Patella Medialization

Patellar maltracking problems in total knee arthroplasty have ranged from 1 to 20% in the literature, and up to 50% of knee revisions are due to patella-related complications.4,46,47 Multiple causes

FIGURE 7.4. Photograph of the ultracongruent polyethylene insert with standard primary femoral component.

of patellar maltracking have been cited, including excessive postoperative valgus, internally rotated tibial or femoral components, malposition of the tibial or femoral component in the coronal plane, and malposition of the patellar component.48-54 Correction of patellar maltracking has traditionally involved the use of a lateral retinacular release. Problems related to lateral retinacular release include increased postoperative pain and wound-healing complications, delayed rehabilitation, and compromised patellar blood supply.15-17,19,27 Work at our institution has found that lateral retinacular release is required in 46% of patients whose patellar component is centralized on the patella, and in only 17% of patients whose patellar component is relatively medialized by centering over the anatomical high point or sagittal ridge.55 This technique is described next in the techniques section. It must be emphasized that the previous design and combined surgical procedure, as mentioned before, must be followed to limit patellar complications.

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