Patellar Fracture After Total Knee Arthroplasty With Retention: A Retrospective Analysis of 2954 Consecutive Cases

To the best of our knowledge, there have been no large case studies on patellar fracture after total knee arthroplasty (TKA) with patella retention.

From 2005 to 2019, 2954 consecutive TKAs with patella retention were retrospectively reviewed. The incidence of patellar fracture was confirmed. Perioperative demographic factors associated with patellar fracture were compared between the nonpatellar fracture control (randomly selected after age and sex matching) and patellar fracture patient groups. To confirm the prognosis of identified patellar fractures, Hospital for Special Surgery knee score, union rates, and complications after treatment were evaluated. Treatment outcomes were compared as per the treatment method, and fracture type was classified by shape.

For primary TKAs with patella retention, patellar fracture occurred in 32 of 2883 cases (incidence 1.11%). When comparing the preoperative demographic factors between the patellar fracture and control groups, there was a significant difference in knee flexion of the affected limb. Twenty-three cases were treated nonoperatively, and nine cases were treated operatively. Of the 32 patellar fractures, 28 had confirmed union, and the HSS score at the latest follow-up increased significantly from the preoperative score. The only complication noted after treatment was nonunion in three cases. We found no significant differences in treatment results as per the treatment method and fracture type.

Patellar fracture after TKA with retained patella is infrequent, with relatively improved clinicoradiological results over those of patellar fracture after TKA with resurfaced patella reported in the literature. The improved results did not differ as per the treatment method and fracture type.