Kneecap > Treatments
Patellectomy and Partial Patellectomy
Preparing for Surgery
If your fractured kneecap cannot
be treated non-operatively, you may have to undergo
surgery to have the broken pieces of your kneecap placed
back into the best possible position under direct visualization
and held in place with metal wires, pins, and/or screws.
This is known as open reduction internal fixation (ORIF).
If some of the broken pieces are too small to be fixed,
they are removed. If part of or the entire kneecap is
so severely fractured that it cannot be repaired, it
may be partially or totally removed. The decisions you
make and the actions you take before your surgery can
be every bit as important as the procedure itself in
giving you the best possibility of a healthy recovery.
Most insurance companies require a second opinion before
agreeing to reimburse a patient for a surgical procedure.
Getting a second opinion from a surgeon who is as qualified
as the surgeon who gave the initial diagnosis is advisable
in any case.
to your return home from the hospital, make sure you
have received any equipment you will need when you get
home from the hospital. This may include a knee brace,
crutches, walker, ice packs or coolers, or a continuous
passive motion (CPM) machine. You should receive prescriptions
for any of these from your doctor when your surgery
the potential risks and benefits of the surgery, and
ask your surgeon any questions that will help you better
understand the procedure. It can also help to talk to
someone else who has undergone the same surgery.
physical problems or changes in your overall health,
such as a fever or infection, should be reported to
your surgeon, and you should notify your surgeon of
any medication you are taking.
the use of any anti-inflammatory medicine, especially
aspirin, a week prior to surgery, to prevent excessive
bleeding during the procedure.
reduce the risk of infection, improve healing, and decrease
complications, try to quit smoking or decrease the amount
you smoke. In general, smokers have a higher overall
infection and complication rate.
possible, practice walking with your crutches in case
you need to use them after surgery.
sure the orthopedist performing the surgery is board-certified,
which can be determined by calling the American Board
of Orthopaedic Surgery at 919-929-7103.
to ask the doctor
to take to the hospital
If you are not admitted
directly to the hospital from the emergency room for
your surgery, you will be allowed to go home and schedule
your fractured kneecap surgery at a more convenient
time over the next few days. Prior to surgery, you may
be instructed to go to the hospital for pre-admission
testing a few days before surgery. A nurse will review
your medical history and provide you with all the preoperative
instructions you need.You will be asked about your past
medical history, given a complete physical exam and
undergo the appropriate routine blood and urine tests
and diagnostic studies (e.g. X-rays and electrocardiogram).
If you are taking any medications, you will receive
instructions about which medications to take and the
appropriate dosing prior to your surgery. At most medical
centers, you will go to "patient admissions"
to check in for your surgery. There may be separate
areas for ambulatory outpatients (patients who go home
the same day after surgery) and for overnight inpatient
surgery check-in. Be sure to ask your doctor or one
of his assistants about this. After you have checked
in to the hospital, you will go to a holding area where
the final preparations are made. The mandatory paperwork
is completed and your knee area may be shaved (this
is not always necessary). You will be asked to change
into a hospital gown and, if necessary, to remove all
of your jewelry, watches, dentures, and glasses. You
will have the opportunity to speak with your orthopedic
surgeon or one of his assistants, and meet the anesthesiologist
or anesthetist (a nurse who has done graduate training
to provide anesthesia under the supervision of an anesthesiologist).
Then, you will walk or ride on a stretcher to the operating
room. Unless requested, most patients are not sedated
until they go into the operating room. Here are some
important steps to remember for the day of your surgery:
will probably be told not to eat or drink anything after
midnight on the night before your surgery. This will
reduce the risk of vomiting while you are under general
your surgery is going to be an outpatient procedure,
arrange for someone to drive you home when you are released,
as the anesthetic and pain medications may make you
your surgery is going to be an inpatient overnight stay
procedure, pack a bag for yourself that contains toiletries,
underwear, personal phone numbers you may need, and
any other items you would like to have during your hospital
a loose pair of pants or other clothing that will fit
comfortably over your knee bandage when you leave the
it easy. Keeping a good frame of mind can help ease
any nerves or anxiety about undergoing surgery. Distractions
such as reading, watching television, chatting with
visitors, or talking on the telephone can also help.
to take to the hospital
In a full or partial patellectomy,
all or part of the kneecap is removed. This surgery
usually lasts approximately two hours.
anesthesia is typically used for surgery, though in
some cases a spinal or epidural anesthetic is used.
An anesthesiologist will administer the drugs to put
you to sleep once you are in the operating room.
linear incision is made over the front of the kneecap
to expose the fractured kneecap. The fractured pieces
are examined. If part of or the entire kneecap is so
secerely fractured that it cannot be repaired, it may
be partially removed (partial patellectomy) or totally
removed (full patellectomy).
the bony fragments of the kneecap are removed. The quadriceps
tendon above the kneecap, the patellar tendon below,
and the other soft tissues around the kneecap are preserved.
Thus, you will still be able to extend your knee after
a partial or full patellectomy, but the strength of
the extension will be weaker.
are closed with sutures or clips, which can be removed
approximately two to three weeks after surgery, and
the patient is taken to the recovery room.
After surgery to remove all or part of your kneecap
(full or partial patellectomy), you will be transported
to the recovery room where you will be closely observed
for one to two hours while the immediate effects of
the anesthesia wear off. After surgery, you will experience
some pain. Adequate pain medications will be prescribed
for you. You will be given oral, IV (intravenous), or
intramuscular pain medications when you ask for them.
In some cases, you will be given an IV patient-controlled
analgesia (PCA) device, which delivers pain medications
in safe amounts when you push a button. Your knee will
be bandaged and may have ice on it. There will likely
be pain, and you can expect to be given pain medication
as needed. Be sure to ask for medication as soon as
you feel pain coming on, because pain medication works
best on pain that is building rather than on pain that
is already present. The nurses will not give you more
than your doctor has prescribed and what is considered
to be safe. You should try to move your hips, feet,
and ankles while you are in the recovery room to improve
circulation. Your temperature, blood pressure, and heartbeat
will be monitored by a nurse, who, with the assistance
of the doctor, will determine when you are ready to
leave the hospital or, if necessary, be admitted for
an overnight stay. You may be able to bear some weight
on your leg, but you will probably have to use crutches
or a walker while a cast or knee immobilizer is on your
leg. Older patients may heal more slowly, and their
physicians may recommend they remain in a cast or knee
immobilizer and continue using crutches, a walker, or
a cane for a longer period of time. At the time of discharge,
you will be given instructions for what to do over the
next couple of days. In addition, you will be given
an appointment to return and a prescription for pain
medication. As soon as you are fully awakened, you are
usually allowed to go home. You will be unable to drive
a car, so be sure to have arranged a ride home.
After surgery to repair a fractured kneecap, some patients
remain in the hospital for one to two days. If your
knee is not immobilized, you may be started on range
of motion exercises for your knee. This will begin as
soon as possible after surgery, depending upon when
you are able to tolerate it. This may be done using
a continuous passive motion (CPM) machine. The CPM is
placed on or attached to your bed and then your leg
is placed in it. When turned on, it moves your leg through
a continuous range of motion. After surgery, you will
experience some pain. Adequate pain medications will
be prescribed for you. You will be given oral, IV (intravenous),
and/or intramuscular pain medications when you ask for
them. In some cases, you will be given an IV patient-controlled
analgesia (PCA) device, which allows pain medications
in safe amounts when you push a button. Be sure to ask
for medication as soon as you feel pain coming on because
pain medication works best on pain that is building
rather than on pain that is already present. The nurses
will not give you more medication than your doctor has
prescribed and what is considered safe. Ice also helps
control pain and swelling.
If your fractured kneecap was either
fully or partially removed, you may have a cast or knee
immobilizer on your leg for one to two weeks. Here is
what you can expect and how you can cope with the immobilization
of your leg:
first concern is to monitor pain and swelling for the
first 48 hours while wearing your cast. If your swelling
decreases dramatically, the cast may become too loose.
If swelling increases, circulation can be dangerously
cut off. In both cases, you should contact your physician.
your cast or knee immobilizer clean, dry, and intact.
Wrap it in a plastic shower bag whenever you may come
in contact with water.
most knee injuries, treat with R.I.C.E. (Rest, Ice,
Compression, Elevation). You may or may not be able
to put some weight on your leg, depending on your physician's
recommendation. Wrap ice into a well-sealed plastic
bag and drape it around the cast or knee immobilizer
at knee level for as long as possible.
the injured leg above heart level to help blood drain
towards your body. It often helps to sleep with pillows
or blankets under your ankles.
some pain for ten to fourteen days after your initial
injury. If needed, take pain medication as instructed.
your toes as much as possible to help circulate blood.
you develop a rash or irritated skin around your cast,
call your physician.
you sudden increased pain, contact your physician as
early as possible. In general, do not try to "grin
and bear it" if pain does not go away within a
your leg to be immobilized for about four to six weeks
before you can begin range of motion and quadriceps
strengthening exercises. However, straight leg raising,
which exercises the thigh muscles (quadriceps), usually
is recommended as soon as the acute pain associated
with your injury allows it.
avoid complications, only your doctor, a physician assistant
(PA), orthopedic nurse, or cast technician should remove
the cast with a special vibrating cast saw. In most
cases the cast is removed after four to six weeks.
to call the doctor after surgery
Once your cast has been removed or
use of a knee immobilizer has been discontinued following
a full or partial patellectomy, your physician may recommend
physical therapy to help you move about with the aid
of crutches, a walker, or other assistive device to
maintain and improve your overall conditioning. Though
everyone's rehabilitation program is slightly different,
rehabilitation for a fractured kneecap after cast removal
or discontinuance of a knee immobilizer follows a general
pattern. The rehabilitation focuses on strengthening
the muscles around your knee and increasing the range
of motion of the knee. Rehabilitation can begin about
four to six weeks after the injury was treated. Range
of motion is extremely important. Movement may be painful
at first, but it is important to not allow the knee
to stiffen. Rehab then progresses to resistive exercises
- those involving weights - to keep the muscles around
your knee strong. You should eventually be able to resume
functional activities like stair climbing, single leg
support, swimming, and driving. You will be able to
begin more vigorous activities as your kneecap heals
and your leg gets stronger.
strengthening exercises: Kneecap (patella) injuries
Building muscle strength around your
knee can help you avoid further injury to your knee.
Another way to help prevent further knee injuries is
to learn knee-sparing exercise techniques.
Living - the average person takes between 12,000 and
15,000 steps a day. Each step exerts a force between
two and five times your body weight on your knees. After
a knee injury, take it easy on your knees during the
day whenever possible to save them for activities and
exercise. Avoid stairs when there is an elevator, take
the shortest path when walking, and consider wearing
athletic shoes designed to absorb shock.
Strengthening/Conditioning - activities themselves are
not a substitute for conditioning. It is essential to
adhere to the muscle strengthening program you learned
in rehab throughout the remainder of your life. The
best strengthening programs are low-impact and non-weight-bearing,
like stationary bikes and certain weightlifting programs,
so that the knees do not have to absorb shock.
- your sport or activity of choice helps maintain mental
and physical well-being, but it is not a conditioning
program. Sports that require twisting and quick direction
changes put great strain on your knee. Without surgery
to repair your ACL, you should avoid sports like basketball,
soccer, skiing, running, and football that stress your