Patella baja and total knee arthroplasty (TKA)

Patella baja and total knee arthroplasty (TKA)

Patella
Baja
and
total
knee
arthroplasty
Jean
louis
Prudhon
Val
d’isère
2016
Disclosure
•  Consultant
–
royal@es
Groupe
Lepine
•  Special
aknowledgement
to
Jacques
CATON
67
y.o.
female
Severe
overweight
Charnley
C
Func@on
score
25
Knee
score
8
ROM
0/120
3
ques@ons
•  Is
the
patella
baja?
•  Which
surgical
approach?
–  Antero
medial
–  Anterolateral
–  ATT
osteotomy?
•  Which
type
of
TKA?
–  Regular
PS
TKA
–  High
constrained
–  Hinge
Caton
&
Deschamps
Index
P
A
AP
2.1
AT
1.4
CD
original
Index
0.6
T
CD
original
index
is
under
0.8
Pre
op
Patella
is
baja
Ques@ons:
•  How
to
measure
patella
height?
•  Pre
opera@ve
patella
baja:
what
are
the
specific
technical
issues?
•  Post
opera@ve
patella
baja:
–  Do
we
modify
patella
height?
–  what
is
the
impact
on
knee
func@on
(score
and
ROM)
?
Patella
height
measurement
methods
• 
• 
• 
• 
• 
• 
• 
• 
• 
JANSEN
1929
BOON
ITT
1930
Blumensaat1933
Insall‐Salvah
1971
Caton
1977
Blackburne‐
Peel
1977
Laurin
1978
Caton
–Deschamps
1982
Linclau
1984
• 
• 
• 
• 
• 
• 
• 
• 
Bernageau
1984
De
Carvalho
1985
Koshino‐Sugimoto
1989
Grelsamer
1992
Leung‐
Wai
1996
Picard‐Saragaglia
1997
Biedel‐
Albrecht
2006
Chareancholvanich
–
Narkbunnam
2012
Patella
height
measurement
methods
Femoral
reference
Blumensaat
(1938)
Labelle,
Laurin
(1977)
Bernageau,
Goutallier
(1984)
Biedert,
Albrecht
(2006)
Patella
height
measurement
methods
Tibial
reference
Insall,
Salva@
(1971)
Blackburne,
Peel
(1977)
Caton,
Deschamps
(1981)
Grelsamer
(1994)
(Insall‐
Salva@
modifié)
Caton‐Deschamps
Index
1.  This
measure
clears
off
patella
abnormali@es
2.  This
measure
clears
off
ATT
&
@bial
abnormali@es
3.  AT/AP
index
is
not
modified
by
knee
flexion
angle
Caton‐Deschamps
index
and
TKA
•  Original
CD
index
(AT/AP)
•  Modified
index
AT’/AP
(J.
Caton)
(Pre‐Op)
Caton‐Deschamps
index
and
TKA
•  Original
CD
index
(AT/AP)
•  Modified
index
AT’/AP
(J.
Caton)
T
°
67
y.o.
female
Severe
overweight
Charnley
C
Func@on
score
25
Knee
score
8
ROM
0/120
TECHNICAL
ISSUES
previously
discussed:
‐
Surgical
approach
?
‐Ligament
management
?
‐
type
of
TKA
‐
Patella
?
Lateral
approach
(Keblish)
Par@al
ATT
osteotomy
Postero
stabilized
TKA
13mm
rota@ng
regular
PE
tray
Knee
score:
90
Func@on
score
:95
ROM
:
0/130
How
about
the
patella?
AP
2
AT°
1.9
INDEX
0.95
Pre‐op
AP
2.1
AT
1.4
AT°
2.1
Modified
index
1
Post‐op
AP
2
AT°
1.9
Modified
index
0.95
How
much
do
we
modify
patella
height
in
TKA
?
•  purpose
of
the
study:
–  Using
modified
Caton
patella
index,
•  1
Validate
the
method
•  2
Analyse
modifica@ons
of
patella
height
before
and
aqer
TKA
•  material
–
methods
•  3
results
•  4
discussion
Material
method
–  60
consecu@ve
TKA
implanted
from
april
2014
to
april
2015
–  Postero
stabilized
rota@ng
cementless
THA
(groupe
lépine
TM)
–  One
senior
surgeon
Material
method
–  Patella
replacement
in
all
cases
–  Domical
shape
–  full
Poly
Cemented
component
–  Data
collected
on
file
maker
Pro
–  2
evaluators
Material
method
29
females,
31
males
Age:
70.5
(53‐86)
Status
Ae@ology
Surgical
approach
other
TT
transfer
Tibial
osteotomy
PF
OA
Rhumatoid
A
post
trauma@c
Ligament
injury
Tri
comp
OA
lateral
OA
Medial
OA
0
5
10
2%
5%
25
21%
20
15
20
25
30
Antero
medial
antero
lateral
par@al
ATT
osteotomy
15
ATT
osteotomy
10
72%
5
0
normal
mild
obesity
severe
obesity
morbid
obesity
Material
method
–  IKS
Score:
(knee
+func@on)
pre
and
post
op
–  ROM:
pre
and
post
op
–  Original
Caton
Deschamps
index
pre
op
–  Modified
Caton
Index:
pre
and
post
op
results
–  Original
Caton
Deschamps
index
pre
op
1,4
ALTA
>
1.2
2
cases
1,2
Titre
de
l'axe
1
0,8
0,6
BAJA
<
0.8
10
cases
0,4
0,2
Mean
index
original
Caton&Deschamps
:
0.9
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
results
Modified
Caton
Index:
pre
op
2
1,8
1,6
1,4
1,2
1
0,8
0,6
0,4
Mean
modified
Caton
index
:
1.3
0,2
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
results
Original
index
vs
modified
Index
pre
op
2
1,8
1,6
1,4
1,2
1
0,8
0,6
0,4
0,2
0
Mean
index
original
Caton&Deschamps
:
0.9
Mean
original
index:
0.94
Mean
modified
Caton
index
:
1.3
Mean
modified
index:
1.32
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
results
modified
Index
post
op
1,8
1,6
1,4
Titre
de
l'axe
1,2
1
0,8
0,6
0,4
0,2
Post
op
mean
modified
index:
1.13
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
results
modified
Index
pre
op
vs
post
op
2
1,8
1,6
Titre
de
l'axe
1,4
1,2
1
0,8
0,6
0,4
0,2
Pre
op
mean
modified
index
:
1.32
Post
op
mean
modified
index:
1.13
Globally
the
height
of
patella
is
lower
a2er
TKA
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
Focus
on
some
results…
2
1,8
1,6
Titre
de
l'axe
1,4
1,2
1
0,8
0,6
0,4
«right
in
the
target
»
0,2
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
AP
1.9
AT°
2.1
Index
modifié
1.1
Pre
op
knee
15
func@on
20
ROM
0/120
AP
2.2
AT°
2.4
INDEX
1.1
Post
op
knee
82
func@on
75
ROM
3/120
Focus
on
some
results…
2
1,8
1,6
Titre
de
l'axe
1,4
1,2
1
0,8
0,6
0,4
«
poor
shot
»
0,2
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
AP
1.9
AT°
3.2
Index
modifié
1.7
Pre
op
knee
49
func@on
60
ROM
0/120
AP
2.4
AT°
2.5
INDEX
1,05
Post
op
knee
60
func@on
62
ROM
5/120
Discussion:
further
ques@ons
to
answer
•  Patella
baja
or
pseudo
patella
baja
?
J
Arthroplasty.
2002
Jan;17(1):66‐9.
–  Patella
tendon
shortening
Patella
baja
a8er
total
knee
arthroplasty:
is
it
really
patella
baja?
Grelsamer
RP.
–  Proximal
joint
line
eleva@on
•  Surg
Technol
Int.
2004;12:231‐8.
Incidence
on
knee
func@on
?
Patella
baja
and
total
knee
arthroplasty
(TKA):
eBology,
diagnosis,
and
•  management.
How
to
prevent
it
?
Chonko
DJ,
Lombardi
AV
Jr,
Berend
KR.
Knee
Surg
Sports
Traumatol
Arthrosc.
2015
Dec;23(12):3601‐6.
doi:
10.1007/
s00167‐014‐3257‐1.
Epub
2014
Sep
2.
PrevenBon
of
pseudo‐patella
baja
during
total
knee
arthroplasty.
Seo
JG,
Moon
YW,
Kim
SM,
Park
SH,
Lee
BH,
Chang
MJ1,
Jo
BC.
•  Work
is
on
process
…
Knee
Surg
Sports
Traumatol
Arthrosc.
2015
Dec;23(12):3601‐6.
doi:
10.1007/
s00167‐014‐3257‐1.
Epub
2014
Sep
2.
PrevenBon
of
pseudo‐patella
baja
during
total
knee
arthroplasty.
Seo
JG1,
Moon
YW1,
Kim
SM2,
Park
SH3,
Lee
BH1,
Chang
MJ1,
Jo
BC4.
J
Arthroplasty.
2002
Jan;17(1):66‐9.
Patella
baja
a8er
total
knee
arthroplasty:
is
it
really
patella
baja?
Grelsamer
RP.
Surg
Technol
Int.
2004;12:231‐8.
Patella
baja
and
total
knee
arthroplasty
(TKA):
eBology,
diagnosis,
and
management.
Chonko
DJ,
Lombardi
AV
Jr,
Berend
KR.
Données
JC
2008
•  Hauteur
rotulienne
avant
et
après
PTG
(Hermes
PS)