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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
  • 27 Downloads

Abstract

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.

Keywords

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

Notes

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.

References

  1. 1.
    Insall JN, Ranawat CS, Aglietti P, Shine J (1976) A comparison of four models of total knee-replacement prostheses. J Bone Joint Surg Am 58(6):754–765Google Scholar
  2. 2.
    Healy WL, Wasilewski SA, Takei R, Oberlander M (1995) Patellofemoral complications following total knee arthroplasty. Correlation with implant design and patient risk factors. J Arthroplasty 10(2):197–201.  https://doi.org/10.1016/S0883-5403(05)80127-5 Google Scholar
  3. 3.
    Chan JY, Giori NJ (2017) Uncemented metal-backed tantalum patellar components in total knee arthroplasty have a high fracture rate at midterm follow-up. J Arthroplasty 32(8):2427–2430.  https://doi.org/10.1016/j.arth.2017.02.062 Google Scholar
  4. 4.
    Keblish PA, Varma AK, Greenwald AS (1994) Patellar resurfacing or retention in total knee arthroplasty. A prospective study of patients with bilateral replacements. J Bone Joint Surg Br 76(6):930–937.  https://doi.org/10.1302/0301-620X.76B6.7983122 Google Scholar
  5. 5.
    Barrack RL, Bertot AJ, Wolfe MW, Waldman DA, Milicic M, Myers L (2001) Patellar resurfacing in total knee arthroplasty: a prospective, randomized, double-blind study with five to seven years of follow-up. J Bone Joint Surg Ser A 83(9):1376–1381.  https://doi.org/10.2106/00004623-200109000-00013 Google Scholar
  6. 6.
    Beaupre L, Secretan C, Johnston D, Lavoie G (2012) A randomized controlled trial comparing patellar retention versus patellar resurfacing in primary total knee arthroplasty: 5–10 year follow-up. BMC Res Notes 5:273.  https://doi.org/10.1186/1756-0500-5-273 Google Scholar
  7. 7.
    Bourne RB, Burnett RSJ (2004) The consequences of not resurfacing the patella. Clin Orthop Related Res 428:166–169.  https://doi.org/10.1097/01.blo.0000147137.05927.bf Google Scholar
  8. 8.
    Pavlou G, Meyer C, Leonidou A, As-Sultany M, West R, Tsiridis E (2011) Patellar resurfacing in total knee arthroplasty: Does design matter? A meta-analysis of 7075 cases. J Bone Joint Surg Ser A 93(14):1301–1309.  https://doi.org/10.2106/JBJS.J.00594 Google Scholar
  9. 9.
    Schiavone Panni A, Cerciello S, Del Regno C, Felici A, Vasso M (2014) Patellar resurfacing complications in total knee arthroplasty. Int Orthop 8(2):313–317.  https://doi.org/10.1007/s00264-013-2244-3 Google Scholar
  10. 10.
    Johnson TC, Tatman PJ, Mehle S, Gioe TJ (2012) Revision surgery for patellofemoral problems: should we always resurface? Clin Orthop Related Res 470(1):211–219.  https://doi.org/10.1007/s11999-011-2036-2 Google Scholar
  11. 11.
    Roberts DW, Hayes TD, Tate CT, Lesko JP (2015) Selective patellar resurfacing in total knee arthroplasty: a prospective, randomized, double-blind study. J Arthroplasty 30(2):216–222.  https://doi.org/10.1016/j.arth.2014.09.012 Google Scholar
  12. 12.
    Campbell DG (2006) Patellar resurfacing in total knee replacement: a ten-year randomised prospective trial. J Bone Joint Surg Br 88(6):734–739.  https://doi.org/10.1302/0301-620X.88B6.16822 Google Scholar
  13. 13.
    Doolittle KH, Turner RH (1988) Patellofemoral problems following total knee arthroplasty. Orthop Rev 17(7):696–702Google Scholar
  14. 14.
    Mayman D, Bourne RB, Rorabeck CH, Vaz M, Kramer J (2003) Resurfacing versus not resurfacing the patella in total knee arthroplasty: 8- to 10-year results. J Arthroplasty 18(5):541–545.  https://doi.org/10.1016/S0883-5403(03)00150-5 Google Scholar
  15. 15.
    Garneti N, Mahadeva D, Khalil A, McLaren CA (2008) Patellar resurfacing versus no resurfacing in Scorpio total knee arthroplasty. J Knee Surg 21(2):97–100Google Scholar
  16. 16.
    Pakos EE, Ntzani EE, Trikalinos TA (2005) Patellar resurfacing in total knee arthroplasty: a meta-analysis. J Bone Joint Surg Ser A 87(7):1438–1445.  https://doi.org/10.2106/JBJS.D.02422 Google Scholar
  17. 17.
    Agarwala S, Shetty V, Karumuri L, Vijayvargiya M (2018) Patellar resurfacing versus nonresurfacing with patellaplasty in total knee arthroplasty. Indian J Orthop 52(4):393.  https://doi.org/10.4103/ortho.IJOrtho_512_16 Google Scholar
  18. 18.
    Xu C, Chu X, Wu H (2007) Effects of patellar resurfacing on contact area and contact stress in total knee arthroplasty. Knee 14(3):183–187.  https://doi.org/10.1016/j.knee.2007.01.005 Google Scholar
  19. 19.
    Browne C, Hermida JC, Bergula A, Colwell CW, D’Lima DD (2005) Patellofemoral forces after total knee arthroplasty: effect of extensor moment arm. Knee 12(2):81–88.  https://doi.org/10.1016/j.knee.2004.05.006 Google Scholar
  20. 20.
    Lachiewicz PF, Soileau ES (2006) Patella maltracking in posterior-stabilized total knee arthroplasty. Clin Orthop Related Res 452:155–158.  https://doi.org/10.1097/01.blo.0000238803.97713.7d Google Scholar
  21. 21.
    Brick GW, Scott RD (1988) The patellofemoral component of total knee arthroplasty. Clin Orthop Relat Res 231:163–178Google Scholar
  22. 22.
    Hanssen AD, Pagnano MW, Stock B (2004) Revision of failed patellar components. Instr Course Lect 53:201–206Google Scholar
  23. 23.
    Gililland JM, Swann P, Pelt CE, Erickson J, Hamad N, Peters CL (2016) What is the role for patelloplasty with gullwing osteotomy in revision TKA? Clin Orthop Related Res 474:101–106.  https://doi.org/10.1007/s11999-015-4363-1 Google Scholar
  24. 24.
    Kelly M (2001) Patellofemoral complications following total knee arthroplasty. Instr Course Lect 50:403–407.  https://doi.org/10.5606/totbid.dergisi.2012.54 Google Scholar
  25. 25.
    Rajgopal A, Panda I, Yadav S, Wakde O (2018) Stacked tantalum cones as a method for treating severe distal femoral bone deficiency in total knee arthroplasty. J Knee Surg.  https://doi.org/10.1055/s-0038-1669789 Google Scholar
  26. 26.
    Schroer WC, Berend KR, Lombardi AV, Barnes CL, Bolognesi MP, Berend ME, Ritter MA, Nunley RM (2013) Why are total knees failing today? Etiology of total knee revision in 2010 and 2011. J Arthroplasty 28(8 Suppl):116–119.  https://doi.org/10.1016/j.arth.2013.04.056 Google Scholar
  27. 27.
    Berend ME (2012) Evaluation and management of complications of the extensor mechanism. Instr Course Lect 61:405–409Google Scholar
  28. 28.
    Van Hamersveld KT, Marang-Van De Mheen PJ, Nelissen RGHH, Toksvig-Larsen S (2018) Migration of all-polyethylene compared with metal-backed tibial components in cemented total knee arthroplasty: a randomized controlled trial. Acta Orthop 89(4):412–417.  https://doi.org/10.1080/17453674.2018.1464317 Google Scholar
  29. 29.
    Foran JRH, Brown NM, Della Valle CJ, Berger RA, Galante JO (2013) Long-term survivorship and failure modes of unicompartmental knee arthroplasty knee. Clin Orthop Related Res 471(1):102–108.  https://doi.org/10.1007/s11999-012-2517-y Google Scholar
  30. 30.
    Parker DA, Dunbar MJ, Rorabeck CH (2003) Extensor mechanism failure associated with total knee arthroplasty: prevention and management. J Am Acad Orthop Surg 11(4):238–247.  https://doi.org/10.5435/00124635-200307000-00003 Google Scholar
  31. 31.
    Dalury DF, Dennis DA (2003) Extensor mechanism problems following total knee replacement. J Knee Surg 16(2):118–122Google Scholar
  32. 32.
    König C, Sharenkov A, Matziolis G, Taylor WR, Perka C, Duda GN, Heller MO (2010) Joint line elevation in revision TKA leads to increased patellofemoral contact forces. J Orthop Res 28(1):1–5.  https://doi.org/10.1002/jor.20952 Google Scholar
  33. 33.
    Rand JA (2005) Extensor mechanism complications after total knee arthroplasty. Inst Course Lect 54:241–250Google Scholar
  34. 34.
    Brilhault JM, Ries MD (2012) Influence of offset stem couplers in femoral revision knee arthroplasty: a radiographic study. Knee 19(2):112–115.  https://doi.org/10.1016/j.knee.2011.02.005 Google Scholar
  35. 35.
    Nam D, Abdel MP, Cross MB, LaMont LE, Reinhardt KR, McArthur BA, Mayman DJ, Hanssen AD, Sculco TP (2014) The management of extensor mechanism complications in total knee arthroplasty: AAOS exhibit selection. J Bone Joint Surg Ser A 96(6):e47.  https://doi.org/10.2106/JBJS.M.00949 Google Scholar
  36. 36.
    Ortiguera CJ, Berry DJ (2002) Patellar fracture after total knee arthroplasty. J Bone Joint Surg Am 84-A(4):532–540Google Scholar
  37. 37.
    Doo Yoo J, Kim NK (2015) Periprosthetic fractures following total knee arthroplasty. Knee Surg Relat Res 27(1):1–9.  https://doi.org/10.5792/ksrr.2015.27.1.1 Google Scholar
  38. 38.
    Chalidis BE, Tsiridis E, Tragas AA, Stavrou Z, Giannoudis PV (2007) Management of periprosthetic patellar fractures. A systematic review of literature. Injury 38(6):714–724Google Scholar
  39. 39.
    Tharani R, Nakasone C, Vince KG (2005) Periprosthetic fractures after total knee arthroplasty. J Arthroplasty 20(4 Suppl 2):27–32Google Scholar
  40. 40.
    Shervin D, Pratt K, Healey T, Nguyen S, Mihalko WM, El-Othmani MM, Saleh KJ (2015) Anterior knee pain following primary total knee arthroplasty. World J Orthop 6(10):795–803.  https://doi.org/10.5312/wjo.v6.i10.795 Google Scholar
  41. 41.
    Sayeed SA, Naziri Q, Patel YD, Boylan MR, Issa K, Mont MA (2013) Patellar fractures following total knee arthroplasty: a review. J Long-Term Effects Med Implants 23(4):331–336Google Scholar
  42. 42.
    Stoffel KK, Flivik G, Yates PJ, Nicholls RL (2007) Intraosseous blood flow of the everted or laterally-retracted patella during total knee arthroplasty. Knee 14:434–438.  https://doi.org/10.1016/j.knee.2007.07.005 Google Scholar
  43. 43.
    Sarmah SS, Patel S, Reading G, El-Husseiny M, Douglas S, Haddad FS (2012) Periprosthetic fractures around total knee arthroplasty. Ann R Coll Surg Engl 94(5):302–307.  https://doi.org/10.1308/003588412X13171221592537 Google Scholar
  44. 44.
    Hempfing A, Schoeniger R, Koch PP, Bischel O, Thomsen M (2007) Patellar blood flow during knee arthroplasty surgical exposure: intraoperative monitoring by laser Doppler flowmetry. J Orthop Res 25(10):1389–1394.  https://doi.org/10.1002/jor.20416 Google Scholar
  45. 45.
    Hasegawa M, Kawamura G, Wakabayashi H, Sudo A, Uchida A (2009) Changes to patellar blood flow after minimally invasive total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 17(10):1195–1198.  https://doi.org/10.1007/s00167-009-0834-9 Google Scholar
  46. 46.
    Jones KJ, Lazaro LE, Taylor SA, Pardee NC, Dyke JP, Hannafin JA, Warren RF, Lorich DG (2016) Quantitative assessment of patellar vascularity following bone-patellar tendon-bone autograft harvest for ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 24(9):2818–2824.  https://doi.org/10.1007/s00167-015-3510-2 Google Scholar
  47. 47.
    Reuben JD, McDonald CL, Woodard PL, Hennington LJ (1991) Effect of patella thickness on patella strain following total knee arthroplasty. J Arthroplasty 6(3):251–258.  https://doi.org/10.1016/S0883-5403(06)80172-5 Google Scholar
  48. 48.
    Hamilton WG, Ammeen DJ, Parks NL, Goyal N, Engh GA, Engh CA (2017) Patellar cut and composite thickness: the influence on postoperative motion and complications in total knee arthroplasty. J Arthroplasty 32(6):1803–1807.  https://doi.org/10.1016/j.arth.2016.12.033 Google Scholar
  49. 49.
    Garcia RM, Kraay MJ, Conroy-Smith PA, Goldberg VM (2008) Management of the deficient patella in revision total knee arthroplasty. Clin Orthop Relat Res 466(11):2790–2797.  https://doi.org/10.1007/s11999-008-0433- Google Scholar
  50. 50.
    Sheth NP, Pedowitz DI, Lonner JH (2007) Periprosthetic patellar fractures. J Bone Joint Surg Am 89(10):2285–2296.  https://doi.org/10.2106/JBJS.G.00132 Google Scholar
  51. 51.
    Rorabeck CH, Taylor JW (1999) Classification of periprosthetic fractures complicating total knee arthroplasty. Orthop Clin N Am 30(2):209–214Google Scholar
  52. 52.
    Conrad DN, Dennis DA (2014) Patellofemoral crepitus after total knee arthroplasty: etiology and preventive measures. Clin Orthop Surg 6(1):9–19.  https://doi.org/10.4055/cios.2014.6.1.9 Google Scholar
  53. 53.
    Wong J, Yau P, Chiu P (2002) Arthroscopic treatment of patellar symptoms in posterior stabilized total knee replacement. Int Orthop 26(4):250–252.  https://doi.org/10.1007/s00264-002-0347-3 Google Scholar
  54. 54.
    Lucas TS, DeLuca PF, Nazarian DG, Bartolozzi AR, Booth RE (1999) Arthroscopic treatment of patellar clunk. Clin Orthop Related Res 367:226–229Google Scholar
  55. 55.
    Meftah M, Ranawat AS, Ranawat CS (2011) The natural history of anterior knee pain in 2 posterior-stabilized, modular total knee arthroplasty designs. J Arthroplasty 26(8):1145–1148.  https://doi.org/10.1016/j.arth.2010.12.013 Google Scholar
  56. 56.
    Peralta-Molero JV, Gladnick BP, Lee Y, Ferrer AV, Lyman S, González Della Valle A (2014) Patellofemoral crepitation and clunk following modern, fixed-bearing total knee arthroplasty. J Arthroplasty 29(3):535–540.  https://doi.org/10.1016/j.arth.2013.08.008 Google Scholar
  57. 57.
    Costanzo JA, Aynardi MC, Peters JD, Kopolovich DM, Purtill JJ (2014) Patellar clunk syndrome after total knee arthroplasty; risk factors and functional outcomes of arthroscopic treatment. J Arthroplasty 29(9 Suppl):201–204.  https://doi.org/10.1016/j.arth.2014.03.045 Google Scholar
  58. 58.
    Choi WC, Ryu K-J, Lee S, Seong SC, Lee MC (2013) Painful patellar clunk or crepitation of contemporary knee prostheses. Clin Orthop Relat Res 471(5):1512–1522.  https://doi.org/10.1007/s11999-012-2652-5 Google Scholar
  59. 59.
    Shoji H, Shimozaki E (1996) Patellar clunk syndrome in total knee arthroplasty without patellar resurfacing. J Arthroplasty 11(2):198–201Google Scholar
  60. 60.
    Snir N, Schwarzkopf R, Diskin B, Takemoto R, Hamula M, Meere PA (2014) Incidence of patellar clunk syndrome in fixed versus high-flex mobile bearing posterior-stabilized total knee arthroplasty. J Arthroplasty 29(10):2021–2024.  https://doi.org/10.1016/j.arth.2014.05.011 Google Scholar
  61. 61.
    Tang YH, Wong WK, Wong HL (2014) Patellar clunk syndrome in fixed-bearing posterior-stabilised versus cruciate-substituting prostheses. J Orthop Surg 22(1):80–83.  https://doi.org/10.1177/230949901402200120 Google Scholar
  62. 62.
    Gholson JJ, Goetz DD, Westermann RW, Hart J, Callaghan JJ (2017) Management of painful patellar clunk and crepitance: results at a mean follow-up of five years. Iowa Orthop J 37:171–175Google Scholar
  63. 63.
    Lee G-C, Cushner FD, Scuderi GR, Insall JN (2004) Optimizing patellofemoral tracking during total knee arthroplasty. J Knee Surg 17(3):144–149 (discussion 149–150) Google Scholar
  64. 64.
    Gsparini G, Familiari F, Ranuccio F (2013) Patellar malalignment treatment in total knee arthroplasty. Joints 1(1):10–17Google Scholar
  65. 65.
    Lonner JH, Lotke PA (1999) Aseptic complications after total knee arthroplasty. The Journal of the American Academy of Orthopaedic Surgeons 7(5):311–324Google Scholar
  66. 66.
    Schindler OS (2012) Basic kinematics and biomechanics of the patellofemoral joint part 2: the patella in total knee arthroplasty. Acta Orthopaedica Belgica 78(1):11–29Google Scholar
  67. 67.
    McPherson EJ (2006) Patellar tracking in primary total knee arthroplasty. Instr Course Lect 55:439–448Google Scholar
  68. 68.
    Motsis EK, Paschos N, Pakos EE, Georgoulis AD (2009) Review article: patellar instability after total knee arthroplasty. J Orthop Surg 17(3):351–357.  https://doi.org/10.1177/230949900901700322 Google Scholar
  69. 69.
    Malo M, Vince KG (2003) The unstable patella after total knee arthroplasty: etiology, prevention, and management. J Am Acad Orthop Surg 11(5):364–371.  https://doi.org/10.5435/00124635-200309000-00009 Google Scholar
  70. 70.
    Eisenhuth SA, Saleh KJ, Cui Q, Clark CR, Brown TE (2006) Patellofemoral instability after total knee arthroplasty. Clin Orthop Related Res 446:149–160.  https://doi.org/10.1097/01.blo.0000214415.83593.db Google Scholar
  71. 71.
    Matz J, Howard JL, Morden DJ, MacDonald SJ, Teeter MG, Lanting BA (2017) Do changes in patellofemoral joint offset lead to adverse outcomes in total knee arthroplasty with patellar resurfacing? A radiographic review. J Arthroplasty 32(3):783-787.e1.  https://doi.org/10.1016/j.arth.2016.08.032 Google Scholar
  72. 72.
    Nicoll D, Rowley DI (2010) Internal rotational error of the tibial component is a major cause of pain after total knee replacement. J Bone Joint Surg Br 92(9):1238–1244.  https://doi.org/10.1302/0301-620X.92B9.23516 Google Scholar
  73. 73.
    Clavé A, Le Henaff G, Roger T, Maisongrosse P, Mabit C, Dubrana F (2016) Joint line level in revision total knee replacement: assessment and functional results with an average of seven years follow-up. Int Orthop 40(8):1655–1662.  https://doi.org/10.1007/s00264-015-3096-9 Google Scholar
  74. 74.
    Peeira GC, von Kaeppler E, Alaia MJ, Montini K, Lopez MJ, Di Cesare PE, Amanatullah DF (2016) Calculating the position of the joint line of the knee using anatomical landmarks. Orthopedics 39(6):381–386.  https://doi.org/10.3928/01477447-20160729-01 Google Scholar
  75. 75.
    Rjagopal TS, Nathwani D (2011) Can interepicondylar distance predict joint line position in primary and revision knee arthroplasty? Am J Orthop (Belle Mead, N.J.) 40(4):175–178Google Scholar
  76. 76.
    Berger RA, Crossett LS, Jacobs JJ, Rubash HE (1998) Malrotation causing patellofemoral complications after total knee arthroplasty. Clin Orthop Related Res 356:144–153.  https://doi.org/10.1097/00003086-199811000-00021 Google Scholar
  77. 77.
    Scuderi GR, Insall JN, Scott NW (1994) Patellofemoral pain after total knee arthroplasty. J Am Acad Orthop Surg 2(5):239–246Google Scholar
  78. 78.
    Whiteside LA (1997) Distal realignment of the patellar tendon to correct abnormal patellar tracking. Clin Orthop Related Res 344:284–289Google Scholar
  79. 79.
    Patel J, Ries MD, Bozic KJ (2008) Extensor mechanism complications after total knee arthroplasty. Instr Course Lect 57:283–294Google Scholar
  80. 80.
    Rosenberg AG (2012) Management of extensor mechanism rupture after TKA. J Bone Joint Surg Br 94(11 Suppl A):116–119.  https://doi.org/10.1302/0301-620X.94B11.30823 Google Scholar
  81. 81.
    Park SS, Kubiak EN, Wasserman B, Sathappan SS, Di Cesare PE (2005) Management of extensor mechanism disruptions occurring after total knee arthroplasty. Am J Orthop (Belle Mead, N.J.) 34(8):365–372Google Scholar
  82. 82.
    Bates MD, Springer BD (2015) Extensor mechanism disruption after total knee arthroplasty. J Am Acad Orthop Surg 23(2):95–106.  https://doi.org/10.5435/JAAOS-D-13-00205 Google Scholar
  83. 83.
    Rand JA, Morrey BF, Bryan RS (1989) Patellar tendon rupture after total knee arthroplasty. Clin Orthop Related Res 244:233–238Google Scholar
  84. 84.
    Chhapan J, Sankineani SR, Chiranjeevi T, Reddy MV, Reddy D, Gurava Reddy AV (2018) Early quadriceps tendon rupture after primary total knee arthroplasty. Knee 25(1):192–194.  https://doi.org/10.1016/j.knee.2017.12.002 Google Scholar
  85. 85.
    Anand S, Kanwat M, Mishra A, Mittal R, Yadav CS (2018) Management of patellar tendon rupture after total knee arthroplasty using hamstring graft: a case report. J Orthop Case Rep 8(2):57–60.  https://doi.org/10.13107/jocr.2250-0685.1050 Google Scholar
  86. 86.
    Jaureguito JW, Dubois CM, Smith SR, Gottlieb LJ, Finn HA (1997) Medial gastrocnemius transposition flap for the treatment of disruption of the extensor mechanism after total knee arthroplasty. J Bone Joint Surg Am 79(6):866–873.  https://doi.org/10.1016/0883-5403(94)90174-0 Google Scholar
  87. 87.
    Busfield BT, Huffman GR, Nahai F, Hoffman W, Ries MD (2004) Extended medial gastrocnemius rotational flap for treatment of chronic knee extensor mechanism deficiency in patients with and without total knee arthroplasty. Clin Orthop Related Res 428:190–197.  https://doi.org/10.1097/01.blo.0000148593.44691.30 Google Scholar
  88. 88.
    Corten K, Struelens B, Evans B, Graham E, Bourne RB, MacDonald SJ (2013) Gastrocnemius flap reconstruction of softtissue defects following infected total knee replacement. Bone Joint J 95-B(9):1217–1221.  https://doi.org/10.1302/0301-620X.95B9.31476 Google Scholar

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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