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Updated: Jan 1 2024

TKA Patellar Maltracking

  • Summary
    • TKA Patellar Maltracking is a common cause of patient dissatisfaction following TKA and is the most common reason for secondary surgery following total knee arthroplasty.
    • Diagnosis is made clinically with a combination of anterior knee pain, patellar subluxation during ambulation, and limitation in knee flexion.
    • Treatment may be nonoperative or operative depending on underlying etiology.
  • Epidemiology
    • Incidence
      • most common reason for secondary surgery following total knee arthroplasty
  • Etiology
    • Causes
      • may be related to
        • prosthetic design
        • extensor mechanism imbalance
        • asymmetric patellar resection
        • malrotation
          • internal rotation of components 
        • patellar malpositioning
  • Presentation
    • Symptoms
      • complaints may include
        • feelings of subluxation
        • frank dislocation
        • peri-patellar pain
        • limited flexion
  • Imaging
    • Radiographs
      • recommended views
        • AP
          • used to assess placement of femoral component and Q angle
        • lateral
          • used to assess size and rotation of femoral component
        • tangential
          • used to assess subluxation of patella, placement of patellar component, angle of patellar resection, and patellar tilt
      • findings
        • laterally subluxed patella
        • increased Q angle
        • anterior placement of femoral component
        • asymmetric patellar resection
        • lateral placement of patellar component
        • lateral osteophyte on patella
    • CT
      • best to assess for rotational malalignment
  • Treatment
    • Must appropriately address etiology
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