Kneecap removal

Definition

Kneecap removal, or patellectomy, is the partial or total surgical removal of the patella, commonly called the kneecap.

Purpose

Kneecap removal is performed under three circumstances:

The kneecap is fractured or shattered.
The kneecap dislocates easily and repeatedly.
Degenerative arthritis of the kneecap causes extreme pain.

Demographics

A person of any age can break a kneecap in an accident. When the bone is shattered beyond repair, the kneecap has to be removed. No prosthesis or artificial replacement part is put in its place.

Dislocation of the kneecap is most common in young girls between the ages of 10–14. Initially, the kneecap will pop back into place of its own accord, but pain may continue. If dislocation occurs too often, or the kneecap does not go back into place correctly, the patella may rub the other bones in the knee, causing an arthritis-like condition. Some people are also born with birth defects that cause the kneecap to dislocate frequently.

Degenerative arthritis of the kneecap, also called patellar arthritis or chondromalacia patellae, can cause so much pain that it becomes necessary to remove the kneecap. As techniques of joint replacement have improved, arthritis in the knee is more frequently treated with total knee replacement .

People who have had their kneecap removed for degenerative arthritis and then later require a total knee replacement are more likely to have problems with the stability of their artificial knee than those who only have total knee replacement. This occurs because the realigned muscles and tendons provide less support once the kneecap is removed.

Description

General anesthesia is typically used for kneecap removal surgery, though in some cases a spinal or epidural anesthetic is used. The surgeon makes a linear incision over the front of the kneecap. The damaged kneecap is examined. If a part or the entire kneecap is so severely damaged that it cannot be repaired, it may be partially removed (partial patellectomy) or totally removed (full patellectomy). If kneecap removal is total, the muscles and tendons attached to the kneecap are cut and the kneecap is removed. However, the quadriceps tendon above the kneecap, the patellar tendon below, and the other soft tissues around the kneecap are preserved so that the patient may still be able to extend the knee after surgery. Next, the muscles are sewn together, and the skin is closed with sutures or clips that stay in place for about two weeks.

Diagnosis/Preparation

Prior to surgery, x rays and other diagnostic tests are done on the knee to determine if removing the kneecap is the appropriate treatment. Preoperative blood and urine tests are also done.

Patients are asked not to eat or drink anything after midnight on the night before surgery. On the day of surgery, patients are directed to the hospital or clinic holding area where the final preparations are made. The knee area is usually shaved and the patient is asked to change into a hospital gown and to remove all jewelry, watches, dentures, and glasses.

Aftercare

Pain medication may be prescribed for a few days. The patient will initially need to use a cane or crutches to walk. Physical therapy exercises to strengthen the knee should start as soon as tolerated after surgery. Driving should be avoided for several weeks. Full recovery can take months.

Risks

Risks involved with kneecap removal are similar to those associated with any surgical procedure, mainly allergic reaction to anesthesia, excessive bleeding, and infection.

Kneecap removal is very delicate surgery because the kneecap is part of the extensor mechanism of the leg, meaning the muscles and ligaments, the patella, the quadriceps tendon, and the patellar tendon; which all allow the knee to extend and remain stable when extended. When the kneecap is removed, the extensor assembly becomes more lax, and it may be impossible to ever regain full extension.

Normal results

People who undergo kneecap removal because of a broken bone or repeated dislocations have the best chance for complete recovery. Those who have this operation because of arthritis may have less successful results, and later need a total knee replacement.

Resources

BOOKS

Harner, C. D., K. G. Vince, and F. H. Fu, eds. Techniques in Knee Surgery. Philadelphia: Lippincott, Williams & Wilkins, 2001.

Winter Griffith, H., et al., eds. "Kneecap Removal." In The Complete Guide to Symptoms, Illness and Surgery, 3rd edition. New York: Berkeley Publishing, 1995.

PERIODICALS

Juni, P., et al. "Population Requirement for Primary Knee Replacement Surgery: A Cross-sectional Study." Rheumatology 42 (April 2003): 516–521.

Meijer, O. G., and Van Den Dikkenberg. "Levels of Analysis in Knee Surgery." Knee Surgery Sports Traumatology Arthroscopy 11 (January 2003): 53–54.

Petersen, W., C. Beske, V. Stein, and H. Laprell. "Arthroscopical Removal of a Projectile from the Intra-articular Cavity of the Knee Joint." Archives of Orthopaedic Trauma Surgery 122 (May 2002): 235–236.

ORGANIZATIONS

The American Academy of Orthopaedic Surgeons. 6300 North River Road, Rosemont, IL 60018-4262. (847) 823-7186, (800) 346-AAOS. http://www.aaos.org .

The American Association of Hip and Knee Surgeons (AAHKS). 704 Florence Drive, Park Ridge, IL 60068-2104. (847) 698-1200. http://hhtp://www.aahks.org .

OTHER

"Patellectomy." The Knee Guru Page. <http://www.kneeguru.co.uk/html/step_05_patella/step_05_patelle tomy.html> .

" Patellectomy or Partial Patellectomy." Pro Team Physicians. <http://www.proteamphysicians.com/Patient/Treat/knee/kneefractu e/patellectomy_procedure.asp> .

Tish Davidson, AM
Monique Laberge, PhD

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?

Kneecap removal surgery is usually performed in an outpatient setting and hospital stays, if any, are short, not exceeding more than a day. An orthopedic surgeon performs the surgery. Orthopedics is the medical specialty that focuses on the diagnosis, care, and treatment of patients with disorders of the bones, joints, muscles, ligaments, tendons, nerves, and skin.

QUESTIONS TO ASK THE DOCTOR

How is the kneecap removed?
What type of anesthesia will be used?
How long will it take for the knee to recover from the surgery?
When will I be able to walk without crutches?
What are the risks associated with kneecap removal surgery?
How many kneecap removal procedures do you perform in a year?

User Contributions:

Mr J. Butterworth

Sep 23, 2008 @ 11:11 am

My wife had a patella removed several years as it was dislocating and had several fissures. Although this appeared to cure the problem, in later life her knee has become very unstable and she can now only walk extremely slowly with the aid of two walking sticks. Can anything be done to improve this situation. Any help would be greatly appreciated.

DAVE

Aug 25, 2010 @ 5:17 pm

I HAD A TOTAL KNEE REPLACEMENT HOWEVER THEY DIDNOT PUT A BIG ENOUGHT LINER SO HAD TO HAVE ANOTHER OPERATION TO ENLARGE THE LINER. WHEN THEY WENT IN THEY FOUND MY KNEECAP WAS FRACTURED AND HALF OF IT WAS DEAD. SO REMOVED 1/2 OF CAP. NOW IT IS FALLING APART AND MAY HAVE TO BE REMOVED. WILL I BE ABLE TO FUNCTION WITH OUT IT AND WILL THE TENDONS WEAR OUT RUBBING OVER THE ARTIFICAL KNEE? WHAT OTHER PROBLEMS WILL I HAVE. THANK YOU

robert rogers

Sep 20, 2010 @ 6:06 am

i had a totale knee replacement in may of 2010, the knee never looked right? so i went back to the doctor and he said i torn somthing in the knee. so i had surgery in september2010. he said he cut my hamstings, and took out my knee cap. the incision does not look to good. the skin looks buckled. how long will it take to fully heal, and is it normal to take a knee cap out that was from a total knee replacement. please help

hiram goins

Dec 16, 2010 @ 6:18 pm

When a procedure like this is proformed do the surgeon need to put a drainage meganism in the area of operation to keep it from becoming infected if they sew it up and put a cast on that leg? Because my daughter was in a car accident and her knee was shattered and she had to have an patellectomy which after the surgery they sewed her up and put a full cast on her and 3 weeks later she had develop an infection, therefore they had to go back in to remove the infection, and then this time they put the drain in and had to put a IV pick to treat her for 6 weeks to flush out the infection. Could this be malpractice? concerned Father.

john warnstaff

Jan 7, 2011 @ 8:20 pm

my mom had knee surgery done,still was very painful.dr said need 2nd surgery,got the second surgery to take whole knee cap out.now she is still in alot of pain.now the dr says she needs a third surgery because its to loose,she does not want to go through another surgery...what to do.in pain.besides cold hot pack and pain pills not working.she is taking ibu etc...what to do?

Christine

Jan 14, 2011 @ 1:01 am

I had a patellectomy done back in 1994. The results were awful. I had had a dislocating kneecap since being about 10 years-old, had a surgery to fix that at 21, so much osteoarthritis set in over the next two decades or so that I could barely walk without considerable pain. That's when I had the kneecap removed. Bad idea. The quads in my leg atrophied so badly I have great difficulty walking without a cane. Cannot climb stairs. Occasionally, the knee still feels as though it will dislocate (as though I still had the knee cap). Doctors claim they have never seen such bad atrophy but frankly, from what I have read here and on many other sites (like Knee Geeks, etc.), I don't honestly think a patellectomy should be done at all unless everything else has been exhausted. treatment-wise. If I could go back I would NOT have the knee cap removed. I have had life long problems with both knees (they are really bad) and in my opinion, orthopedic surgeons often rush into an operation, and don't tell the patient what they are really facing. Rehabilitation is grueling and unless you keep at it seemingly forever, the benefits end with the last appointment. You can do a ton of research here on the Web but orthopedic doctors simply are NOT giving patients enough information, instead rushing into severe surgical procedures that judging from many comments on a variety of sites such as this, aren't working! We have a long way to go in the field of orthopedics in my opinion and until an operation is proven to be of benefit to all (or at least most), it should NOT be performed! Removing a knee cap can and often is nearly incapacitating. Not fond of TKR either. I haven't had it and don't intend to. Too many people I know have have had numerous problems. And the so-called "miracle" of cartilidge implantation does not always have positive results either. You only hear of the successes and never the failures. These sites contain a great many failures that I believe the orthopedic profession would like to simply cover up.

Lori

Feb 10, 2011 @ 8:08 am

I am 54 years old. Had a patellectomy 10 years ago.Fell on Saturday-felt like the knee dislocated (with no kneecap)In extreme pain.From what I have read this is a dislocation of the extensor mechanism...it felt like all my ligaments and tendons went from the left of the knee to the right...hurt like hell.Waiting for a MRI-wondering how much damage I have done-I have had 10 previous surgeries on the right knee-I think this knee has had it-but I am not a fan of TKR in my situation as of now...looking for help from anyone and any thoughts?

Kimberly

Mar 25, 2011 @ 12:00 am

I had a full patellectomy October 2009. I had a car accident in 2001 and went through years of pain and grinding (grade 3-4 chrondomalacia). After two surgeries and two doctors' opinions, I had my kneecap removed. I am commenting to let those who may have this procedure done know I had a great experience and recovery. I am now training to run marathons. It does become sore and give it out while standing on occasion, but that's an awesome trade for the pain I previously experienced for eight years that became worse every year. I could not ride a bike and now I am able to spend the evenings riding bikes or running with my kiddos. I was 25 when I had the surgery. I believe the most important part is to stay active!!!

Jo-Ann Eady

May 14, 2011 @ 2:14 pm

My mother (80 years old) underwent a patellectomy on July 1 2010 due to undetected infection after surgery to repair her kneecap 3 months before. Since then her pain has increased to the point that she can't stand for more than 5 minutes at a time. She has tried many narcotic pain meds with little relief and had to stop physio as the pain was so bad. Any advice?

B K Pathak

Jun 14, 2011 @ 1:01 am

My 26 yr old son's right knee patella was shattered in an accident two yrs ago and patella was removed. He still cannot put his right foot confidently as he does not feel supported at the knee. As per this article this occurs because the realigned muscles and tendons provide less support once the kneecap is removed for arthritis related removal. Will it be same in his case or he will be able to perform all knee functions normally? If not, what is the remedy? I want to know if medically full recovery is possible, as if nothing has happened to the knee?

Sep 18, 2011 @ 7:19 pm

I am now 45 yrs old and have been very active all of my life. I started having knee problems in my teens. I have now had 7 knee surgeries between the 2 knees. I had the patella removed from my left knee at age 22. It was painful and had to really stick to the rehab. To this day, I can do single legged squats and such on the left knee(the one with no knee cap). I have fallen on it, bumped it, and continued to run several miles a day,when I was a bit younger.I feel very fortunate. I have no pain. I have always been able to fully extend the leg and hold it there.I still ride and jump my horses. I can mount my largest horse(17.3H) from the ground. The left quad. is smaller then the right, but not really any less strong. I am having surgery on Tuesday on the right knee again. This will be the 4th arthroscopy,on the right knee, with the potential of a patellectomy. We will see how this ends up.I am looking forward to walking comfortably again.I have the same orthopedic surgeon that I did back in the '80s. He is awesome and kept these pair of knees going :)My Mom had total knees done by him with no complications. And, my husband has had one arthroscopy by him with no problems.He makes great treats things conservatively, but if needed, is such a talented surgeon. Good luck to you all.

maureen

Oct 25, 2011 @ 2:14 pm

i am considering having my knee cap removed as suggested by my surgeon, but i have read very few good reports so would like to hear from anyone who has had a good outcome or otherwise

BJN

Dec 8, 2011 @ 6:06 am

I am 59, had knee cap removed in 1969 (Boston). I now have arthritis and am in quite a bit of pain. I anticipate non-surgical approaches, which I am currently undergoing, will not work to relieve pain but am very hesitant about TKR. DP - can you share who your surgeon is and where located.
Thanks so much.

harryjjj

Dec 26, 2011 @ 10:22 pm

Maureen:
I had my kneecap removed in 1970, due to continual dislocations (I'm now 61). I don't recommend it. Stabilizing the kneecap would have been preferable, so the physicians tell me. One problem is loss of strength when straightening the leg. You may have a different situation, however.

Laura

Jan 25, 2012 @ 3:15 pm

I am 31 years old and recently have had my knee cap removed due to a tumor. The tumor came about in 2008 slipped down the stairs and fractured it. Had surgery the tumor was removed and bone graft took its place. The 6 weeks later more rumors formed in the soft tissue. On the shin. Had to have surgery to get those removed and they took a good chunk from my leg and had to have a skin graft. And that covered part of the knee cap and shin. I was fine with little untill 2011 the tumor came back in the knee cap. After lots of questions and seeing a reconstruction sergeon. They finally was going to operate again but before my surgery. I slipped once again this time on liquid that was on a tile floor and shattered my knee cap. They were stumped on what to do so I waited months. And they removed my knee cap took the tendons and muscle from my calf. Wrapped it around and conected it to my thigh and shin tendons and had to get another skin graft. The graft got Infected and tendons started to grow out of it. It is now all healed I am able to walk on it with no pain but it does give out from time to time but I can catch myself with my other leg. I am in PT working on getting to bend all of the way it is a challenge because of the skin graft.

Glynda

Jan 29, 2012 @ 7:19 pm

I had my knee cap totally removed, 4 years ago, due to a fall that shattered my knee cap. I am still having issues with my knee buckling, shooting pain to the right of the incision. I am at my whit's end as what to do. My ortho. Dr sees me every 3 months, tells me to come back, in 3 more, this has been the routine for years. Any advise would be greatly appreciated.

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