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The Journal of Bone and Joint Surgery, Vol 67, Issue 9 1321-1327, Copyright © 1985 by Journal of Bone and Joint Surgery, Inc
Patellar dislocation following total knee replacement
RL Merkow, M Soudry and JN Insall
The reported incidence of patellar problems after total knee replacement
has ranged from 5 to 30 per cent. Patellar dislocation is infrequent but
can cause disabling symptoms. Between January 1974 and May 1982, eleven
patients (twelve knees) with symptomatic lateral dislocation of the patella
after total knee replacement were treated at The Hospital for Special
Surgery by realignment of the extensor mechanism. All of the patients were
women. Their average age was sixty-two years and average weight,
eighty-seven kilograms. The diagnosis was osteoarthritis in seven knees and
rheumatoid arthritis in five. Most of the patients had had preoperative
valgus deformity (average, 18 degrees). The cause of dislocation was trauma
in three knees, incorrect tracking of the patella after replacement in six,
and malrotation of the tibial component in three. Four different prosthetic
designs had been used. The design of the implant did not appear to be a
factor causing dislocation in this group. The patellar dislocation was
treated by proximal realignment of the quadriceps in ten knees, lateral
retinacular release alone in one, and revision of the tibial and femoral
components combined with proximal realignment in one. After an average
follow-up of thirty-four months (range, twenty-four to fifty-seven months),
the results according to The Hospital for Special Surgery knee-rating scale
were excellent in ten knees and good in two, and there had been no
redislocations.
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