Variables affecting patellar height in patients undergoing primary total knee replacement
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ORIGINAL PAPER
Variables affecting patellar height in patients undergoing primary total knee replacement Khaled Hamed Salem 1,2
&
Miten Rajendra Sheth 3
Received: 18 June 2020 / Accepted: 17 November 2020 # The Author(s) 2020
Abstract Background Alteration of patellar height is commonly encountered in total knee arthroplasty (TKA), and failure to address patella baja can result in suboptimal functional outcomes. It may therefore be prudent to evaluate pre-operative patellar height (PPH) and to seek risk factors for patella baja. Methods Two hundred eighty-five patients who underwent TKA were included. Patient’s age, gender, body mass index (BMI), and history of prior arthroscopy were recorded. PPH was measured using plateau-patella angle (PPA) as well as the BlackburnPeel (BP), Caton-Deschamps (CD), and Insall-Salvati (IS) ratios. Results The average patients’ age was 71 years with a mean BMI of 30.45. There were 191 female and 94 male patients. Onefourth of the cases had at least one prior knee arthroscopy. Multivariate linear regression analysis identified gender and BMI as variables significantly affecting the IS ratio (p: < 0.05). Gender also had a significant correlation with PPA. Male patients were likely to have lower PPA (p: < 0.03). Though increasing age had a positive correlation with patellar height, this was not statistically significant. History of prior arthroscopy had no significant effect on any of the four PPH measurements. Conclusion Lower patellar height is significantly correlated to male gender and high BMI. We suggest that obese male patients be screened for pre-operative patella baja. This can help in surgical planning and optimizing results in TKA. Keywords Patellar height . Insall-Salvati ratio . Total knee replacement . Patella Baja
Introduction Patellar position has a great influence on knee joint biomechanics, and abnormalities in patellar height may affect patellofemoral function [1]. In recent years, patellar height has become an important consideration in evaluating knee conditions and planning treatment, particularly in joint arthroplasty [2, 3]. Several methods have been described to evaluate patellar position, in normal and symptomatic knees, on lateral radiographs. Though no method is perfect, three popular ratios are widespreadly reported in the literature: Insall and Salvati (IS), Blackburne and Peel (BP), and
* Khaled Hamed Salem [email protected] 1
Department of Orthopaedic Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
2
Department of Orthopaedic Surgery, RWTH University Aachen, Aachen, Germany
3
The Knee Clinic, Mumbai, Maharashtra, India
Caton-Deschamps (CD) ratios [4–6]. Recently described, the plateau-patella angle (PPA) has simplified patellar height measurement and is as valid and reproducible as the previously described measurements [7, 8]. Decreased patellar height, known as patella baja or infera, is when the patella is placed too distally relative to the femoral trochlea. Patella baja may occur either due to true shortening of
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