Total knee arthroplasty following patellectomy

Eleven patients with a previous patellectomy and primary total knee arthroplasty (TKA) had chart reviews, recent clinical examinations, evaluation of roentgenograms, rating of knee arthroplasty on a standard scale, and quantitation of quadriceps and hamstring torque using an isokinetic dynamometer. Good to excellent results were present in only five of the 11 knees studied, compared with 11 of 11 patients in a control group with intact patellae. Quadriceps and hamstring torque and strength were diminished relative to the control groups. Factors that correlated with a success or failure of TKA in patients with previous patellectomy included: number of previous knee operations, three or less; presence of severe arthritis changes roentgenographically; and quadriceps performance of greater than 40 ft-lb at 30°/second testing speed. Patients without patellae who lack these favorable prognostic factors for a successful TKA should be strongly considered for bracing or primary arthrodesis, rather than knee arthroplasty.