Open Access Case report

Spontaneous patella fracture associated with anterior tibial tubercle pseudarthrosis in a revised knee replacement following knee Arthrodesis

Alfonso Manzotti1*, Simone Aldè1, Chris Pullen2, Pietro Cerveri3 and Norberto Confalonieri1

Author Affiliations

1 1st Orthopaedic Department, C.T.O. Hospital, Via S. Pertini 21,Via Bignami 1, 20040, Cambiago Milan, Italy

2 Royal Melbourne Hospital, Grattan Street, Parkville, Victoria Australia

3 Bioengineering Department, Politecnico di Milano, Milan, Italy

For all author emails, please log on.

BMC Musculoskeletal Disorders 2013, 14:317  doi:10.1186/1471-2474-14-317

Published: 6 November 2013



Conversion of a knee arthrodesis to a Total Knee Arthroplasty is an uncommon procedure. Revision Total Knee Arthroplasty in this setting presents the surgeon with a number of challenges including the management of the extensor mechanism and patella.

Case presentation

We describe a unique case of a 69 years old Caucasian man who underwent a revision Total Knee Arthroplasty using a tibial tubercle osteotomy after a previous conversion of a knee arthrodesis without patella resurfacing. Unfortunately 9 months following surgery a tibial tubercle pseudarthrosis and spontaneous patella fracture occurred. Both were managed with open reduction and internal fixation. At 30 months follow-up the tibial tubercle osteotomy had completely consolidated while the patella fracture was still evident but with no signs of further displacement. The patient was completely satisfied with the outcome and had a painless range of knee flexion between 0-95°.


We believe that patients undergoing this type of surgery require careful counseling regarding the risk of complications both during and after surgery despite strong evidence supporting improved functional outcomes.

Knee; Arthrodesis; Arthroplasty; Revision; Complication; Patella