Multicenter Randomized Clinical Trial of Highly Cross-Linked Polyethylene Versus Conventional Polyethylene in 518 Primary TKAs at 10 Years.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: Disclosure: This study received funding through philanthropic support by the Anna Maria and Stephen Kellen Foundation (MPA) and from Stryker Corporation. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article ( http://links.lww.com/JBJS/I264 ). 13. Knee. 2009 Mar;16(2):92-7. doi: 10.1016/j.knee.2008.08.003. Epub 2008 Sep 25. How to address the patella in revision total knee arthroplasty. Maheshwari AV(1), Tsailas PG, Ranawat AS, Ranawat CS. Author information: (1)Ranawat Orthopaedics, Hospital for Special Surgery, 535 East 70th Street, 6th floor, New York, NY 10021, United States. adityavikramm@gmail.com Patellar issues need to be carefully addressed during any revision TKA and the surgeon often faces the question of what to do with the patella at the time of revision. The choice of treatment is often made by balancing what is technically feasible with the risk of potential complications and takes into account the reason for the revision, the type of implant (i.e., metal-backing or all-polyethylene), the duration of implantation, the fixation, the stability, the sterilization technique, the wear, the presence of osteolysis, the compatibility with the femoral component, and most importantly the remaining bone stock. The various treatment options then include retention of the patellar component, revision of the patellar component, removal of the component with retention of the patellar bony shell (patelloplasty or resection arthroplasty), excision of the patella (partial or total patellectomy), secondary resurfacing, and reconstruction/augmentation of the patellar bone stock. Isolated patellar revision is associated with a high complication rate and recurrent failure when poor patellar tracking, incongruent designs and malalignment of the femoral and tibial components exist. Retention of a well-fixed all-PE (non-oxidized) patella is advocated where possible and revision of metal-backed patella is recommended (unless well fixed with poor bone stock). In the situation of a deficient patella, patelloplasty, augmentation procedures and very rarely patellectomy are other viable options. DOI: 10.1016/j.knee.2008.08.003