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Subluxing patella after TKA

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  • Subluxing patella after TKA

    I would really appreciate input on a patient. He had an older TKA and had to have a revision after an infection. He had not been able to even do a full LAQ, but had so much swelling that I couldn't see what was happening. Swelling went down and I finally realized his patella is subluxing laterally. I can manually relocate it and hold it in place (with a bit of force) and he can immediately perform a LAQ. He is subluxing in closed chain too, which has caused buckling with weightbearing. It starts subluxing immediately when initiating movement, not just toward full extension. His ortho just gave him a J brace today and I just can't get it to do the same thing I can with my hands... it's not keeping the patella in place. Any suggestions?
    Erik Pohlman, PT, DPT

  • #2
    Bilateral Patella Dislocation after Total Knee Arthroplasty: A Report of Two Cases and a Review of the Literature

    Postoperative complications may impair the outcome of total knee arthroplasty (TKA). Patellar instability is one of the causes for revision surgery [1]. It may occur after TKA with or without patellar resurfacing. Subluxation is more common than dislocation, but the incidence of symptomatic instability leading to revision is few (0.5 to 0.8%) [2]. The etiology of patellofemoral instability can be related to (a) the surgical technique and component positioning, (b) extensor mechanism imbalance, and (c) other causes. Component malposition during surgery is one of the most common causes of patellar instability [3].
    Early diagnosis with surgical realignment and repair of the extensor mechanism can provide good outcomes after this complication.
    Much depends on the surgeon / physio relationship. The current generation in London are very engaged, it wasn't always so. I used to write to the old school types with my findings, outline what I proposed to do with a time limited trial of physiotherapy, and send the patient back to the surgeon if they failed to progress.
    Last edited by Jo Bowyer; 05-05-2018, 06:01 PM. Reason: context
    Jo Bowyer
    Chartered Physiotherapist Registered Osteopath.
    "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi