Grayson Whisper, Baek Nathaniel, Hopkinson William, Schmitt Daniel, Brown Nicholas M
Department of Orthopaedic Surgery & Rehabilitation, Loyola University Health System, Maywood, IL, USA.
Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA.
J Orthop. 2024 Oct 18;62:90-93. doi: 10.1016/j.jor.2024.10.023. eCollection 2025 Apr.
Extensor mechanism disruption following total knee arthroplasty (TKA) is a rare, yet serious complication. While previous patellar abnormalities are a theoretical risk factor for this complication, there is a scarcity of literature describing the impact of prior extensor mechanism dysfunction (EMD) on this and other complications following TKA. In this study, we describe our institutional experience with complications following TKA after EMD.
Sixty-one knees that underwent total knee arthroplasty between April 2007 and April 2023 in patients with previous EMD were identified. Extensor mechanism dysfunction types included patellar fracture, patellar tendon rupture, patellar realignment surgery, previous patellar dislocation, and a chronic laterally tracking patella impacting extensor mechanism function. Primary outcomes included extensor mechanism failure, infection, dislocation, aseptic loosening, revision surgery, and stiffness requiring manipulation under anesthesia (MUA).
A total of 61 knees, comprised of 53-patients, were included. There were complications witnessed in fifteen patients, leading to a 24.6 % overall complication rate. There was one extensor mechanism disruption in the form of a partial quadriceps tendon tear requiring repair. There was one patellar dislocation requiring reoperation. There were five superficial infections successfully treated non-operatively and four deep infections requiring reoperation. A total of nine reoperations were performed, four of which were revisions. Four patients underwent MUA due to severe post-operative stiffness.
In this study, we found a high complication rate following TKA in patients with previous extensor mechanism dysfunction. There was one case of partial quadriceps tendon rupture requiring repair.
全膝关节置换术（TKA）后伸肌机制破坏是一种罕见但严重的并发症。虽然先前的髌骨异常是该并发症的一个理论风险因素，但描述先前伸肌机制功能障碍（EMD）对TKA后该并发症及其他并发症影响的文献较少。在本研究中，我们描述了我们机构在EMD后TKA并发症方面的经验。
确定了2007年4月至2023年4月期间在先前有EMD的患者中接受全膝关节置换术的61个膝关节。伸肌机制功能障碍类型包括髌骨骨折、髌腱断裂、髌骨重新排列手术、先前的髌骨脱位以及影响伸肌机制功能的慢性外侧髌骨轨迹异常。主要结局包括伸肌机制衰竭、感染、脱位、无菌性松动、翻修手术以及需要在麻醉下进行手法治疗（MUA）的僵硬。
共纳入61个膝关节，涉及53名患者。15名患者出现并发症，总体并发症发生率为24.6%。有1例伸肌机制破坏，表现为部分股四头肌肌腱撕裂需要修复。有1例髌骨脱位需要再次手术。有5例表浅感染通过非手术成功治疗，4例深部感染需要再次手术。共进行了9次再次手术，其中4次是翻修手术。4例患者因术后严重僵硬接受了MUA。
在本研究中，我们发现先前有伸肌机制功能障碍的患者TKA后并发症发生率较高。有1例部分股四头肌肌腱断裂需要修复。
