Zachary C. Lum, DO, Mauro Giordani, MD, John P. Meehan, MD

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Presentation transcript:

Zachary C. Lum, DO, Mauro Giordani, MD, John P. Meehan, MD Total knee arthroplasty after Hauser procedure: beware of the patellar tendon! Zachary C. Lum, DO, Mauro Giordani, MD, John P. Meehan, MD Arthroplasty Today DOI: 10.1016/j.artd.2018.07.004 Copyright © 2018 The Authors Terms and Conditions

Figure 1 Case 1: 67-year-old male patient with misdiagnosed Hauser procedure. Note the square sclerotic lines consistent with tubercle transfer. See Figure 10 for details on location of tubercle transfer. Arthroplasty Today DOI: (10.1016/j.artd.2018.07.004) Copyright © 2018 The Authors Terms and Conditions

Figure 2 Case 2: Preoperative anterior-posterior radiographs. Note the location and trajectory of the screws. Arthroplasty Today DOI: (10.1016/j.artd.2018.07.004) Copyright © 2018 The Authors Terms and Conditions

Figure 3 Case 2: Preoperative lateral radiographs noting the medialization of the screw head past the expected point of the tubercle. Arthroplasty Today DOI: (10.1016/j.artd.2018.07.004) Copyright © 2018 The Authors Terms and Conditions

Figure 4 (a and b) Preoperative computer tomography of Hauser procedure (a) and normal tibia (b). Note the location of the new tibial tubercle, far beyond the medial midline of the normal tubercle; a potential problem if performing a standard medial peripatellar arthrotomy. Arthroplasty Today DOI: (10.1016/j.artd.2018.07.004) Copyright © 2018 The Authors Terms and Conditions

Figure 5 Preoperative anatomical landmarks on the left knee of the patient described in case 2. Note the medialized tibial tubercle on the left side of the photo. Arthroplasty Today DOI: (10.1016/j.artd.2018.07.004) Copyright © 2018 The Authors Terms and Conditions

Figure 6 Location of standard medial peripatellar arthrotomy in this left knee. Note the location of the tibial tubercle on the medial side, left of the photo. An arthrotomy here would result in complete patellar tendon transection. Arthroplasty Today DOI: (10.1016/j.artd.2018.07.004) Copyright © 2018 The Authors Terms and Conditions

Figure 7 Exposure with lateral peripatellar approach. Subperiosteal dissection laterally to Gerdy's Tubercle, maintaining the iliotibial band insertion. Internal rotation to protect the patellar tendon and obtain exposure. Medial side is to the left. Arthroplasty Today DOI: (10.1016/j.artd.2018.07.004) Copyright © 2018 The Authors Terms and Conditions

Figure 8 Intraoperatively, femoral and tibial cuts were made, trials performed, patellar preparation being performed. The patella tracked very well and the knee was stable in all aspects of flexion and full extension. Medial is left in the photo. Arthroplasty Today DOI: (10.1016/j.artd.2018.07.004) Copyright © 2018 The Authors Terms and Conditions

Figure 9 (a) Postoperative AP demonstrates well aligned TKA components. (b) Postoperative lateral radiograph with well fixed and aligned components. Arthroplasty Today DOI: (10.1016/j.artd.2018.07.004) Copyright © 2018 The Authors Terms and Conditions

Figure 10 Original Hauser procedure, tibial tubercle transplant medially, combined with lateral release and medial reefing. Arthroplasty Today DOI: (10.1016/j.artd.2018.07.004) Copyright © 2018 The Authors Terms and Conditions