Patellar bone deficiency in revision total knee arthroplasty

Abstract

Patellar bone deficiency in revision total knee arthroplasty (TKA) determines the surgical procedure. Different reconstructive and ablative techniques, dependent on the remaining bone stock, are described. The primary patella implant can be retained in up to 50 % of revision situations. Reasons for replacement are aseptic and septic loosening, implant failure, expanding osteolysis, maltracking of the patella and "metal-backed" prosthesis. The aim of the reconstruction is the stable fixation and proper tracking of the implant by restoring the extensor mechanism. Dependent on the extent of bone loss and the availability of apatellar rim, the following surgical procedures are recommended. When the remaining bone thickness is 10mm or more: implantation of apolyethylene "onlay-type" patella; when it is between 6-9mm and there is an intact patellar rim: reconstruction with abiconvex "inlay-type" patella implant, where the biconvex shape replaces the bone defect partially. When there is deficient bone stock (less than 6mm) or no cortical patellar rim then augmenting procedures with autologous spongiosa and procedures such as "impaction bone grafting", "trabecular metal" prosthesis, where the trabecular part of the implant serves as the base for the cemented polyethylene button, "gull-wing" osteotomy, which is an adapting and configuring technique of osteotomy; and in exceptional cases patelloplasty or patellectomy are used. Regarding the importance of the patellar component in biomechanics of the joint and function of the extensor mechanism, the reconstruction of the patella should be the primary aim. Patelloplasty or patellectomy should be avoided.