barcelona patella final巴塞罗那髌骨

Patella/ExtensionapparatusinRevisionTKAP.RitschlOrthopedicClinicGersthofViennaKneeSurgery-FromComplexPrimarytoRevisionBarcelona17-18.10.2013KeyPoints-PatellaRevision1Whentoretain2Whentorevise4Possibilitisofreconstructionsduetoboneloss BiconvexPatella Impectiongrafting Gullwingprocedure Metalbackaugmentation 3HowtoremoveKneeSurgery-FromComplexPrimarytoRevisionWhentoretainSolidfixationNopittingordelaminationSatisfactorymatchtonewtrochleaGoodtrackingRiskforinsufficientresidualbonestockincaseofrevisionLonner:JBJSA2003Barrack:J.Arthropl.2000WhentoreviseMetalbackedpatellaPatellabonefractureNo/BadmatchtonewtrochleaLoose,pitting/delamination,maltracking,Lonner:JBJSA2003Barrack:J.Arthropl.2000GammaradiatedH.Ri.♂85a08.10.2013

H.Ri.♂85a03.10.2013

Patellabonefracture3HowtoremoveKeepthebonestockasmuchaspossibleMetal-backed

Diamond-edgedcircularsawblade3HowtoremovePatellameniscusImplantboneinterfaceOscillatingsaworanosteotomeRemovethepegsandremainingbonecementPatellarimisOK8-10mmLessgoodremainingbonestockMaheshwerCBetal.CORR2005;440:126–130

Waterpickwash-outisnotdemonstratedCementedall-polybiconvexpatellarprosthesisSevereBonyDeficiency Resectionarthroplasty(patelloplasty) Ismoreahistoricaltreatmentoption

Gull-wingosteotomy

Bonegraftingandaugmentationprocedure

Trabecularmetalpatellaprosthesis

1-3mmPatellashellMedialandlateralborderofthePatellaaredisplaced“greensticking”ina“V”oragullwingconfigurationpletemidlinesagitallosteotomy VinceKetal.:J.Arthropalsty2000;15:254GreggR.Kleinetal.:JArthroplasty.2010;25:49-253Gull-wingOsteotomyPatellar

BoneGraftingProceduresSuturedcircumferentiallyaroundthepatellatohelpretainthebonegraft.

HanssenAD.JBoneJointSurgAm.2001;83:171–176.Softtissueflapisconstructedfromperipatellarfibrousscartissuesuprapatellarpouchventralfascialata Thetantalumaugmentationissuturedtoanyboneorsofttissue Servesasafoundationforcementingapolybutton. DoesnotrequireacorticalrimofpatellarboneRiesMD,CORR2006;452:166–170.NasserS:JArthroplasty.2004;195:562–572.PorousTantalumPatellarProsthesisConclusionPatellainRevisionTKA

PatellectomyandpurePatelloplastyshouldbeavoidedTrytoreconstructandrestorethePatellatoachievebetterclinicaleExtensionapparatusinRevisionTKASharkeyPF:Whyaretotalkneearthroplastiesfailingtoday?ClinOrthopRelatRes2002;404:7-13.Incidence:12%ofrevisionkneeproceduresSeverity:fromslightsubluxationinflexiontocompleteavulsionofthepatellartendon1Soft-tissueassociatedfailures2ComponentpositionfailuresFemurTibiaPatella3Extensormechanismrupture/fracturesQuadricepstendonPatellafracturePatellartendon/tubercleavulsion

KeyPoints-

ExtensionapparatusKneeSurgery-FromComplexPrimarytoRevision“Clunk”Syndromoccurswhenrisingfromalowchair.fibrousnoduleontheundersurfaceofthequadricepsmechanismcatchesontheanterioredgeoftheboxofaPS-TKA.ArthoscopictreatmentPatellacrepitus.DennisDA:JohnInsallAwardClinOrthopRelatRes.2011Jan;469(1):10-7Meantimetopresentation:10.9mopostop.inPSkneesIncidence0-14%.DesignrelatedIntercondylarboxheightratioRetrospectivestudy60/4000Onesingledesign(PFCSigmaPS)IntercondylarboxheightratioratioofthelengthoftheintercondylarboxtotheAPwidthofthefemoralcomponentathigherrisk>0,7PatellacrepitusCorrelateswith:greaternumberofpreviouskneesurgeriesdecreasedpatellarcomponentsizeDennisDAJohnInsallAwardClinOrthopRelatRes.2011Jan;469(1):10-7decreasedcompositepatellarthicknessshorterpreop.andpostop.patellartendonlengthincreasedposteriorfemoralcondylaroffsetuseofsmallerfemoralcomponentsuseofthickerPEinsertsflexedposture

ofthefemoralcomponentP.Ther.♀88a30.09.2013

TraumaticDisruptionoftheRetinaculumLateralreleaseDoublefoldingofthemedialretinaculumLARSbandagereinforcement1Soft-tissueassociatedfailures2ComponentpositionfailuresFemurTibiaPatella3Extensormechanismrupture/fracturesQuadricepstendonPatellafracturePatellartendon/tubercleavulsion

KeyPoints-

ExtensionapparatusKneeSurgery-FromComplexPrimarytoRevisionPatellarmaltracking-subluxation/dislocationFemoralortibialcomponentsare

internallyrotated,ExcessivevalgusalignmentObliquepatellarcutorlateral

placementofthepatellarcomponentComponentpositionfailures1Soft-tissueassociatedfailures2ComponentpositionfailuresFemurTibiaPatella3Extensormechanismrupture/fracturesQuadricepstendonPatellafracturePatellartendon/tubercleavulsion

KeyPoints-

ExtensionapparatusKneeSurgery-FromComplexPrimarytoRevisionRuptureQuadricepstendonafterTKACompleteandpartialtearsDobbsRE:JBJSAm,2005Jan01;87(1):37-45DobbsRE:JBJSAm,2005Jan01;87(1):37-45Predisposingsystemicfactors:rheumatoidarthritis,diabetesmellitus,chronicrenalfailure,obesity,hyperthyroidismPredisposinglocalfactors:StiffkneepriorTKA,multiplearthrotomy,chronicsteroiduse,poorpatellarpositioning,lateralretinacularreleaseDiagnosis

atypicalhistoryofafallextensorlagpalpabledefectIncidence:0.1%Meaninterval:TKA–Rupture32mo(max/min2d-200months)OperativeproceduresDirectsuturefixation,withorwithoutdrill-holesinthepatella

DobbsRE:JBJSAm,2005Jan01;87(1):37-45DobbsRE:JBJSAm,2005Jan01;87(1):37-4534tearsafterTKA11complete10operated8directsuturerepair2/10LARSLigamentAugmentationReconstrationSystem4doingwellFUP34months23partial16operateddirectsuturerepair12doingwellFUP74monthsComplicationrate

Infection12%Secondoperation35%Conclusion:DirectsuturealoneisnotsufficientReinforcementwithmuscle/tendonflapsand/oraugmentationwithsyntheticmaterial(LARS)

ChronicQuadricepstendonruptureAcuteextensortendonruptureDirectrepairandaugmentation.ChronicextensortendonruptureReinforcementwitheithersemitendinosusandgracilistendonMedialgastrocnemiusflap,Augmentationwithsyntheticmaterial(LARS)AdviceRuptureQuadricepstendonafterTKANearthepatellapole:suturethroughdrillholesorsutureanchors>20°extensorlagcutoffpointforsurgicalrepairRosenbergA.G.:JBJSBr2012;94-B,SuppleA:116–19.PatellafractureTwomainquestions:Isthepatellacomponentloose?Isextensorlaggreaterthan20°?PatellacomponentwellfixedKneeimmobiliser,followedbygradualmobilisation.Excisesmallfragments,Fixmajorfragments,Assessbonestockforfurtherpatellamanagement,PatellectomyforfailedpatellarfracturerepairGoodpainreliefLesssatisfactoryfunctionChangMA,Patellectomyaftertotalkneearthroplasty.CORR2005;440:175–177.PatellacomponentnotwellfixedZ.J.male,68y2LongitudinaloldsubluxedpatellafractureZ.J.male,68y19.04.2013Z.J.male,68y23.04.2013PatellartendonAcuteavulsionsAcutedisruptionChronictendonrupturesAcuteavulsionRefixationdrillholesinboneorsutureanchors.Supplementalsemi-tendinosisreconstructionAcutedisruptionCadambiA,EnghGA.JBJS[Am]1992;74-A:974–979.EndtoendsutureSupplementalsemi-tendinosisreconstructionMaintainingitsdistalattachment,Releasedwithatendonstripper.PassedthroughatransverseholeintheinferiorpatellaReattacheddistallyintoremainingsofttissueatthetendonorigin.Semi-tendinosisreconstructionChronictendonrupturescomplicatedbyretractionorshorteningAchillestendonallograftCrossettLS,JBJS[Am]2002;84-A:1354–1361.Bone-patellartendon-boneallograftMalhotraR,JArthroplasty2008;23:1146–1151.KnittedmonofilamentpolypropylenegraftBrowneJA,JBJS[Am]2011;93-A:1137–1143.Completeallograftextensorreconstructionifthesetechniquesmentionedabovearenotappropriate,Patellarheightiscompromisedbychronicretraction,Patellaisnecrotic.ChronictendonretractionLigamentumpatella,QuadricepstendonafterPatellafractureBiologicalreconstructionTransverseoldpatellafractureChronicretraction1,5yposttraumaF.Joh.♂50a16.08.2013

präoperativCompleteextensiondeficitF.Joh.♂50a10.10.2013

DiscisionofthemusclefasciaoftheM.rectusfemorisbacksideF.Joh.♂50a10.10.2013

Quadricepsmobilisation,Medialvastusstaysattachedtotheprox.patellapoleF.Joh.♂50a10.10.2013

ElongationoftheM.rectusfemorisbymusclefasciareleaseAugmentationoftheoftheelongatedM.rectusfemoriswithafascialataestripProximisationofthetibialTuberosityF.Joh.♂50a10.10.2013

F.Joh.♂50a10.10.2013

Midtermresultsofcruciateretainingtotalkneearthroplastyinpatellectomizedpatients.DahiyaV1,GuptaH,RajgopalA,VasdevA.Authorinformation1DepartmentofOrthopaedics,MedantaBoneandJointInstitute,Medanta,theMedicitySector38,Gurgaon,Haryana,India.AbstractBACKGROUND:Totalkneearthroplasty(TKA)inpatellectomizedpatientsgivesinferiorresultswhencomparedwiththoseinwhichthepatellaispresent.Theliteratureisambiguousabouttheroleofcruciateretainingorsacrificingimplantsfortheseknees.Inthisstudy,weassessedthemidtermresultsofTKAinpatellectomizedkneesusingacruciateretainingimplant.MATERIALSANDMETHODS:ThirtythreepatientswithapriorpatellectomyunderwentacruciateretainingTKAandwerefollowedupforanaverageof9.3years(range2-14years).Ateachfollowupvisit,theywereevaluatedclinically,radiologicallyandbytheHospitalforSpecialSurgeryScoringSystem.RESULTS:Twentyonekneesdidnothaveanypainordifficultyinclimbingstairs,10kneeswereslightlypainfulonstairsbutpainfreeonwalkingonflatgroundandtwokneesexperiencedmildtomoderatepainonwalkingupanddownstairsaswellasonflatground.Theaveragerangeofmotionpreoperativelywas87°,whichpostoperativelyincreasedto118°.TheaverageHospitalforSpecialSurgeryKneescoresincreasedfrom52to89points.Noneofthekneesshowedanyprogressiveradiolucenciesorevidenceofanyloosening/osteolysisorfracturesinfollowup.CONCLUSION:CruciateretainingTKAoffersgoodresultsatmidtermfollowupinpatientswithapriorpatellectomy.KEYWORDS:Cruciateretainingtotalkneearthroplasty,patellectomy,totalkneearthroplastyConclusionPatellofemoralproblemsafterTKAcoversSoft-tissuefailuresComponentpositionfailuresExtensormechanismrupture/fractures

DifficultsurgeryHighrateofcomplicationsandfailureDifferencebetweenpatientsandsurgeonsexpectationsThankYouAllograftChronicorlatedisruptionsTypesallograftreconstructionAchillestendonallograft:PatellaandQuadricepstendonwereintactPatellacanbemobilizedinthepr