The Journal of Arthroplasty
Volume 19, Issue 6 , Pages 714-719, September 2004

Radiographic changes in the patella following quadriceps turndown for revision total knee arthroplasty1

  • Paul N. Smith, MBBS (FRACS)

      Affiliations

    • Corinna Chambers, Philip, Canberra, Australia, Australia
    • ,
  • David A. Parker, MBBS (FRACS)

      Affiliations

    • Sydney Orthopaedic, Arthritis, & Sports Medicine, Level 1, Chatswood, New South Wales, Australia
    • ,
  • Jill Gelinas, MD (FRCSC)

      Affiliations

    • London Health Science Centre, University Campus, London, Ontario, Canada, Canada
    • ,
  • Cecil H. Rorabeck, MD (FRCSC)

      Affiliations

    • London Health Science Centre, University Campus, London, Ontario, Canada, Canada
    • Corresponding Author InformationReprint requests: Dr. Cecil H. Rorabeck, University Hospital, London Health Sciences Centre, 339 Windermere Road, London ON N6A 5A5, Canada
    • ,
  • Robert B. Bourne, MD (FRCSC)

      Affiliations

    • London Health Science Centre, University Campus, London, Ontario, Canada, Canada

Received 27 July 2002; accepted 20 March 2004.

Abstract 

Quadriceps turndown is a technique that may be used to enhance exposure of the tight total knee arthroplasty (TKA), particularly in the revision scenario. This technique does, however, compromise the vascularity of the patella, with avascular necrosis (AVN) being a possible sequela. A modified Coonse-Adams quadriceps turndown was performed in 29 revision TKAs in 27 patients. Immediate preoperative and sequential postoperative radiographs were analyzed for changes in the patella, including sclerosis, flattening, fracture, and fragmentation, as evidence of possible AVN, and clinical scores were collected prospectively. Eight patellae had such radiographic changes. Despite a lack of corresponding worsening in clinical outcome in these patients, quadriceps turndown is shown to have a high risk of subsequent changes consistent with patellar AVN, and should be avoided when other available techniques can achieve satisfactory exposure.

Keywords:  patella, radiograph, avascular, necrosis, turndown, knee, arthroplasty

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  • 1 No benefits or funds were received in support of this study.

PII: S0883-5403(04)00256-6

doi:10.1016/j.arth.2004.03.007

The Journal of Arthroplasty
Volume 19, Issue 6 , Pages 714-719, September 2004

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