Biconvex Patellar Components: 96% Durability at 10 Years in 262 Revision Total Knee Arthroplasties

J Bone Joint Surg Am. 2021 Jul 7;103(13):1220-1228. doi: 10.2106/JBJS.20.01064.


Background: The optimal strategy to address osseous deficiencies of the patella during revision total knee arthroplasty (TKA) remains controversial. One possible solution is a cemented biconvex patellar component used such that the non-articular convexity both improves fixation and makes up for bone loss. The aim of this study was to determine the outcomes of the use of biconvex patellar components in a large series of revision TKAs.

Methods: From 1996 to 2014, 262 revision TKAs were performed at a single institution using a biconvex patellar component. Implant survivorship, clinical and radiographic results, and complications were assessed. The mean patient age at the TKA revision was 69 years, and 53% of the patients were female. The mean follow-up was 7 years.

Results: The 10-year survivorship free of revision of the biconvex patellar component due to aseptic loosening was 96%. The 10-year survivorship free of any revision of the biconvex patellar component was 87%. The 10-year survivorship free of any rerevision and free of any reoperation was 75% and 70%, respectively. The mean Knee Society Score (KSS) improved from 45.4 before the index revision to 67.7 after it. The mean residual composite thickness seen on the most recent radiographs was 18.1 mm. In addition to the complications leading to revision, the most common complications were periprosthetic patellar fracture (6%), of which 3 required revision; superficial wound infection (6%) requiring antibiotic therapy only or irrigation and debridement; and arthrofibrosis (3%).

Conclusions: In this cohort of 262 revision TKAs, biconvex patellar components used to treat marked patellar bone loss demonstrated excellent durability with a 10-year survivorship free of patellar rerevision due to aseptic loosening of 96%. The biconvex patellar components were reliable as evidenced by substantial improvements in clinical outcomes scores and a low risk of complications.

Level of evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Arthroplasty, Replacement, Knee / statistics & numerical data*
  • Female
  • Follow-Up Studies
  • Humans
  • Knee Prosthesis / statistics & numerical data*
  • Male
  • Middle Aged
  • Patella / diagnostic imaging
  • Patella / surgery*
  • Periprosthetic Fractures / epidemiology
  • Periprosthetic Fractures / therapy
  • Postoperative Complications / epidemiology
  • Postoperative Complications / therapy
  • Prosthesis Design
  • Prosthesis Failure*
  • Prosthesis Retention*
  • Reoperation / statistics & numerical data*
  • Retrospective Studies
  • Surgical Wound Infection / epidemiology
  • Surgical Wound Infection / therapy
  • Time Factors
  • Treatment Outcome
  • Young Adult