Helito Camilo Partezani, Gobbi Riccardo Gomes, Tirico Luis Eduardo Passarelli, Pecora Jose Ricardo, Camanho Gilberto Luis
Orthopedics. 2014 Feb;37(2):e211-3. doi: 10.3928/01477447-20140124-28.
Replacement of the patella during total knee arthroplasty (TKA) remains controversial. Despite some attempts to establish guidelines for this procedure, there is still no consensus in the literature. When the patella is replaced, the patient is subjected to certain complications, including loosening of the component. The loosened patellar component most commonly migrates to the intra-articular region of the knee. However, there have been a few reports of migration of the component to the extra-articular region, particularly when release of the lateral retinaculum and osteonecrosis of the patella are involved. The authors report a case of patellar component loosening and extra-articular and transcutaneous migration of the component 9 years after TKA. This report is unique because, during the primary procedure, no lateral release was performed and no patellar necrosis was evident on radiographs. The component was removed in the operating room and the wound cleaned and closed. Because of the probable slow migration of the component, there was no communication between the external environment and the joint at the time of surgery. There were no further complications after the wound healed. This case emphasizes the need for periodic radiographic follow-up after TKA.
全膝关节置换术（TKA）中髌骨置换仍存在争议。尽管有人试图为该手术制定指南，但文献中仍未达成共识。当髌骨被置换时，患者会面临某些并发症，包括假体松动。松动的髌骨假体最常向膝关节内区域迁移。然而，有少数报道称假体向关节外区域迁移，特别是当涉及外侧支持带松解和髌骨坏死时。作者报告了1例TKA术后9年髌骨假体松动并向关节外及经皮迁移的病例。该报告具有独特性，因为在初次手术过程中未进行外侧松解，且X线片上未显示明显的髌骨坏死。在手术室取出假体，清理并缝合伤口。由于假体可能迁移缓慢，手术时外部环境与关节之间没有相通。伤口愈合后未出现进一步并发症。该病例强调了TKA术后定期进行影像学随访的必要性。
