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The John Insall Award: Control-matched Evaluation of Painful Patellar Crepitus After Total Knee Arthroplasty

  • Symposium: Papers Presented at the Annual Meetings of the Knee Society
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Patellar crepitus (PC) is reported in up to 14% of subjects implanted with cruciate-substituting total knee arthroplasty (TKA). Numerous etiologies of PC have been proposed.

Questions/purposes

We determined when painful PC typically occurs postoperatively and compared patients undergoing primary TKA who developed painful PC requiring subsequent surgery with a matched group without this complication to identify clinical, radiographic, and surgical variables associated with this complication.

Methods

From the databases of two institutions (greater than 4000 TKAs), we identified 60 patients who required surgery for painful PC from 2002 to 2008. This group was then compared with an identified control group of 60 TKA subjects without PC who were matched for the key variables of age, gender, and body mass index to determine clinical, radiographic, and surgical factors associated with the development of PC.

Results

The mean time to presentation of PC was 10.9 months. The incidence of PC correlated with a greater number of previous knee surgeries, decreased patellar component size, decreased composite patellar thickness, shorter preoperative and postoperative patellar tendon length, increased posterior femoral condylar offset, use of smaller femoral components and thicker tibial polyethylene inserts, and placement of the femoral component in a flexed posture.

Conclusions

Many of the factors associated with an increased incidence of postoperative PC such as shortened patellar tendon length, use of smaller patellar components, decreased patellar composite thickness, and increased posterior femoral condylar offset may all increase quadriceps tendon contact forces against the superior aspect of the intercondylar box, increasing the risk of fibrosynovial proliferation and entrapment within the intercondylar region of the femoral component. Based on these findings, the authors recommend use of larger patellar components when possible, avoid oversection of the patella or increasing posterior femoral condylar offset, and advising patients preoperatively who have had previous knee surgery or demonstrate a shortened patellar tendon length of an increased risk of development of postoperative patellar crepitus.

Level of Evidence

Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank the research personnel of Colorado Joint Replacement and OrthoCarolina as well as Joshua Carothers, MD, for their help in collecting and organizing the data analyzed in this report.

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Authors and Affiliations

  1. Colorado Joint Replacement, 2535 S Downing Street, #100, Denver, CO, 80210, USA

    Douglas A. Dennis MD & Raymond H. Kim MD

  2. Department of Biomedical Engineering, University of Tennessee, Knoxville, TN, USA

    Douglas A. Dennis MD

  3. University of Colorado Denver Medical School, Denver, CO, USA

    Douglas A. Dennis MD

  4. Rocky Mountain Musculoskeletal Research Laboratory, Denver, CO, USA

    Douglas A. Dennis MD

  5. Denver-Vail Orthopedics, Parker, CO, USA

    Derek R. Johnson MD

  6. OrthoCarolina, Charlotte, NC, USA

    Bryan D. Springer MD & Thomas K. Fehring MD

  7. Vanderbilt University, Nashville, TN, USA

    Adrija Sharma PhD

Authors
  1. Douglas A. Dennis MD
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  2. Raymond H. Kim MD
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  3. Derek R. Johnson MD
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  4. Bryan D. Springer MD
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  5. Thomas K. Fehring MD
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  6. Adrija Sharma PhD
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Corresponding author

Correspondence to Douglas A. Dennis MD.

Additional information

The Rocky Mountain Musculoskeletal Research Laboratory has received funding for clerical support in preparation of this manuscript. No authors have received any financial support directly related to the preparation of this manuscript, although one or more of the authors (DAD, TKF) serve as consultants to the manufacturing company (Depuy, Inc) of the implant studied in this review.

The current analysis has received approval from the Institutional Review Boards of the participating institutions.

This work was performed at Colorado Joint Replacement, Denver, CO, USA, and OrthoCarolina, Charlotte, NC, USA.

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Dennis, D.A., Kim, R.H., Johnson, D.R. et al. The John Insall Award: Control-matched Evaluation of Painful Patellar Crepitus After Total Knee Arthroplasty. Clin Orthop Relat Res 469, 10–17 (2011). https://doi.org/10.1007/s11999-010-1485-3

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  • DOI: https://doi.org/10.1007/s11999-010-1485-3

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