ratio (HR) 8.8) and there was a slightly increased risk in males (HR 1.9) and in osteoarthritic knees (HR 1.8). In the nine fractures which occurred within four years of primary implantation (group 1), failure to correct adequately a preoperative varus deformity and the use of a bone graft to correct such a deformity were both strongly associated with fracture (HR 13.9 and 15.8, respectively). In eight fractures which occurred more than five years after primary replacement (group 2) we could detect no significant risk factors. Early complications occurred in two patients after the 16 revision procedures for tray fracture. One had a deep infection and the other refracture of the tray.     

Impact of modern technique on long-term results of total condylar knee arthroplasty

This study reports the 14-year survivorship for 106 consecutive total condylar knee arthroplasties implanted using modern technique. All were performed by a single surgeon and have been observed prospectively since 1979. Failure was defined as revision for any reason, or radiographic evidence of loosening of the components. Life-table analysis reveals a 95.6% clinical survival rate at 14 years, with no radiographically loose components. Confidence interval is +/- 4.2%. There were 4 revisions, but none for aseptic loosening, and there are no impending revisions. Thirty-seven patients (49 knees) were known to be deceased as of April 1993, and 8 other patients are lost to followup. Clinical results for patients with pre- and postoperative Hospital For Special Surgery knee scores show 72 knees rated excellent and 11 good (mean score, 90 points). The 4 failures were rated poor. Mean flexion was 100 degrees. Radiographs of 93 knees were evaluated using the criteria of the Knee Society. Average overall alignment was 5 degrees valgus. Radiolucencies were present in 29 of 78 femoral components with adequate radiographs, and averaged 1 mm in 1 zone. Tibial radiolucency was present in 42 of 93 tibiae, again averaging 1 mm in 1 zone, with no loose pegs. In comparison with the first series of total condylar prostheses, this series showed comparable clinical results, with improved radiographic results, and no radiographic failures.     

Patella fractures associated with injuries of the knee ligament

Concurrent fractures of the patella and knee ligament ruptures are rare. From September 1985 to November 1989, 112 fractures of the patella were treated operatively at the Department of Traumatology at Celje General Hospital. In six patients (5%), associated badly injured ligaments of the knee joint were noted. During the operation, osteosynthesis of the patella was performed after the injured ligaments had been reconstructed. It is essential to examine the knee ligaments under general anesthesia before performing osteosynthesis of the patella. We have found no reports on this uncommon injury in the literature.     

Revision knee arthroplasty with patella replacement versus bony shell

A study was undertaken to assess the clinical results of revision total knee arthroplasty in which an unresurfaced bony shell was left after removing a patellar component versus those in which a patellar component was implanted. Followup was obtained in 123 of 130 consecutive revision total knee replacements (94%) from three centers. In 21 knees a shell of patellar bone was left and 92 knees had a patellar component in place. Ten patients had a patellectomy and were excluded from consideration. The group with the bony shell had a lower postoperative knee score but the preoperative Knee Society clinical score was significantly lower as well in this group of patients. Compared with the group of patients with the patellar component in place, the group of patients with knees left with a bony shell had a significantly higher percentage of patients who had difficulty using stairs, a higher percentage of patients who were not satisfied with their surgery, and a higher percentage of patients who rated their surgery as unsuccessful in returning them to normal daily activities. When a patellar component was not able to be implanted in revision total knee arthroplasty, a lower quality result was observed.