Lateral Patellofemoral Impingement: A Cause of Treatable Pain after TKA

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