Case Report on Painful Patellar Crepitation Following a Knee Replacement with Preserved Patella

John Christian Parsaoran Butarbutar, Joshua Edward Hananto, Irvan Irvan

Abstract


Patellar clunk crepitation is a well-known complication following knee replacement surgery and is associated with posterior stabilized knee replacement surgery and surgical technique. Currently, patellar clunk or crepitation management following knee replacement surgery with preserved patella remains unclear. The purpose of this case report is to discuss whether patellar clunk or crepitation management should include debridement with patellar resurfacing or debridement alone. This case describes a patellar crepitation after knee replacement surgery with the preserved patella. The surgery went uneventfully using the standard medial parapatellar approach. However, the patient was still unsatisfied with the chronic left knee pain (>3 months) and crepitation that developed following the surgery, and the patient was diagnosed with patellar clunk and crepitation (PCC). A patellar resurfacing procedure was performed with a satisfactory clinical outcome. Replicating the original joint line level and placing the tibial component posteriorly play a pivotal role in preventing PCC. Debridement and patellar resurfacing procedures are recommended in this type of case to overcome the valgus knee alignment and the placement of the tibial component.


Keywords


Clunk, crepitation, debridement, knee arthroplasty, knee replacement, patellar resurfacing

Full Text:

PDF

References


  1. Kahlenberg CA, Nwachukwu BU, McLawhorn AS, Cross MB, Cornell CN, Padgett DE. Patient satisfaction after total knee replacement: a systematic review. HSS J ®. 2018;14(2):192–201.
  2. Gopinathan P. Patello-femoral clunk syndrome-current concepts. J Orthop. 2014;11(2):55–7.
  3. Snir N, Schwarzkopf R, Diskin B, Takemoto R, Hamula M, Meere PA. Incidence of patellar clunk syndrome in fixed versus high-flex mobile bearing posterior-stabilized total knee arthroplasty. J Arthroplasty. 2014;29(10):2021–4.
  4. Sequeira SB, Scott J, Novicoff W, Cui Q. Systematic review of the etiology behind patellar clunk syndrome. World J Orthop. 2020;11(3):184–96.
  5. Gopinathan P. Patello-femoral clunk syndrome-current concepts. J Orthop. 2014;11(2):55–7.
  6. Conrad DN, Dennis DA. Patellofemoral crepitus after total knee arthroplasty: etiology and preventive measures. Clin Orthop Surg. 2014;6(1):9.
  7. Miller MA, Zachary JF. Mechanisms and morphology of cellular injury, adaptation, and death. In: Pathologic basis of veterinary disease . Elsevier; 2017. p. 2–43.e19.
  8. Agarwala SR, Mohrir GS, Patel AG. Patellar clunk syndrome in a current high flexion total knee design. J Arthroplasty. 2013;28(10):1846–50.
  9. Song SJ, Park CH, Bae DK. What to know for selecting cruciate-retaining or posterior-stabilized total knee arthroplasty. Clin Orthop Surg. 2019;11(2):142.
  10. Cho W. Knee joint arthroplasty. Knee Joint Arthroplasty. First ed. Springer: Berlin; 2014.
  11. Geannette C, Miller T, Saboeiro G, Parks M. Sonographic evaluation of patellar clunk syndrome following total knee arthroplasty. J Clin Ultrasound. 2017;45(2):105–7.
  12. Heyse TJ, Chong LR, Davis J, Haas SB, Figgie MP, Potter HG. MRI Diagnosis of patellar clunk syndrome following total knee arthroplasty. HSS J ®. 2012;8(2):92–5.
  13. Benazzo F, Perticarini L, Jannelli E, Ivone A, Ghiara M, Rossi SMP. Controversy: supporting patellar resurfacing in total knee arthroplasty–do it. EFORT Open Rev. 2020;5(11):785–92.
  14. Muhamed R, Saralaya V V, Murlimanju B V, Chettiar GK. In vivo magnetic resonance imaging morphometry of the patella bone in South Indian population. Anat Cell Biol. 2017;50(2):99–103.
  15. Ab Rahman S, Ahmed Shokri A, Ahmad MR, Ismail AF, Termizi NS. Intraoperative patella dimension measurement in asian female patients and its relevance in patellar resurfacing in tKA. Adv Orthop. 2020;2020:1–6.
  16. Thiengwittayaporn S, Srungboonmee K, Chiamtrakool B. Resurfacing in a posterior-stabilized total knee arthroplasty reduces patellar crepitus complication: a randomized, controlled trial. J Arthroplasty. 2019;34(9):1969–74.
  17. Chen K, Dai X, Li L, Chen Z, Cui H, Lv S. Patellar resurfacing versus nonresurfacing in total knee arthroplasty: an updated meta-analysis of randomized controlled trials. J Orthop Surg Res. 2021;16(1):83.
  18. Joseph Gholson J, Goetz DD, Westermann RW, Hart J, Callaghan JJ. Management of painful patellar clunk and crepitance: results at a mean follow-up of five years. Iowa Orthop J. 2017;37:171–5;
  19. Petersen W, Rembitzki IV, Brüggemann G-P, Ellermann A, Best R, Koppenburg AG-, et al. Anterior knee pain after total knee arthroplasty: a narrative review. Int Orthop. 2014;38(2):319–28.
  20. Putman S, Boureau F, Girard J, Migaud H, Pasquier G. Patellar complications after total knee arthroplasty. Orthop Traumatol Surg Res. 2019;105(1S):S43–S51.
  21. Sequeira SB, Scott J, Novicoff W, Cui Q. Systematic review of the etiology behind patellar clunk syndrome. World J Orthop. 2020;11(3):184–96.
  22. Joint replacement (primary): hip, knee and shoulder. London: National Institute for Health and Care Excellence (NICE); June 4, 2020.
  23. Benazzo F, Perticarini L, Jannelli E, Ivone A, Ghiara M, Rossi SMP. Controversy: supporting patellar resurfacing in total knee arthroplasty - do it. EFORT open Rev. 2020;5(11):785–92.
  24. Fukunaga K, Kobayashi A, Minoda Y, Iwaki H, Hashimoto Y, Takaoka K. The incidence of the patellar clunk syndrome in a recently designed mobile-bearing posteriorly stabilised total knee replacement. J Bone Joint Surg Br . 2009;91–B(4):463–8.
  25. Sringari T, Maheswaran SS. Patellar clunk syndrome in patellofemoral arthroplasty - A case report. Knee. 2005;12(6):456–7.
  26. Montaser M, Moustafa A. Patelloplasty without resurfacing of the patella in total knee replacement in patients without severe patellofemoral osteoarthritis. Egypt Orthop J. 2015;50(4):254.
  27. Liu Z, Fu P, Wu H, Zhu Y. Patellar reshaping versus resurfacing in total knee arthroplasty- Results of a randomized prospective trial at a minimum of 7years’ follow-up. Knee. 2012;19(3):198–202.




DOI: https://doi.org/10.15395/mkb.v55n1.2727

Article Metrics

Abstract view : 370 times
PDF - 429 times

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.


 


Creative Commons License
MKB is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License

 


View My Stats