Document Detail


The John Insall Award: control-matched evaluation of painful patellar Crepitus after total knee arthroplasty.
MedLine Citation:
PMID:  20706813     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Patellar crepitus (PC) is reported in up to 14% of subjects implanted with cruciate-substituting total knee arthroplasty (TKA). Numerous etiologies of PC have been proposed.
QUESTIONS/PURPOSES: We determined when painful PC typically occurs postoperatively and compared patients undergoing primary TKA who developed painful PC requiring subsequent surgery with a matched group without this complication to identify clinical, radiographic, and surgical variables associated with this complication.
METHODS: From the databases of two institutions (greater than 4000 TKAs), we identified 60 patients who required surgery for painful PC from 2002 to 2008. This group was then compared with an identified control group of 60 TKA subjects without PC who were matched for the key variables of age, gender, and body mass index to determine clinical, radiographic, and surgical factors associated with the development of PC.
RESULTS: The mean time to presentation of PC was 10.9 months. The incidence of PC correlated with a greater number of previous knee surgeries, decreased patellar component size, decreased composite patellar thickness, shorter preoperative and postoperative patellar tendon length, increased posterior femoral condylar offset, use of smaller femoral components and thicker tibial polyethylene inserts, and placement of the femoral component in a flexed posture.
CONCLUSIONS: Many of the factors associated with an increased incidence of postoperative PC such as shortened patellar tendon length, use of smaller patellar components, decreased patellar composite thickness, and increased posterior femoral condylar offset may all increase quadriceps tendon contact forces against the superior aspect of the intercondylar box, increasing the risk of fibrosynovial proliferation and entrapment within the intercondylar region of the femoral component. Based on these findings, the authors recommend use of larger patellar components when possible, avoid oversection of the patella or increasing posterior femoral condylar offset, and advising patients preoperatively who have had previous knee surgery or demonstrate a shortened patellar tendon length of an increased risk of development of postoperative patellar crepitus.
LEVEL OF EVIDENCE: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Authors:
Douglas A Dennis; Raymond H Kim; Derek R Johnson; Bryan D Springer; Thomas K Fehring; Adrija Sharma
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Clinical orthopaedics and related research     Volume:  469     ISSN:  1528-1132     ISO Abbreviation:  Clin. Orthop. Relat. Res.     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2010-12-24     Completed Date:  2011-01-25     Revised Date:  2013-05-29    
Medline Journal Info:
Nlm Unique ID:  0075674     Medline TA:  Clin Orthop Relat Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  10-7     Citation Subset:  AIM; IM    
Affiliation:
Colorado Joint Replacement, 2535 S Downing Street, #100, Denver, CO 80210, USA. kslutzky@coloradojoint.com
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Arthroplasty, Replacement, Knee / adverse effects*,  instrumentation
Awards and Prizes
Case-Control Studies
Colorado
Female
Humans
Knee Joint / radiography,  surgery*
Knee Prosthesis
Logistic Models
Male
Middle Aged
North Carolina
Odds Ratio
Pain Measurement
Pain, Postoperative / etiology*,  radiography,  surgery
Patella / radiography,  surgery*
Prosthesis Design
Reoperation
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Young Adult
Comments/Corrections

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