Background Information:

What are the other Names for the Procedure?

• Patellectomy

What is the Kneecap Removal surgical procedure?

• Kneecap Removal is a surgical intervention technique that involves the partial or complete removal of the kneecap, which is also known as the patella
• This procedure is recommended for individuals, who have a degenerative joint disorder, such as osteoarthritis that affects the kneecap

What part of the Body does the Procedure involve?

A Kneecap Removal procedure involves the kneecap, the knee joint, surrounding muscles, tendons, and ligaments, attached to the kneecap.

Why is the Kneecap Removal surgical procedure Performed?

A Kneecap Removal surgical procedure is performed for the following reasons:

• Kneecap fracture, when the kneecap is damaged beyond repair
• Recurring dislocation associated with the kneecap
• Osteoarthritis of the kneecap

What are some Alternative Choices for the Procedure?

Currently, there is no alternative choice to a Kneecap Removal procedure. It is performed when the bone is damaged beyond repair.

What are the Recent Advances in the Procedure?

Kneecap Removal is a “gold standard” procedure. There are no recent advances available for Kneecap Removal.

What is the Cost of performing the Kneecap Removal surgical procedure?

The cost of Kneecap Removal surgical procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding Kneecap Removal surgical procedure and what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
• Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

http://www.surgery.com/procedure/kneecap-removal (accessed on 08/02/2014)

Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5^th Edition, New York, 2006

Prior to Kneecap Removal surgical procedure:

How is the Kneecap Removal surgical procedure Performed?

• A Kneecap Removal procedure is usually done under general anesthesia
• The orthopedic surgeon incises the skin over the kneecap. The kneecap is exposed and mobilized, by cutting the muscles and tendons attached to it
• The kneecap is either partially removed (Partial Patellectomy) or completely removed (Total Patellectomy), depending on the extent of damage
• The muscles and tendons are sutured back again, to preserve mobility at the knee joint. The skin incision is then sutured

Where is the Procedure Performed?

Generally, a Kneecap Removal procedure is performed in a hospital.

Who Performs the Procedure?

An orthopedic surgeon performs a Kneecap Removal surgical procedure.

How long will the Procedure take?

The Kneecap Removal procedure usually takes 1-2 hours to perform.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the Kneecap Removal surgical procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
• Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
• Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
• Normally local anesthesia is not used; however do inform the physician if you are allergic to any local anesthetics, lidocaine, etc
• Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
• It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
• Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
• The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
• For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for Kneecap Removal procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Kneecap Removal surgical procedure?

Before the Kneecap Removal procedure, the patient has to undergo certain tests, such as:

• Routine blood and urine analysis
• X-ray of both knees

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is a Kneecap Removal procedure?
• Why is this procedure necessary?  How will it help?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed?
• What are the risks while performing the procedure?
• What are the complications that might take place, during recovery?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• What are the costs involved?

During the Kneecap Removal surgical procedure:

What kind of Anesthesia is given, during the Procedure?

General anesthesia by injection and inhalation is usually administered for a Kneecap Removal procedure. Sometimes, spinal anesthesia by injection may be used.

How much Blood will you lose, during the Procedure?

Normally, the blood loss is very minimal in a Kneecap Removal procedure, unless any complications are noted; in which case, there may be some additional blood loss.

What are the possible Risks and Complications during the Kneecap Removal surgical procedure?

There are general factors that increase the risk of getting complications during surgery and they include:

• Obesity: Generally greater the degree of obesity, greater is the surgical risk
• Smoking: Longer the smoking history (in pack years smoked), greater the surgical risk
• Advancing age
• Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
• Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
• Poorly functioning liver, as evidenced by increased blood liver function tests
• Hypertension (increased blood pressure), especially if it is poorly controlled
• Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
• Poor lung function, as evidenced by abnormal lung function tests
• History of bleeding disorders
• Longstanding illness, such as autoimmune disorders, chronic infections
• Poor immune system due to a variety of causes

The possible risks or complications that may arise during the Kneecap Removal surgery are:

• Excessive bleeding
• Infection in the surgical wound
• Anesthetic complications

What Post-Operative Care is needed at the Healthcare Facility after the Kneecap Removal surgical procedure?

• After the Kneecap Removal surgical procedure, patients will be sent to an area of the hospital called postoperative recovery area (or PACU)
• A patient’s blood pressure, heart rate, and respiration cycle will be closely monitored. Any additional pain associated with the procedure will also be treated
• Individuals are usually discharged from the hospital 3-6 days after the surgery is performed

After the Kneecap Removal surgical procedure:

What are the possible Risks and Complications after the Kneecap Removal surgical procedure?

The possible risks and complications that may arise after a Kneecap Removal procedure are:

• Infection in the surgical wound
• Formation of blood clots in the deep veins of the leg, if the legs are not mobilized early. The clots may break-off, travel through blood vessels, and obstruct one or more arteries within the lungs (pulmonary embolism). Hence, it is highly recommended that the individual starts walking as soon as possible
• The kneecap along with the attached muscles and tendons help in extending (straightening) the leg and stabilizing the knee. Following removal of the kneecap, stretching the knee to its full extent might not be possible

What is the Prognosis after the Surgery?

A complete recovery from a Kneecap Removal procedure is normally achieved. The prognosis is usually excellent, without any serious complications being noted.

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

• Pain that worsens and swelling around the surgical wound
• Bleeding or fluid drainage from the surgical wound
• The occurrence of any symptom that causes uneasiness, such as nausea or vomiting
• Noticeable discoloration of the toes, numbness or cold sensation in the toes
• Signs of an infection
• Dizziness
• Muscle aches, headache
• Fever, feeling sick
• Complications associated with prescription medications used in treatment

What Post-Operative Care is needed at Home after the Kneecap Removal surgical procedure?

At home, the following post-operative care is recommended, after a Kneecap Removal procedure:

• Slowly resume regular/daily activities as soon as possible, which aids in faster recovery
• Begin by using a walker, followed by crutches and then a cane, if needed
• Individuals are advised to use assistive devices, such as a raised toilet seat, bench for the bathtub, in order to limit bending at the knee
• Individuals are advised to use handrails to assist with walking up and down stairs
• Identify your maximum range of motion and stay within that limit, until the recovery is complete
• Avoid lifting or pulling heavy objects
• Resume showering and keep the wound clean and dry. Gently wash the surgical wound with an unscented soap
• Elevate legs while resting, to prevent the formation of blood clots and reduce the possibility of swelling
• Complete the course of prescribed medication, as advised by your physician
• Blood thinning medication may be prescribed by your physician to help prevent the formation of blood clots
• Take antibiotic medication to help combat or prevent infection, as advised by the physician
• Avoid taking nonprescription medications, such as aspirin. However, individuals may take acetaminophen to relieve pain, per advise from your physician
• Avoid all activities that are physically strenuous for up to 6 weeks after surgery
• Resume driving only after 3 weeks of being discharged from the healthcare facility, or follow your physician’s advise
• Individuals are advised to have to clear liquids immediately after surgery, until the gastrointestinal tract begins functioning properly. Then, individuals are advised to have a well-balanced diet, which can aid in a faster recovery

How long does it normally take to fully recover, from the Procedure?

It usually takes approximately 6-12 weeks to fully recover, from a Kneecap Removal procedure.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The tissue is taken for further examination and later disposed as per the standard medical procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

• The tissue removed is processed in the laboratory under a pathologist's supervision.
• Slide(s) are prepared once the tissue is processed and is examined by a pathologist and a pathology report issued.
• Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Kneecap Removal surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The outpatient facility or a physician’s office
• An anesthesiologist (if anesthesia was administered)
• Orthopedic surgeon

The patient is advised to inquire and confirm the type of billing, before the Kneecap Removal procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA