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J Knee Surg 2021; 34(03): 280-286
DOI: 10.1055/s-0039-1695704
Original Article

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

Bo-Hyun Hwang
1   Department of Orthopaedic Surgery, Joint & Arthritis Research, Himchan Hospital, Seoul, Korea
2   Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
,
Kwang-Am Jung
1   Department of Orthopaedic Surgery, Joint & Arthritis Research, Himchan Hospital, Seoul, Korea
,
Alvin Ong
3   Department of Orthopaedic Surgery, Rothman Institute, Philadelphia
,
Hye-Sun Ahn
1   Department of Orthopaedic Surgery, Joint & Arthritis Research, Himchan Hospital, Seoul, Korea
,
Seong-Hwan Moon
2   Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
,
Su-Chan Lee
1   Department of Orthopaedic Surgery, Joint & Arthritis Research, Himchan Hospital, Seoul, Korea
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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.

Keywords

total knee arthroplasty - posterior stabilized - patellar impingement on tibial polyethylene - function - risk factor


Publication History

Received: 14 January 2019

Accepted: 15 July 2019

Article published online:
30 August 2019

© 2019. Thieme. All rights reserved.

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