Patellar Instability after Total Knee Arthroplasty: A Surgical Case Report.

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Abstract

Conflict of interest statement: Conflict of Interest: Nil 12. Bone Joint J. 2021 Jun;103-B(6):1103-1110. doi: 10.1302/0301-620X.103B6.BJJ-2020-1954.R2. Isolated tibial insert exchange in revision total knee arthroplasty : reliable and durable for wear; less so for instability, insert fracture/dissociation, or stiffness. Tetreault MW(1), Hines JT(1), Berry DJ(1), Pagnano MW(1), Trousdale RT(1), Abdel MP(1). Author information: (1)Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA. AIMS: This study aimed to determine outcomes of isolated tibial insert exchange (ITIE) during revision total knee arthroplasty (TKA). METHODS: From 1985 to 2016, 270 ITIEs were performed at one institution for instability (55%, n = 148), polyethylene wear (39%, n = 105), insert fracture/dissociation (5%, n = 14), or stiffness (1%, n = 3). Patients with component loosening, implant malposition, infection, and extensor mechanism problems were excluded. RESULTS: Survivorship free of any re-revision was 68% at ten years. For the indication of insert wear, survivorship free of any re-revision at ten years was 74%. Re-revisions were more frequent for index diagnoses other than wear (hazard ratio (HR) 1.9; p = 0.013), with ten-year survivorships of 69% for instability and 37% for insert fracture/dissociation. Following ITIE for wear, the most common reason for re-revision was aseptic loosening (33%, n = 7). For other indications, the most common reason for re-revision was recurrence of the original diagnosis. Mean Knee Society Scores improved from 54 (0 to 94) preoperatively to 77 (38 to 94) at ten years. CONCLUSION: After ITIE, the risk and reasons for re-revision correlated with preoperative indications. The best results were for polyethylene wear. For other diagnoses, the re-revision rate was higher and the failure mode was most commonly recurrence of the original indication for the revision TKA. Cite this article: Bone Joint J 2021;103-B(6):1103-1110. DOI: 10.1302/0301-620X.103B6.BJJ-2020-1954.R2