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KMID : 0613319960020010008
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Journal of the Korean Bone and Joint Tumor Soceity
1996 Volume.2 No. 1 p.8 ~ p.17
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The Effect of Total Patellectomy in the Prosthetic Replacement of Proximal Tibia
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Park Il-Hyung
Kim Jae-Do
Ihn Joo-Chul
Jeon In-Ho
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Abstract
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The purpose of this study is a comparative evaluation of range motion, especially extension deficit between the group of total patellectomy and that of intact patella, after reconstruction of the patellar tendon in the prosthetic replacement of a proximal tibia. Between 1990 and 1994,15 patients who had a primary malignancy on proximal tibia were operat-ed on. All patients were evaluated clinically and radiographically.Two patients were excluded because one had a deep infection treated with arthrodesis of the knee and the other was a composite allograft. The mean follow-up of the 13 patients was 27 months(15-47),including 10 osteosarcomas,1 chondrosarcoma,1 malignant fibrous histiocytoma and 1 malignant giant cell tumor. Eleven patients had a resection of the proximal tibia and 2 had an extracapsular total knee resection with dis-tal femur. Reconstruction of the defect was done in 8 cases with a custom-made Link Endo-Model Total Rotation Knee Joint Prosthesis,and in 5 with How Medica Modular Resection System(HMRS). We used two methods to reconstruct the ligamentum patellage.Fixation of the patellar tendon to the prosthsis only with suturing and/or stapling(group SS)was done in7.Transposition of gastrocnemius muscle to enhance fixation and to cover the prosthesis(group TG) was done in 6.Regardless of fixa-tion methods,total patellectomy was done in 5 either to lengthen the patellar tendon or to make pri-mary skin closure easier or for both.In 8 cases,patella was left intact or resurfaced with polyethylene prosthesis.
Active extension was measured while the patient was in a sittiong position.There is no statistically meaningful difference in terms of extension deficif(Wilcoxon rank test,p=0.8800) between patellec-tomy group and intact patella group,and between group of fixation only with suturing and that of gas-trocnemius transposition.Two cases of extension deficit over 30 degree were seen in group SS and in the group of intact patella. Conclusively,total patellectomy could be an option without increasing the risk of extension deficit when primary skin closure is difficult or patellar tendon is a little bit short to be fixed.There is no rat-ing in the Ennekion system of functional evaluation that this finding into consideration.
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KEYWORD
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Ligamentum patellae, Total patellectomy, Range of motion of knee
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