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CC BY-NC-ND 4.0 · Joints 2018; 06(03): 204-210
DOI: 10.1055/s-0038-1675845
Review Article
Georg Thieme Verlag KG Stuttgart · New York

The Challenge of Managing the “Third-Space” in Total Knee Arthroplasty: Review of Current Concepts

Pierluigi Antinolfi
1   Service of Orthopedics and Trauma Surgery, Santa Maria della Misericordia Hospital, Perugia, Italy
,
Francesco Manfreda
2   Department of Orthopedics and Traumatology, University of Perugia, Perugia, Italy
,
Giacomo Placella
3   Service of Orthopedics and Traumatology, Azienda Ospedaliera Regionale San Carlo, Potenza, Italy
,
Julien Teodori
2   Department of Orthopedics and Traumatology, University of Perugia, Perugia, Italy
,
Giuliano Cerulli
4   I.R.T.A.L. Istituto di Ricerca Traslazionale Apparato Locomotore, Nicola's Foundation, Arezzo, Italy
,
Auro Caraffa
1   Service of Orthopedics and Trauma Surgery, Santa Maria della Misericordia Hospital, Perugia, Italy
2   Department of Orthopedics and Traumatology, University of Perugia, Perugia, Italy
› Author Affiliations
Further Information

Publication History

31 January 2018

07 October 2018

Publication Date:
10 December 2018 (online)

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Abstract

Total knee arthroplasty (TKA) is the best treatment for advanced knee osteoarthritis and it has proven to be durable and effective. Anterior knee pain (AKP) is still one of the most frequent complications after TKA, but sometimes no recognized macroscopic causes can be found. The correct treatment of patella is considered the key for a proper management of AKP. The inclusion of patellar resurfacing during TKA has been described as a potential method for the reduction of AKP. After surgeons started to resurface the patella, new complications emerged, such as component failure, instability, fracture, tendon rupture, and soft tissue impingement. Patelloplasty has been proposed as a good alternative to resurfacing but whether or not to resurface the patella is still a controversial topic in the literature. Therefore, patellofemoral joint is a complex critical aspect in TKA and choosing between the several options of treatment of patella could not be sufficient. In this review, evidence-based studies do not succeed in resolving this difficult argument. The accurate management of the so-called “third space” should include an accurate assessment of cartilage layers, balance of soft tissue, preoperative anterior tracking, and positioning of the femoral and tibial components. In fact, the selection of suitable implants and adherence to proper surgical technique are the fundamental principles for the success of TKA.

Keywords

total knee arthroplasty - patella - resurfacing - patelloplasty - patellofemoral joint