Updated: 9/6/2018

TKA Patellar Maltracking

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Introduction
  • Epidemiology
    • most common reason for secondary surgery following total knee arthroplasty
  • Causes
    • may be related to
      • prosthetic design
      • extensor mechanism imbalance
      • asymmetric patellar resection
      • malrotation 
      • 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 paellar component
      • lateral osteophyte on patella
  • CT
    • best to assess for rotational malalignment
Treatment
  • Must appropriately address etiology
 

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