Patellofemoral complications with the Insall-Burstein II posterior-stabilized total knee arthroplasty

The Insall-Burstein and Insall-Burstein II posterior-stabilized (I-B II PS) prostheses have been reported to have a high prevalence of patellar compli cations. This is a prospective, consecutive study of 118 primary total knee arthroplasties in 82 patients with the I-B II PS prosthesis implanted by 1 surgeon, using a specific technique for patellar resurfacing. The mean fol low-up time was 4.0 years (range, 2-8 years). Clinical evaluation was perfo rmed using a standard knee score system with specific additional evaluation of the patellofemoral joint. Radiographs were evaluated for fracture, loos ening, and subluxation. Ninety-four knees (80%) were rated excellent, 21 kn ees (17%) good, and 3 knees (3%) fair. The mean flexion was 112 degrees pos toperative. No knee required reoperation for the patellofemoral joint. Ther e were 2 nondisplaced and 1 minimally displaced patellar fractures treated nonoperatively, no patellar clunk syndrome, and no subluxations. Using the patellar evaluation system, 109 knees had no anterior knee pain, 7 knees ha d mild pain, and 2 knees (1 patient) had moderate-to-severe pain only with rising from a chair. Patellofemoral crepitus with active flexion-extension in the seated position was noted in 16 knees (14%) but was painful in only 2 knees (1 patient). With this technique for patellar resurfacing with this prosthesis, patellofemoral complications were only 4.2%, and no knee requi red reoperation for the patella or for loosening. With attention to operati ve technique, patellofemoral resurfacing with this posterior-stabilize tota l knee arthroplasty can be highly successful.