Patellar complications following total knee arthroplasty: a review of the current literature

  • Angelos Assiotis
  • Kendrick To
  • Rhidian Morgan-Jones
  • Ioannis P. Pengas
  • Wasim KhanEmail author
General Review • UPPER LIMB - TUMORS


Total knee arthroplasty is a common operation for treating patients with end-stage knee osteoarthritis and generally has a good outcome. There are several complications that may necessitate revision of the implants. Patella-related complications are difficult to treat, and their consequences impact the longevity of the implanted joint and functional outcomes. In this review, we explore the current literature on patellar complications in total knee arthroplasty and identify risk factors as well as strategies that can help in preventing these complications. We present pertinent findings relating to patellar complications. They can be classified into bony or soft tissue complications and include bone loss, aseptic loosening, periprosthetic fractures, patella fracture, patellar clunk syndrome, patellofemoral instability, extensor mechanism complications, maltracking, patella baja and malrotation. We conclude that patellar complications in total knee arthroplasty are common and have significant implications for the functional outcome of total knee arthroplasty. A high index of suspicion should be maintained in order to avoid them. Implant malpositioning and other forms of intraoperative technical error are the main cause of these complications, and therefore, primary prevention is crucial. When dealing with these established problems, a clear plan of action should be formulated in advance to allow appropriate management as well as anticipation of adverse outcomes.


Patella Patellar complications Patellar fracture Patellar dislocation Prosthesis failure Total knee arthroplasty 


Author contributions

AA and KT contributed equally with writing the manuscript in consultation with WK and IP. RMJ was involved with the acquisition of images, and KT and WK reviewed the final manuscript.

Compliance with ethical standards

Conflict of interest

Angelos Assiotis, Kendrick To, Rhidian Morgan-Jones, Ioannis P. Pengas and Wasim Khan declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  • Angelos Assiotis
    • 1
  • Kendrick To
    • 2
  • Rhidian Morgan-Jones
    • 3
  • Ioannis P. Pengas
    • 4
  • Wasim Khan
    • 2
    Email author
  1. 1.Department of Trauma and OrthopaedicsSt Mary’s HospitalLondonUK
  2. 2.Division of Trauma and Orthopaedics, Department of SurgeryAddenbrooke’s HospitalCambridgeUK
  3. 3.Department of Trauma and OrthopaedicsLlandough General HospitalCardiffUK
  4. 4.Department of Trauma and OrthopaedicsRoyal Cornwall HospitalTruroUK

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