Abstract
A 68-year-old female suffering from habitual patellar dislocations following a mal-positioned total knee arthroplasty (TKA) was successfully treated with a biplanar closed wedge distal femoral osteotomy (CWDFO) and medial patello-femoral ligament (MPFL) reconstruction. To the best of our knowledge, no such case has been previously described. Our experience with this case suggests that treatment for a patella dislocation following valgus mal-positioning of TKA should be considered positively.Level of evidenceV
Highlights
Patellar instability is often the cause of total knee arthroplasty (TKA) failure [13]
We showed for the first time that a combination of CWHTO and an medial patello-femoral ligament (MPFL) reconstruction can treat a habitual patella dislocation caused by a mal-positioned TKA with excellent clinical outcomes at 2 years follow-up
Despite a decrease in the frequency of patella instability due to improvements in implant design and surgical technique, this adverse event still accounts for about 10% of all TKA complications [6]
Summary
Patellar instability is often the cause of TKA failure [13] The reasons underlying this instability must be determined precisely before it can be treated, including possible errors in the prosthesis implantation (such as an abnormal internally rotated femoral and/or tibial component, a poorly restored patellar offset, medialization of the femoral component or abnormal patellar resurfacing), alignment defects, an excessively large tibial tuberosity to the trochlear groove (TT- TG) distance, and/ or patella alta) [11]. Case presentation A 68-year-old female was referred to our hospital due to habitual patellar instability. She had received a TKA without patella resurfacing at another hospital 15 years previously but had been suffering from severe knee pain and patella instability for 8 years. X-rays of the knee revealed a tibial posterior sag, the femoral component had been installed at an extremely valgus position, and the patella surface was still native, but irregular and
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