Total knee replacement with and without patellar resurfacing was performed in 6 cadaver specimens. The contact pressure and contact area between femur and patella was measured at 60°of flexion. In comparison to specimens without resurfacing the specimens with small size resurfacing showed a significant decrease in contact area, whereas average and maximum pressure were unchanged. In specimens with medium size resurfacing, contact area and average pressure increased slightly, whereas maximum pressure increased significantly. Patellar resurfacing did not change the retropatellar pressure, but was associated with reduced contact area.Résumé 6 cadavres ont été examinés après implantation d'une prothèse totale du genou avec et sans implants de restructuration de la surface rotulienne. Les mesures de la pression et de la surface de contact ont été réalisées avec une flexion du genou à un angle de 60°. En comparant les résultats de genoux sans implants et genoux avec implants de la rotule de taille "petite", on remarque que ces derniers ont causé une diminution significative de la surface de contact rétro-rotulienne. Les pressions moyenne et maximum n'ont pas changé de manière déterminante. Les implants de taille "moyenne" ont conduit à une augmentation considérable de la pression maximum et à une diminution significative de la force alors que la surface de contact et la pression moyenne ont elles, légèrement augmenté. Après la pose des deux types d'implants de la rotule on a constatée une réduction significative de la surface de contact, mais ne pas de la pression rétro-rotulienne.

The aim of this study was to evaluate the retropatellar pressure, force, and contact area in cases of knee arthroplasty compared to knees without arthroplasty. We examined six leg specimens before and after knee arthroplasty. The modified Thiel fixation was used, and arthroplasty was the Genesis I without patellar implant (Fa. Smith & Nephew, Schenefeld). Contact measurements were performed with pressure-sensitive film (Fuji Prescale type "super low") in 45 degrees, 60 degrees, 90 degrees, and 120 degrees knee flexion. The results were evaluated with special software, "Pressure Imaging and Analyzing System FPD-901 Series". The leg was exarticulated in the hip joint and the knee joint was opened from a suprapatellar approach. The film was placed at a defined area between the facies patellaris of the femur and facies articularis of the patella. Instantaneous pressure was measured during a time of 5-s pressure increase and a further 5 s. A force of 280 N was applied to the quadriceps muscle. Before knee arthroplasty, the contact area measured 154.3 mm2, the average pressure was 1.14 MPa, the force 182.13 N. After knee arthroplasty, the contact area was 119.94 mm2, the average pressure 1.522 MPa, the force 180.98 N. Following knee arthroplasty the contact area decreased significantly (P = 0.015), and the average (P = 0.0001) and maximum pressure (P = 0.0003) increased significantly. The force did not change significantly (P = 0.7642). The choice of the knee arthroplasty implant and approach to the knee joint should be considered in order to achieve an increased retropatellar contact area thus preventing smaller contact areas than before knee arthroplasty. The increased contact area could also prevent increasing retropatellar pressures after knee arthroplasty and further complications.

Ziel der Studie war die Erfassung von retropatellaren Kontaktcharakteristika beim Kniegelenk in verschiedenen Flexions-und Rotationswinkeln. Dazu wurden 6 Thiel-fixierte Leichen mittels Fuji •-Druckmeßfolie (Fa. Tiedemann & Betz) vom Typ Super Low Pressure vorgenommen. Die Messungen wurden bei 0°, 45°, 60°, 90° und 120° mit einem neutralen Zug von 280 N sowie einem lateral bzw. medial dominierenden Zug durchgeführt. Das Femur wurde hierbei in rotatorischer Neutralposition sowie um jeweils 10° nach innen und außen gedreht eingespannt. Die induzierten Momente wurden über eine Einspannung des Unterschenkels ausgeleitet. Die Kontaktflachen verkleinerten sich mit zunehmender Beugung. Die Fläche war bei medialem Zug größer als bei lateralem. Auch bei Innenrotation kam es im Vergleich zur Außenrotation zu einer kleineren Kontaktfläche. Die Druckbestimmung ergab in allen Belastungssituationen vergleichbare Werte. Auch die retropatellaren Kräfte waren insgesamt wenig unterschiedlich. Nur zwischen den Belastungssituationen neutralen und medialen Muskelzuges konnte ein signifikanter Unterschied in der Kontaktfläche, dem Druck und der Kraft festgestellt werden. Die veränderte Rotation bewirkte keine signifikante Veränderung. Beim Vergleich verschiedener Flexionsstellungen konnten nur sehr wenige signifikante Unterschiede festgestellt werden. Um möglichst große retropatellare Kontaktflächen zur Druckverteilung und letztlich zur Prävention einer Retropatellar arthrose zu haben, sind somit ein dominierender medialer Muskelzug und eine Außenrotati-onsstellung des Femurs günstig.The aim of the present study was to evaluate retropatellar contact characteristics at different angles of flexion of the knee joint. To this end, 6 cadaveric legs were examined using pressure sensitive film (Fuji Prescale type "super low") at angles of flexion of 45°, 60°, 90° and 120° both in neutral rotation and 10° internal and external rotation of the femur in the same knee joints. A force of 140 N was applied to both the vastus medialis and lateralis, and a comparison made with a medially and a laterally dominating muscle force. The contact areas decreased with increasing angles of flexion. The medially dominating muscle traction increased the contact area. Comparison between internal and external rotation revealed a decrease in contact area on internal rotation. The pressure measurements were comparable in all loading situations. Comparison between neutral and medial traction revealed significant differences in contact area, pressure and force. The influence of femoral rotation showed no significant difference. A comparison of the different angles of flexion revealed only few significant differences. To prevent the development of retropatellar arthrosis, maximum contact areas are necessary. The study has shown an advantage for medially dominating muscle traction, and external rotation of the femur. Einleitung

The aim of this study was to document the changes in retropatellar pressure, contact area and forces due to different sizes and placement of the patella resurfacing in knee arthroplasty. Six cadaver specimens (after Thiel fixation) were examined after the implantation of the total knee arthroplasty Genesis I. The patella sizes "small" and "medium" were placed as the "onlay" version, centered as well as off-centered by 0.4 cm in all four directions. Pressure and area measurements were done with Fuji pressure measuring film, which was placed between the patellar fascia of the femur and the patella in a defined position. The pressure was measured by applying a predetermined force for 5 s. The examinations were done with 60 degrees knee flexion and a force of 280 N. In our results there were no significant differences between, patella sizes. No significant differences for the medial, distal and proximal placement were found for the small patella. The lateral placement led to a significant decrease in the contact area (P = 0.0277), maximum pressure (P = 0.0422) and force (P = 0.0277). The average pressure did not change significantly (P = 0.1159). For the medium size patella there were no significant differences for medial or distal placement. The comparison of lateral and central placement revealed a significant decrease in the contact area (P = 0.0446). Comparing distal and proximal positioning, a significant increase in contact area and significant decrease in force were found (P = 0.0277 and P = 0.0277 respectively). In conclusion, the choice of small or medium patella resurfacing does not seem to have a significant influence. In comparison to the results without patella implants, the implantation of the small patella caused a significant decrease in the retropatellar contact area (P = 0.03) and force (P = 0.03). Average and maximum pressure did not change significantly (P = 0.6 and P = 0.35) even though pressure increased slightly. For the medium size, maximum pressure (P = 0.03) increased significantly and force decreased significantly (P = 0.0277) whereas contact area and average pressure increased slightly. The results of the different placements of the patella implant do not support the recommendation for a medial shift. However, at least the lateralized implantation led to a reduction of contact area and force as well as to a slight increase of pressure which is considered as unfavorable.