ABSTRACT
Multiple etiologies may cause anterior knee pain after total knee arthroplasty. While
prior studies have addressed component positioning and surgical technique, no series
in the literature describes lateral patellofemoral impingement as a source of the
pain. Over a 2-year period at our institution, 18 patients with 19 painful total knee
arthroplasties were diagnosed with lateral patellofemoral impingement. All underwent
revision surgery with either lateral facetectomy or revision of the patellar dome.
These patients were followed with Knee Society scores for 1 year. Knee Society scores
were significantly improved at 8 weeks, 16 weeks, and 1 year. Lateral patellofemoral
impingement should always be considered in the differential diagnosis of the painful
total knee arthroplasty. This should be evaluated clinically through direct palpation
of the lateral facet, and radiographically with the sunrise view. Lateral facetectomy
or patellar revision can be performed with predictably good clinical results.
KEYWORDS
Painful total knee arthroplasty - patellofemoral impingement - anterior knee pain
REFERENCES
- 1
Parvizi J, Rapuri V R, Saleh K J, Kuskowski M A, Sharkey P F, Mont M A.
Failure to resurface the patella during total knee arthroplasty may result in more
knee pain and secondary surgery.
Clin Orthop Relat Res.
2005;
438
191-196
- 2
Meneghini R M.
Should the patella be resurfaced in primary total knee arthroplasty? An evidence-based
analysis.
J Arthroplasty.
2008;
23
(7, Suppl)
11-14
- 3
Scuderi G R, Insall J N, Scott N W.
Patellofemoral pain after total knee arthroplasty.
J Am Acad Orthop Surg.
1994;
2
(5)
239-246
- 4
Mahoney O M, McClung C D, dela Rosa M A, Schmalzried T P.
The effect of total knee arthroplasty design on extensor mechanism function.
J Arthroplasty.
2002;
17
(4)
416-421
- 5
Harwin S F, Greene K A, Hitt K.
Triathlon total knee arthroplasty: 4-year outcomes with a high-performance implant.
J Knee Surg.
2008;
21
(4)
320-326
- 6
Barrack R L, Schrader T, Bertot A J, Wolfe M W, Myers L.
Component rotation and anterior knee pain after total knee arthroplasty.
Clin Orthop Relat Res.
2001;
392
(392)
46-55
- 7
Lee G C, Cushner F D, Scuderi G R, Insall J N.
Optimizing patellofemoral tracking during total knee arthroplasty.
J Knee Surg.
2004;
17
(3)
144-149
discussion 149-150
- 8
Dennis D A.
Evaluation of painful total knee arthroplasty.
J Arthroplasty.
2004;
19
(4, Suppl 1)
35-40
- 9
Doerr T E, Eckhoff D G.
Lateral patellar burnishing in total knee arthroplasty following medialization of
the patellar button.
J Arthroplasty.
1995;
10
(4)
540-542
Robert CercekM.D.
The CORE Institute – Research, 14520 West Granite Valley Drive
Suite 210, Sun City West, Phoenix, AZ 85375
Email: robert.cercek@thecoreinstitute.com
