REVISION WITH PROXIMAL TUBE REALIGNMENT SURGERY AND SOFT-TISSUE REBALANCING IS A VIABLE OPTION FOR PATELLAR INSTABILITY AFTER TOTAL KNEE REPLACEMENT IN SELECTED CASES

G. De Giosa¹ , F.D. Cannito¹, G. Giannini¹, C. Buono¹, S. Urga¹, G. Solarino²

¹ School of Medicine University of Bari “Aldo Moro”, AOU General Hospital, Department of Translational Biomedicine and Neuroscience “DiBraiN” Neuroscience and Sense Organs, Orthopaedic and Trauma Unit, Bari, Italy
² Orthopaedics University of Bari “Aldo Moro”- AOU Policlinico Consorziale, Department of Translational Biomedicine and Neuroscience, Orthopaedic and Trauma Unit, Bari, Italy

Correspondence to:

Journal of Orthopedics 2024 September-December; 16(3): 145-149

Received: 13 August 2024 Accepted: 18 September 2024

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Abstract

Patellar instability is a complication after total knee replacement and a clear causative factor for patients’ dissatisfaction. With modern implants, the design of the components does not appear to be a causative factor, as it can often be due to technical surgical errors such as the mispositioning of the components (mostly in internal rotation). To treat patellar instability and restore the proper geometry and biomechanics of the replaced knee, we performed the proximal “tube” realignment of the patella, as described by Insall. Preoperatively, knees were studied for any malrotation with CT, according to Berger’s protocol. Satisfactory clinical outcomes were recorded, with no recurrence at the last follow-up, with the technique described and the use of a dome-shaped patellar component that can be forgiving for stability despite its propensity for increased contact stress.

Keywords: arthroplasty, Insall, knee biomechanics, patellofemoral instability, proximal realignment, TKA, TT-TG angle