Long-term Follow-up of Patellar Nonresurfacing in Total Knee Arthroplasty

BACKGROUND@#We aimed to confirm the long-term effect of patellar nonresurfacing (patellar decompression) in preventing anterior knee pain after total knee arthroplasty (TKA) and to investigate the possible complications.@*METHODS@#Among patients who underwent primary TKA after being diagnosed as having advanced osteoarthritis (Kellgren-Lawrence grade 4) at our institution from January 2004 to December 2010, 121 patients who were followed up for more than 7 years were included in this study. Patients who underwent TKA with and without patellar decompression were classified as the study group and control group, respectively. A clinical knee rating score was used to compare the postoperative clinical outcomes between groups. To identify complications after patellar decompression, simple radiographs (weight-bearing anteroposterior and lateral views, patella in 30° and 45° axial views, and whole scanogram) were taken during follow-up.@*RESULTS@#There were no complications such as patellar fracture, osteonecrosis, and subluxation. At 2 years after surgery, the prevalence of anterior knee pain was 12.7% and 18.0% in the study group and control group, respectively (p = 0.42), and the number of patients with patellofemoral osteoarthritis grade II or over was lower in the study group (p = 0.03). At 7 years after surgery, the prevalence of anterior knee pain was 18.3% and 24.0% in the study group and control group, respectively (p = 0.45), and there was no statistically significant intergroup difference in the number of patients with patellofemoral osteoarthritis grade II or over (p = 0.11).@*CONCLUSIONS@#Patellar nonresurfacing TKA reduces anterior knee pain in the early postoperative period. The procedure can be considered a relatively safe option with fewer complications; however, its effectiveness appears to decrease over time.

Conservative Treatment of Genu Recurvatum: A Case Report

Genu recurvatum has commonly treated by Ilizarov devices, and treatment with an orthosis has rarely been reported. A 54 month old girl visited our hospital because of left knee hyperextension. The overall imbalance of the quadriceps with the hamstring muscles created 25 degrees of hyperextension. So we applied a knee-ankle-foot orthosis (KAFO) for treatment. After six months, the plain radiograph show 2 degrees hyperextension and stabilization of the knee. Genu recurvatum can be treated with an orthosis in a patient with imbalanced quadriceps and a hamstring muscle problem.