Anterior knee pain following total knee replacement caused by isolated Paget's disease of patella

摘要

We as a routine do not resurface the patella during a total knee replacement in our hospital. I present below a case where we had to do so because the patient developed anterior knee pain following a total knee replacement that was diagnosed as arising from isolated Paget's disease of the patella. Whether to resurface the patella during total knee replacement (TKR) still remains controversial. There are proponents for routine patellar resurfacing, for not resurfacing and for selective resurfacing. The results of randomised prospective controlled trials are unable to provide clear guidelines to recommend routine resurfacing of the patella. Introduction The aetiology of anterior knee pain after replacement is unproven but is generally thought to be related to the patellofemoral joint. A possible mechanism may be related to the contact of degenerative or damaged patellar cartilage against the femoral component. Resurfacing of the patella was not a feature of many early designs of total knee prostheses. The occurrence of postoperative patellofemoral pain resulted in the incorporation of patella resurfacing into subsequent designs. Whether to resurface the patella during total knee replacement (TKR) still remains controversial. There are proponents for routine patellar resurfacing, for not resurfacing and for selective resurfacingWe as a routine do not resurface the patella during a total knee replacement. I present below a case where we had to do so because the patient developed anterior knee pain following a total knee replacement that was diagnosed as arising from isolated Paget's disease of the patella. Case report A 75 year old patient presented to clinic with pain in his left knee for several years. Pain present at rest and at night and affecting his walking. Clinical findings showed a swollen knee with a fixed flexion deformity of 10 degree and range of motion 10-90 degree. X-ray suggested advanced osteoarthritis affecting all the compartments [Fig 1]