Trabecular metal augmentation for idiopathic avascular necrosis of the patella following non-resurfaced total knee arthroplasty

John Hiatt; Liam Ortega; Logan Druessel; Sam Eaddy; Hassan Choudhry; Brandon Reiman; Arpam Dutta; Richard Miller

doi:10.18203/issn.2455-4510.IntJResOrthop20260523

Authors

John Hiatt Department of Orthopaedic Surgery, Mercy Health St. Vincent Medical Center, Toledo, OH, USA
Liam Ortega Department of Orthopaedic Surgery, Mercy Health St. Vincent Medical Center, Toledo, OH, USA
Logan Druessel Department of Orthopaedic Surgery, Mercy Health St. Vincent Medical Center, Toledo, OH, USA
Sam Eaddy Department of Orthopaedic Surgery, Mercy Health St. Vincent Medical Center, Toledo, OH, USA
Hassan Choudhry Department of Orthopaedic Surgery, Mercy Health St. Vincent Medical Center, Toledo, OH, USA
Brandon Reiman Department of Orthopaedic Surgery, Mercy Health St. Vincent Medical Center, Toledo, OH, USA
Arpam Dutta Department of Orthopaedic Surgery, Mercy Health St. Vincent Medical Center, Toledo, OH, USA https://orcid.org/0000-0001-9808-0579
Richard Miller Department of Orthopaedic Surgery, Mercy Health St. Vincent Medical Center, Toledo, OH, USA

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20260523

Keywords:

Total knee arthroplasty, Patella, Avascular necrosis, Revision arthroplasty, Trabecular metal

Abstract

Avascular necrosis (AVN) of the patella is an uncommon complication following non-resurfaced total knee arthroplasty (TKA) and is typically attributed to compromised blood supply during surgery. We presented a case of idiopathic patellar AVN in a 71-year-old male one year after TKA with a non-resurfaced patella. Radiographs at that time revealed patellar erosion, prompting patelloplasty with a Zimmer NexGen Trabecular Metal Augmentation Patella (Zimmer Biomet, Warsaw, Indiana). Two weeks post-operatively, the patient resumed activities of daily living with minimal pain. At nine months, radiographs showed further patellar resorption and fragmentation, though the implant remained well-aligned. The patient exhibited no extensor lag but did present with mild weakness compared to the contralateral side. This case highlights trabecular metal patellar augmentation as a viable surgical option for managing symptomatic idiopathic patellar avascular necrosis following non-resurfaced total knee arthroplasty. The procedure preserved extensor mechanism function and provided meaningful clinical improvement, underscoring its potential role in select patients with limited patellar bone stock.

Metrics

Metrics Loading ...

References

Maheshwari AV, Tsailas PG, Ranawat AS, Ranawat CS. How to address the patella in revision total knee arthroplasty. Knee. 2009;16(2):92-7. DOI: https://doi.org/10.1016/j.knee.2008.08.003

Putman S, Boureau F, Girard J, Migaud H, Pasquier G. Patellar complications after total knee arthroplasty. Orthop Traumatol Surg Res. 2019;105(1):43-51. DOI: https://doi.org/10.1016/j.otsr.2018.04.028

Takahashi A, Kamimura M, Sano H, Kashiwaba M, Ohnuma M, Itoi E. Radiolucent zone of the patella following total knee arthroplasty without patellar resurfacing. J Orthop Sci. 2014;19(4):558-63. DOI: https://doi.org/10.1007/s00776-014-0570-y

Christopher ZK, Deckey DG, Chung AS, Spangehl MJ. Patellar osteolysis after total knee arthroplasty with patellar resurfacing: a potentially underappreciated problem. Arthroplast Today. 2019;5(4):435-41. DOI: https://doi.org/10.1016/j.artd.2019.09.005

Wells ME, Dunn JC. Pathophysiology of Avascular Necrosis. Hand Clin. 2022;38(4):367-76. DOI: https://doi.org/10.1016/j.hcl.2022.03.011

DeBell H, Pinter Z, Pinto M, Bergstresser S, Lee S, de Cesar Netto C, et al. Vascular supply at risk during lateral release of the patella during total knee arthroplasty: A cadaveric study. J Clin Orthop Trauma. 2019;10(1):107-10. DOI: https://doi.org/10.1016/j.jcot.2017.11.009

Noh JH, Roh YH. Osteonecrosis of bipartite patella following total knee arthroplasty without lateral release. Acta Orthop Traumatol Turc. 2019;53(1):74-6. DOI: https://doi.org/10.1016/j.aott.2018.04.003

Bourke MG, Sclavos EK, Jull GA, Buttrum PJ, Dalton PA, Russell TG. A comparison of patellar vascularity between the medial parapatellar and subvastus approaches in total knee arthroplasty. J Arthroplasty. 2012;27(6):1123-7. DOI: https://doi.org/10.1016/j.arth.2012.01.013

Choi Y, Koo J, Moon SW, Yang Y, Son J. Long-term Follow-up of Patellar Nonresurfacing in Total Knee Arthroplasty. Clin Orthop Surg. 2020;12(1):49-54. DOI: https://doi.org/10.4055/cios.2020.12.1.49

Lafforgue P. Pathophysiology and natural history of avascular necrosis of bone. Joint Bone Spine. 2006;73(5):500-7. DOI: https://doi.org/10.1016/j.jbspin.2006.01.025

Pijnenburg L, Felten R, Javier RM. A review of avascular necrosis, of the hip and beyond. Rev Med Interne. 2020;41(1):27-36. DOI: https://doi.org/10.1016/j.revmed.2019.10.332

Moharana SS, De I, Panda S, Jeetendra C, Rana R. Avascular Necrosis of Patella - A Rare Case Report. J Orthop Case Rep. 2023;13(4):53-6. DOI: https://doi.org/10.13107/jocr.2023.v13.i04.3614

Ries MD, Cabalo A, Bozic KJ, Anderson M. Porous tantalum patellar augmentation: the importance of residual bone stock. Clinical orthopaedics and related research. 2006;452:166-70. DOI: https://doi.org/10.1097/01.blo.0000229359.27491.9f

Garcia RM, Kraay MJ, Conroy-Smith PA, Goldberg VM. Management of the deficient patella in revision total knee arthroplasty. Clinical orthopaedics and related research. 2008;466(11):2790-7. DOI: https://doi.org/10.1007/s11999-008-0433-y

Nelson CL, Lonner JH, Lahiji A, Kim J, Lotke PA. Use of a trabecular metal patella for marked patella bone loss during revision total knee arthroplasty. J Arthroplasty. 2003;18(1):37-41. DOI: https://doi.org/10.1016/S0883-5403(03)00290-0

Tigani D, Trentani P, Trentani F, Andreoli I, Sabbioni G, Del Piccolo N. Trabecular metal patella in total knee arthroplasty with patella bone deficiency. Knee. 2009;16(1):46-9. DOI: https://doi.org/10.1016/j.knee.2008.08.005

Kloiber J, Goldenitsch E, Ritschl P. Patellar bone deficiency in revision total knee arthroplasty. Orthopade. 2016;45(5):433-8. DOI: https://doi.org/10.1007/s00132-016-3253-x

Cameron HU, Huffer B. Avascular necrosis of the patella following total knee replacement. Acta Orthop Belg. 1985;51(5):805-10.

Subramanyam P, Sundaram PS, Rao N. Scintigraphic assessment of patellar vascularity in total knee replacement surgeries following lateral release. Avicenna J Med. 2012;2(3):54-9. DOI: https://doi.org/10.4103/2231-0770.102277

Noorpuri BS, Maqsood M. Osteonecrosis of the patella and prosthetic extrusion after total knee arthroplasty. J Arthroplasty. 2002;17(5):662-3. DOI: https://doi.org/10.1054/arth.2002.33270

Baumgarten KM, Mont MA, Rifai ADO, Hungerford DS. Clin Orthopaed Rel Res. 2007;383:191-6. DOI: https://doi.org/10.1097/00003086-200102000-00021

Huddleston HP, Cregar WM, Alzein MM, Vadhera AS, Wong SE, Yanke AB. Outcomes of Patellar Subchondroplasty Surgery: A Case Series. J Knee Surg. 2023;36(9):941-8. DOI: https://doi.org/10.1055/s-0042-1747944