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Case Report Open Access

Total knee arthroplasty for the treatment of osteoarthritis secondary to bilateral congenital patellar dislocation: A case report and review of the literature

  • Authors:
    • Haishan Lin
    • Ding Yang
    • Xuming Ding
    • Xingjia Yang
    • Yaohua Wang
  • View Affiliations / Copyright

    Affiliations: Department of Orthopedic Surgery, Zhangye People's Hospital Affiliated to Hexi University, Zhangye, Gansu 734000, P.R. China, West China Hospital, Sichuan University, Chengdu, Sichuan 610000, P.R. China, Department of Medical Records, Zhangye People's Hospital Affiliated to Hexi University, Zhangye, Gansu 734000, P.R. China
    Copyright: © Lin et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 234
    |
    Published online on: July 6, 2026
       https://doi.org/10.3892/etm.2026.13228
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Abstract

Congenital patellar dislocation is a relatively rare clinical deformity. In some patients, a delayed diagnosis or lack of early surgical intervention results in permanent patellar dislocation and subsequent knee osteoarthritis. Total knee arthroplasty (TKA) is currently the most effective treatment for end‑stage osteoarthritis, but performing surgery in these patients presents notable technical challenges. The current report presents the case of a 60‑year‑old woman who had been suffering from knee extensor weakness and dysfunction for >50 years, resulting in an active knee extension deficit. The patient experienced a sensation of instability in the knee when going up and down stairs and could only walk short distances without the aid of a cane. These severe symptoms markedly affected daily life. The patient was diagnosed with total knee osteoarthritis (Kellgren‑Lawrence grade IV), secondary to congenital patellar dislocation, according to established clinical and radiological criteria, accompanied by valgus deformity and flexion contracture of the knee joint. The patient underwent a staged bilateral TKA. The procedure utilized the standard Insall approach, with bone cuts performed to achieve mechanical alignment and implantation of conventional primary prostheses. Additionally, the pie‑crusting technique was employed to release the lateral structures, while the overlap‑suturing technique was used to reinforce the medial structures, thereby ensuring proper patellar tracking. At the final follow‑up, the patient exhibited satisfactory clinical outcomes, including a pain‑free gait, full knee extension and good joint range of motion. Imaging confirmed stable prosthesis alignment with no signs of loosening or patellar subluxation, while dynamic assessment demonstrated excellent patellofemoral joint stability. In conclusion, TKA is the most effective treatment for osteoarthritis caused by congenital patellar dislocation. Through the implementation of the pie‑crusting technique and overlap suturing for lateral structural release and medial structural reinforcement, respectively, notable patellar reduction was achieved employing standard prostheses.
View Figures

Figure 1

Preoperative knee CT and X-ray. (A)
Preoperative anteroposterior and lateral knee X-rays showing severe
osteoarthritis with lateral patellar dislocation. (B) CT
three-dimensional reconstruction showing subluxation of the
tibiofemoral and patellofemoral joints, along with marked
osteophyte proliferation. CT, computed tomography.

Figure 2

Preoperative knee CT scan. (A) CT
scanning combining transverse and sagittal planes. (B) CT scanning
combining transverse and coronal planes. Yellow lines are
positioning lines along which reconstruction was performed. CT,
computed tomography.

Figure 3

Intraoperative images of the knee. (A)
Intraoperative views of the right knee procedure. (B)
Intraoperative views of the left knee procedure.

Figure 4

Diagram of lateral retinacular release
and medial plication suture of the knee joint. Schematic
illustration of the surgical incision, lateral retinacular release
by pie-crusting and medial capsular overlapping. A midline incision
with a medial parapatellar approach was used for exposure. The area
marked by the ‘I’: The lateral retinaculum was released using a
sharp blade. The area marked by the medial black incision line: The
medial capsule was plicated and sutured.

Figure 5

Postoperative X-ray following total
knee arthroplasty. (A) Anteroposterior and lateral views of knees.
(B) Full-length lower limb radiographs. (C) Patellar axial
views.

Figure 6

Knee ROM at final follow-up. (A)
Postoperative ROM of the left knee: 0-115˚. (B) Postoperative ROM
of the right knee: 0-115˚. ROM, range of motion.

Figure 7

Both knee incisions demonstrated good
healing. The patellar position was noted to be favorable, and the
tibial rotational alignment was correct.
View References

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Copy and paste a formatted citation
Spandidos Publications style
Lin H, Yang D, Ding X, Yang X and Wang Y: Total knee arthroplasty for the treatment of osteoarthritis secondary to bilateral congenital patellar dislocation: A case report and review of the literature. Exp Ther Med 32: 234, 2026.
APA
Lin, H., Yang, D., Ding, X., Yang, X., & Wang, Y. (2026). Total knee arthroplasty for the treatment of osteoarthritis secondary to bilateral congenital patellar dislocation: A case report and review of the literature. Experimental and Therapeutic Medicine, 32, 234. https://doi.org/10.3892/etm.2026.13228
MLA
Lin, H., Yang, D., Ding, X., Yang, X., Wang, Y."Total knee arthroplasty for the treatment of osteoarthritis secondary to bilateral congenital patellar dislocation: A case report and review of the literature". Experimental and Therapeutic Medicine 32.3 (2026): 234.
Chicago
Lin, H., Yang, D., Ding, X., Yang, X., Wang, Y."Total knee arthroplasty for the treatment of osteoarthritis secondary to bilateral congenital patellar dislocation: A case report and review of the literature". Experimental and Therapeutic Medicine 32, no. 3 (2026): 234. https://doi.org/10.3892/etm.2026.13228
Copy and paste a formatted citation
x
Spandidos Publications style
Lin H, Yang D, Ding X, Yang X and Wang Y: Total knee arthroplasty for the treatment of osteoarthritis secondary to bilateral congenital patellar dislocation: A case report and review of the literature. Exp Ther Med 32: 234, 2026.
APA
Lin, H., Yang, D., Ding, X., Yang, X., & Wang, Y. (2026). Total knee arthroplasty for the treatment of osteoarthritis secondary to bilateral congenital patellar dislocation: A case report and review of the literature. Experimental and Therapeutic Medicine, 32, 234. https://doi.org/10.3892/etm.2026.13228
MLA
Lin, H., Yang, D., Ding, X., Yang, X., Wang, Y."Total knee arthroplasty for the treatment of osteoarthritis secondary to bilateral congenital patellar dislocation: A case report and review of the literature". Experimental and Therapeutic Medicine 32.3 (2026): 234.
Chicago
Lin, H., Yang, D., Ding, X., Yang, X., Wang, Y."Total knee arthroplasty for the treatment of osteoarthritis secondary to bilateral congenital patellar dislocation: A case report and review of the literature". Experimental and Therapeutic Medicine 32, no. 3 (2026): 234. https://doi.org/10.3892/etm.2026.13228
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