TKR after patellectomy

[DaveH]

I had TKR 10 months ago(de Puy) following patellectomy 40 years ago. Walking is difficult due to feeling of restriction. I excercise a lot and quads are reasonable. Surgeon and Physio find it difficult to understand the problem as it is rare combination. I feel desparate at times and would love to hear from anyone who has come back from this successfully. I am male and 67 years of age.

 

[Josephine]

Hello, Dave. You have an unusual problem there. It's not common, certainly, but I have seen a few over my time.

I think what it may be is that when the patella is removed, the ligament in it situated is necessarily reduced in length somewhat as the repair is made, as you can see in the image below. This could be the source of your difficulty.

However, I would suggest that 10 months is a bit early to be assuming your problem is solely due to the previous surgery. It is still possible to get the ligaments and muscles to adjust with the appropriate exercises.

 

[DaveH]

Josephine, Thanks for your swift response. I probably didn't express myself quite right. The restriction of movement comes from within the knee as a resistance to overcome with a clunk.I have no problems in getting 110 deg.+, and I think patella tendon too slack if anything. A knee brace improves walking at least 75 % as the tibia moves forward say 1/2" from femur. There is a friction created there and a 'locking' to overcome resistance at each step. I have a De Puy cruciate substituting (stabilised) joint, and I am not sure if the ACL or PCL were removed in the TKR.

 

[Josephine]

I have a De Puy cruciate substituting (stabilised) joint, and I am not sure if the ACL or PCL were removed in the TKR.

The ACL and PCL are so closely aligned it would not be possible to preserve just one! Thus this is otherwise known as the cruciate sacrificing knee. The stability of this knee is largely dependent upon the correct tensioning of the femoro-patellar ligament. This may tighten up as your quads get back into condition. The straight leg raises will help here.