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Patellar Impingement on Tibial Polyethylene after Primary Total Knee Arthroplasty without Patellar Resurfacing.

Abstract

Patellar impingement on tibial polyethylene (PIP) is one potential complication of total knee arthroplasty (TKA). When PIP occurs, it is often related to inaccurate restoration of the joint line or due to soft-tissue contracture. We investigated the prevalence and etiology of PIP in Asian patients with deeply flexed knees following posterior stabilized (PS)-TKA. We retrospectively reviewed 54 patients (65 knees) with PIP after primary PS-TKAs without patellar resurfacing performed between 2008 and 2011. These patients were compared with a group of 124 patients (130 knees) without PIP matched for age, sex, and body mass index (BMI). The minimum follow-up was 5 years (range, 5-8.1 years). Patients were evaluated by blinded, independent observers using the Oxford knee score, the Waters score, and radiographic parameters. Impingement between the patella and the tibial polyethylene had a mean onset of 13.5 months after PS-TKA. The development of PIP was significantly associated with change in patellar tendon length (odds ratio [OR] = 11.4, 95% confidence interval [CI]: 11.2-11.6%), shorter postoperative patellar tendon length (OR = 2.1, 95% CI: 1.8-2.5%), change in the Insall-Salvati ratio (OR = 0.9, 95% CI: 0.8-1.0%), and joint line elevation (OR = 5.3, 95% CI: 4.8-5.8%) on multiple logistic regression analysis. Our findings reinforce the importance of accurate joint line restoration and the avoidance of iatrogenic injury to the patellar tendon, which can lead to shortening of the patellar tendon. This is a retrospective comparative study and its level of evidence is III.

Authors+Show Affiliations

Department of Orthopaedic Surgery, Joint & Arthritis Research, Himchan Hospital, Seoul, Korea. Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea.Department of Orthopaedic Surgery, Joint & Arthritis Research, Himchan Hospital, Seoul, Korea.Department of Orthopaedic Surgery, Rothman Institute, Philadelphia.Department of Orthopaedic Surgery, Joint & Arthritis Research, Himchan Hospital, Seoul, Korea.Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea.Department of Orthopaedic Surgery, Joint & Arthritis Research, Himchan Hospital, Seoul, Korea.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31470453

Citation

Hwang, Bo-Hyun, et al. "Patellar Impingement On Tibial Polyethylene After Primary Total Knee Arthroplasty Without Patellar Resurfacing." The Journal of Knee Surgery, 2019.
Hwang BH, Jung KA, Ong A, et al. Patellar Impingement on Tibial Polyethylene after Primary Total Knee Arthroplasty without Patellar Resurfacing. J Knee Surg. 2019.
Hwang, B. H., Jung, K. A., Ong, A., Ahn, H. S., Moon, S. H., & Lee, S. C. (2019). Patellar Impingement on Tibial Polyethylene after Primary Total Knee Arthroplasty without Patellar Resurfacing. The Journal of Knee Surgery, doi:10.1055/s-0039-1695704.
Hwang BH, et al. Patellar Impingement On Tibial Polyethylene After Primary Total Knee Arthroplasty Without Patellar Resurfacing. J Knee Surg. 2019 Aug 30; PubMed PMID: 31470453.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Patellar Impingement on Tibial Polyethylene after Primary Total Knee Arthroplasty without Patellar Resurfacing. AU - Hwang,Bo-Hyun, AU - Jung,Kwang-Am, AU - Ong,Alvin, AU - Ahn,Hye-Sun, AU - Moon,Seong-Hwan, AU - Lee,Su-Chan, Y1 - 2019/08/30/ PY - 2019/8/31/entrez PY - 2019/8/31/pubmed PY - 2019/8/31/medline JF - The journal of knee surgery JO - J Knee Surg N2 - Patellar impingement on tibial polyethylene (PIP) is one potential complication of total knee arthroplasty (TKA). When PIP occurs, it is often related to inaccurate restoration of the joint line or due to soft-tissue contracture. We investigated the prevalence and etiology of PIP in Asian patients with deeply flexed knees following posterior stabilized (PS)-TKA. We retrospectively reviewed 54 patients (65 knees) with PIP after primary PS-TKAs without patellar resurfacing performed between 2008 and 2011. These patients were compared with a group of 124 patients (130 knees) without PIP matched for age, sex, and body mass index (BMI). The minimum follow-up was 5 years (range, 5-8.1 years). Patients were evaluated by blinded, independent observers using the Oxford knee score, the Waters score, and radiographic parameters. Impingement between the patella and the tibial polyethylene had a mean onset of 13.5 months after PS-TKA. The development of PIP was significantly associated with change in patellar tendon length (odds ratio [OR] = 11.4, 95% confidence interval [CI]: 11.2-11.6%), shorter postoperative patellar tendon length (OR = 2.1, 95% CI: 1.8-2.5%), change in the Insall-Salvati ratio (OR = 0.9, 95% CI: 0.8-1.0%), and joint line elevation (OR = 5.3, 95% CI: 4.8-5.8%) on multiple logistic regression analysis. Our findings reinforce the importance of accurate joint line restoration and the avoidance of iatrogenic injury to the patellar tendon, which can lead to shortening of the patellar tendon. This is a retrospective comparative study and its level of evidence is III. SN - 1938-2480 UR - https://www.unboundmedicine.com/medline/citation/31470453/Patellar_Impingement_on_Tibial_Polyethylene_after_Primary_Total_Knee_Arthroplasty_without_Patellar_Resurfacing L2 - http://www.thieme-connect.com/DOI/DOI?10.1055/s-0039-1695704 DB - PRIME DP - Unbound Medicine ER -