Simultaneous Bilateral Patella Fracture After Single Stage Bilateral Total Knee Arthroplasty: A Report of Two Cases and Literature Review

Abstract

Introduction: Periprosthetic patellar fracture after total knee arthroplasty (TKA) is an uncommon yet devastating complication, and management of these fractures is challenging with unreliable results. An isolated bilateral patellar fracture is often associated with systemic diseases, steroid usage, and repeated microtrauma. Isolated simultaneous bilateral periprosthetic patellar fracture after TKA is seldom reported in the literature.

Case report: This report consists of two cases of simultaneous isolated closed bilateral eriprosthetic patellar fracture after TKA, treated with open reduction and internal fixation of patella using tension band wiring. Union was achieved in both cases with satisfactory knee range of motion without significant extension lag.

Conclusion: Regardless of the fact that surgical outcome of periprosthetic fracture of the patella has unpredictable and poor results in past, it can be considered for acute traumatic periprosthetic patella fractures with less comminution and good bone stock to avoid revision arthroplasty and poor outcome.

Keywords: Periprosthetic fracture; bilateral; bilateral total knee arthroplasty; patella fracture; tension band wiring.

Figure 1

Pre-operative radiograph of case 1 showing bilateral periprosthetic patella fracture without any signs of implant loosening. Post-operative radiograph after open reduction and internal fixation with tension band wiring showing union.

Figure 2

Case 1. Clinical pictures of case 1 showing knee range of motion at the final follow-up and radiographs after implant removal.

Figure 3

Perioperative radiographs of case 2 after open reduction and internal fixation with tension band wiring and final follow-up radiographs showing fracture union

Figure 4

Clinical pictures of case 2 showing knee range of movements at the final follow-up