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      Osteoarthritis with permanent dislocation of the patella treated by total knee arthroplasty through a lateral approach: A report of two cases

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          Highlights

          • Permanent dislocation of the patella (PDP) is a rare condition. In cases of PDP with tibiofemoral arthritis, total knee arthroplasty may be performed through a medial parapatellar approach with patellar realignment in general.

          • We performed two total knee arthroplasties for PDP with lateral tibiofemoral arthritis through a lateral approach without any realignment procedure.

          • We only have 2 cases, but we suggest that TKA through a lateral approach have potential to be a new treatment option to achieve both a good outcome and repositioning of the patella.

          Abstract

          Introduction

          Permanent dislocation of the patella (PDP) is a rare condition. In cases of PDP with tibiofemoral arthritis, total knee arthroplasty may be performed through a medial parapatellar approach with patellar realignment. In this article we present two cases of PDP with tibiofemoral osteoarthritis successfully treated via lateral approach TKA without any additional realignment procedure. We performed two total knee arthroplasties for PDP with lateral tibiofemoral arthritis through a lateral approach without any realignment procedure. Mobile bearing inserts were used to adjust rotational alignment. The patients showed improved functional outcomes (Japanese Orthopaedic Association Knee score and Oxford Knee Score), and improved range of motion. Three years postoperatively, the patellae remain stable without dislocation nor maltracking, maintaining a high functional score.

          Conclusion

          To treat permanent dislocation of the patella with lateral knee osteoarthritis, TKA through a lateral approach have potential to be a new treatment option to achieve both a good outcome and repositioning of the patella.

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          Most cited references13

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          The SCARE Statement: Consensus-based surgical case report guidelines.

          Case reports have been a long held tradition within the surgical literature. Reporting guidelines can improve transparency and reporting quality. However, recent consensus-based guidelines for case reports (CARE) are not surgically focused. Our objective was to develop surgical case report guidelines.
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            The lateral approach to the valgus knee. Surgical technique and analysis of 53 cases with over two-year follow-up evaluation.

            Valgus deformity correction poses a major challenge in total knee arthroplasty (TKA). The standard medial approach has many technical limitations and disadvantages that include patellofemoral maltracking and subsequent patellar problems. The lateral approach has been developed and utilized successfully in 79 cases (53 with over two-year follow-up evaluation) since 1980. The biomedical rationale of the approach is sound, and addresses the pathologic anatomy of fixed valgus deformity. Surgical technique is direct, anatomical, more physiologic, and maintains soft-tissue integrity. The "lateral release" is performed as part of the approach. Patellofemoral tracking and alignment stability are optimized and medial blood supply preserved. Clinical experience has shown the approach to be more aesthetic and results objectively superior. Scores have been good/excellent in 94.3% of cases. Knee stability is enhanced with the use of nonconstrained prostheses in this difficult group of patients. The lateral approach is recommended as the "approach of choice" for fixed valgus deformity in TKA.
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              Lateral approach is advantageous in total knee arthroplasty for valgus deformed knee

              Introduction For the total knee arthroplasty in valgus deformed knee, superiority of the medial or lateral approach is still controversial. We compared the short-term result of two approach groups. Materials and methods Forty-seven knees in rheumatoid arthritis with valgus deformity from 6° to 24° were randomly divided into two group; medial approach (24 knees) and lateral approach (24 knees). We used Scorpio NRG PS for all knees. Median postoperative periods were 43 months in both groups. We compared the surgical time, and alignment on standing radiograph, range of motion (ROM) pre/postoperatively, and degrees of soft-tissue release procedure, and lateral laxity measured by stress radiograph immediately after operation and at final follow-up. Result Pre/postoperative alignment, surgical time, lateral laxity, and preoperative ROM had no significant in two groups; however, postoperative flexion was superior in lateral approach group 123.8°, 109° in medial approach group. All cases required iliotibial band (ITB) release at Gerdy’s tubercle, 83 % ITB at joint level, 21 % lateral collateral ligament (LCL), 17 % popliteus tendon (PT) in medial approach group, and 88 % ITB at Gerdy’s tubercle, 46 % ITB at joint level, 13 % LCL, 4 % PT in lateral approach group. Discussion In the valgus knee, lateral structures are tight. Lateral approach can directly adjust the tight structure, and also less vascular compromise to the patella than medial approach with lateral patellar release. Less invasiveness to the quadriceps muscle in lateral approach could result into better range of motion after the surgery.
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                Author and article information

                Contributors
                Journal
                Int J Surg Case Rep
                Int J Surg Case Rep
                International Journal of Surgery Case Reports
                Elsevier
                2210-2612
                08 July 2017
                2017
                08 July 2017
                : 38
                : 73-77
                Affiliations
                [0005]Department of Orthopedic Surgery, Takatsuki Hospital, Japan
                Author notes
                [* ]Corresponding author at: Department of Orthopedic Surgery, Takatsuki Hospital, 3-13, Kosobe 1-chome, Takatsuki, Osaka, 569-1192, Japan. fujiwarashuuichi@ 123456yahoo.co.jp
                Article
                S2210-2612(17)30326-7
                10.1016/j.ijscr.2017.07.012
                5524422
                28743096
                0aa48ab3-5af1-4a5e-84f1-9b603c338280
                © 2017 The Author(s)

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 8 April 2017
                : 1 July 2017
                : 3 July 2017
                Categories
                Case Report

                permanent dislocation of the patella,total knee arthroplasty,lateral approach,osteoarthritis,case report

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