Fracture non-union, bone loss, joint instability, and infection may complicate treatment of periprosthetic fractures about a total knee.
In addition, many of these patients are elderly and may have multiple comorbidities which may complicate or preclude extensive reconstructions.
With careful consideration of patient needs, different salvage options exist.
Treatment of patellar fractures around a total knee replacement commonly fail. The blood supply to the patella is challenged by the initial arthroplasty procedure and when the patella is fractured behind the button, it is very difficult to achieve bony union. The size of the remnant patella precludes many of the treatments that are typically utilized for patellar fractures.
Partial or complete patellectomy with extensor mechanism repair/reconstruction should be considered in order to salvage a functional total knee arthroplasty. Limitations of this procedure include loss of extensor strength and probable need for an assistive device for ambulation. However, multiple surgeries for patella non-union can lead to a higher risk of infection and the possibility of amputation.