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VIERNES / FRIDAY<br />
258<br />
dad)<br />
F. Tendon Rupture<br />
1. Quadriceps - increased risk with LRR<br />
2. Patellar - increased risk with revision<br />
TKA<br />
a. Revision TKA<br />
b. Partial tendon release<br />
c. Closed knee manipulation<br />
d. Tibial tubercle osteotomy nonunion<br />
3. Key is PREVENTION<br />
a. Consider quadricepsplasty vs. tibial<br />
tubercle osteotomy<br />
4. Treatment<br />
a. Results usually poor<br />
b. Multiple methods<br />
c. Extensor mechanism allograft<br />
III SURGICAL TECHNIQUE<br />
A. Measure patella and component thicknesses<br />
B. Remove what you replace<br />
C. Thickness - try to maintain 15 mm<br />
D. Measure thickness / symmetry postresection<br />
E. Ensure proper component (patellar, tibial,<br />
femoral) position<br />
F. Ensure central patellar tracking<br />
1. Following tourniquet release<br />
Bibliography<br />
1. Ahmed AM, Burke DL, Hyder A: Force<br />
analysis of the patellar mechanism. J<br />
Orthop Res 5:69, 1987.<br />
2. Bayley JC, Scott RD: Further observations<br />
on metal-backed patellar component failure.<br />
Clin Orthop 236:82, 1988.<br />
3. Bayley IC, Scott PD, Ewald FC, Holmes<br />
GB: Failure of the metal-backed patella<br />
component after total knee replacement.<br />
I Bone Joint Surg 70A:668, 1988.<br />
4. Beight JL, Yao B, Hozack WJ, Hearn<br />
SL, Booth RE, Jr: The patellar “clunk”<br />
syndrome after posterior stabilized total<br />
knee arthroplasty. Clin Orthop 299:139-<br />
1142, 1994.<br />
5. Berman AT, Spence Reid BS, Yanicko<br />
DR Jr, Sih GC, Zimmerman MR: Thermal<br />
induced bone necrosis in rabbits; relation<br />
to implant failure in humans. Clin Orthop<br />
186:284, 1984.<br />
6. Bjorkstrom S, Goldie IF: A study of the<br />
arterial supply of the patella in the normal<br />
state, in chondromalacia patellae and<br />
in osteoarthrosis. Acta Orthop Scand 5<br />
1:63, 1980.<br />
7. Booth RE, Jr: Patellar complications in<br />
total knee arthroplasty. In Scott WN (ed.):<br />
The Knee. St. Louis MO, Mosby, 1994,<br />
pp. 1325-1332.<br />
8. Boyd AD Jr, Ewald FC, Thomas WH, Poss<br />
R, Sledge CB: Long term complications<br />
after total knee arthroplasty with or without<br />
resurfacing of the patella. I Bone Joint<br />
Surg 75A:674-681, 1993.<br />
9. Brick GW, Scott PD: The patellofemoral<br />
component of total knee arthroplasty. Clin<br />
Orthop 23 1:163, 1988.<br />
10. Cepulo Al, Matejczyk M, Moran 3M,<br />
Stahurski TM, Greenwald AS: Mechanical<br />
characteristics of patellofemoral<br />
replacement. Trans Orthop Res Soc 8:4<br />
1, 1983.<br />
11. Clayton ML, Thirupathi R: Patellar complications<br />
after total condylar arthroplasty.<br />
Clin Orthop 170:152, 1982.<br />
12. Conway WF, Gilula LA, Serot DI: Breakage<br />
of the patellar component of a kinematic<br />
knee arthroplasty. Orthopedics 9:532,<br />
1986.<br />
13. Dennis DA: Removal of well-fi xed cementless<br />
metal-backed patellar components.<br />
J Arthroplasty 7(2):1-4, 1992.<br />
14. Dennis DA, Clayton ML, O’Donnell S,<br />
Mack PP. Stringer EA: Posterior cruciate<br />
condylar knee arthroplasty; average<br />
11 year follow-up. Chin Orthop 281:52,<br />
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15. Doolittle KH, Turner RH: Patellofemoral<br />
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Orthop Rev 17:696, 1988.<br />
16. Dupont JA, Baker SA: Complications of
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