Differences in the stress distribution in the distal femur between patellofemoral joint replacement and total knee replacement: a finite element study

Jonbergen, Hans-Peter W. van; Innocenti, Bernardo; Gervasi, Gian Luca; Labey, Luc

doi:10.1186/1749-799x-7-28

Cited by 21 publications

(15 citation statements)

References 38 publications

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“…In addition to the failures of early-generation implants, a relatively high tendency for failures directly related to patellar maltracking has been identified (Arciero and Toomey 1988;Tauro et al 2001;Board et al 2004;van Jonbergen et al 2010). Hendrix et al (2008) performed a review of these outcomes and concluded that although many of the failures have been attributed to component malposition or soft tissue imbalance, the likelihood is that many of them were, in fact, promoted by particular design features of the trochlear components, which put the patella at risk for catching, snapping and subluxation on its proximal and lateral edges.…”

Section: Discussionmentioning

confidence: 99%

“…Patellofemoral arthroplasty (PFA) is a bone conserving solution for patients with isolated PF degeneration after other surgical options have failed (Delanois et al 2008;Müller et al 2012;van Jonbergen et al 2012). This technique is mainly recommended for patients under 55 years of age with isolated anterior compartment arthrosis, allowing, if necessary, for total knee arthroplasty to be performed later (Leadbetter et al 2008;Castro et al 2012).…”

Section: Introductionmentioning

confidence: 99%

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Biomechanical behaviour of cancellous bone on patellofemoral arthroplasty with Journey prosthesis: a finite element study

Castro

Completo

Simões

et al. 2014

Computer Methods in Biomechanics and Biomedical Engineering

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Isolated patellofemoral (PF) arthritis of the knee is a common cause of anterior knee pain and disability. Patellofemoral arthroplasty (PFA) is a bone conserving solution for patients with PF degeneration. Failure mechanisms of PFA include growing tibiofemoral arthritis and loosening of components. The implant loosening can be associated with bone resorption or fatigue-failure of bone by overload. This research work aims at determining the structural effects of the implantation of PF prosthesis Journey PFJ (Smith & Nephew, Inc., Memphis, TN, USA) on femoral cancellous bone. For this purpose, the finite element method is considered to perform computational simulations for different conditions, such as well-fixed and loosening scenarios. From the global results obtained, in the well-fixed scenario, a decrease in strain on cancellous bone was noticed, which can be related to bone resorption. In the loosening scenario, when the cement layer becomes inefficient, a significant increase in cancellous bone strain was observed, which can be associated with bone fatigue-failure.These strain changes suggest a weakness of the femur after PFA.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Biomechanical behaviour of cancellous bone on patellofemoral arthroplasty with Journey prosthesis: a finite element study

Castro

Completo

Simões

et al. 2014

Computer Methods in Biomechanics and Biomedical Engineering

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“…Van Jonbergen HPW et al (26) investigated the stress distribution differences in the distal femur of patients who underwent patellofemoral joint arthroplasty and total knee arthroplasty. Patellofemoral joint arthroplasty forms a stress shield around the prosthesis, but this is less than total knee arthroplasty.…”

Section: Discussionmentioning

confidence: 99%

“…Patellofemoral joint arthroplasty forms a stress shield around the prosthesis, but this is less than total knee arthroplasty. They suggested that special designs of patellofemoral prostheses may result in differences of the femoral stress shield (26).…”

Section: Discussionmentioning

confidence: 99%

Patellofemoral Arthrosis and Patellofemoral Arthroplasty

Yılmaz¹,

Özdemir²,

Kömür³

et al. 2014

JAREM

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The patellofemoral joint tends to develop osteoarthritis due to the high rates of anatomical abnormalities and exposure to large weights through relatively small areas. The rate of isolated patellofemoral arthrosis is 11% in men and 24% in women above 55 years of age. This gender difference may be due to the more frequent presence of patellar aligment problems and dysplasia in women. Although, patellofemoral arthrosis, in general, is treated by conservative methods, surgery should be considered for patients who have failed to benefit from weight loss, physical therapy and drug treatment because the disease leads to pain and loss of function. In the surgical treatment of patellofemoral arthrosis, methods such as arthroscopic debridement, management of loads that affect the patella, cartilage grafting, patellar resurfacing, patellafemoral arthroplasty (PFA), total joint replacement and patellectomy can be used. However, PFA has not been widely used. The reasons were problems with the initial design, and mistakes in patient selection, but those were reduced recently and this has led to increasing interest in the PFA. The current indications of PFA comprise of patients with little or no malalignment, and young patients with isolated patellofemoral disease who were planned for patellectomy due to symptom severity. Indeed, the outcomes from patients who were below 55 years of age with a 5-year follow up are promising. (JAREM 2014; 1: 1-3) Key Words: Patellafemoral joint, arthrosis, patellofemoral arthroplasty ÖZET Patellofemoral eklem büyük yüklerin dar temas alanları üzerinden etki etmesi ve nispeten anatomik anomali oranının sıklığı nedeniyle osteoartrite oldukça meyilli bir eklemdir. Tek başına patellofemoral artroz varlığı 55 yaş üstü erkeklerde %11, kadınlarda %24 oranında görülmekle birlikte bu cinsiyet farklılığının nedeni kadınlarda daha sık olan patellar dizilim bozukluğu ve displazi olabilir. Patellofemoral artroz genellikle konservatif yöntemler ile tedavi edilmeye çalışılsa da; tek başına ağrı ve fonksiyon kaybı yaratması nedeniyle kilo verme, fizik tedavi ve ilaç tedavisinden fayda görmeyen hastalar için cerrahi seçenekler gözönünde bulundurulmalıdır. Patellofemoral artroz cerrahi tedavisinde artroskopik debridman, patellayı etkileyen yüklerin düzenlenmesi, kıkırdak greftlemeleri, patellar yüzey yenilemeleri, Patellofemoral artroplasti (PFA), total eklem replasmanı ve patellektomiye uzanan yöntemler uygulanabilmektedir. Bununla birlikte PFA çok yaygın kullanım alanı bulamamıştır. Bunun nedeni olarak gösterilen ilk tasarımlardaki sorunlar ve hasta seçimindeki hata oranlarının azaltılması ile özellikle son yıllarda PFA'ye olan ilgi de artmıştır. PFA'nin günümüzdeki endikasyonları arasında yanlış dizilimin çok az olduğu ya da hiç olmadığı hastalar ve semptomların ciddiyeti nedeniyle patellektomi planlanan izole patellofemoral hastalığı olan genç hastalar vardır. Gerçekten de 55 yaş altı ve en az 5 yıllık takibi olan hastaların sonuçları cesaret vericidir. (JAREM 2014; 1: 1-3) Anahtar Sözcükler:...

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“…This technique has been shown to be advantageous for obtaining insight within interfaces that otherwise would be problematic to evaluate, namely on the knee joint. 32–37…”

Section: Introductionmentioning

confidence: 99%

Modelling and simulation of alternative designs for the femur–implant interface of Journey patellofemoral prosthesis

Castro

Completo

Simões

et al. 2018

Proceedings of the Institution of Mechanical Engineers, Part L:

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The implantation of conventional patellofemoral arthroplasty solutions has been identified as a source of later femur weakness, which is associated with bone resorption and stress-shielding effect. In this work, the Journey PFJ® arthroplasty system, of Smith & Nephew (UK), is investigated. The purpose is to evaluate the structural effects of different femoral components on the bone–implant interface. The finite element method is used to evaluate the influence of the geometry and stiffness of alternative implants, for post-implantation and long-term scenarios. Firstly, the original bone–femur interface of Journey PFJ®, with four fixation pins, was modelled. Secondly, four alternative models were developed: (i) model with two pins; (ii) model without pins; (iii) model with new pin design; (iv) model with increased thickness. The behaviour of the five models was evaluated and compared. Validation against experimental data was also performed. Results showed that the elastic strain is two to three times lower on bone areas close to the pins, in the post-implantation scenario, which is most likely due to a stress-shielding effect. In a long-term scenario, bone rupture by fatigue may occur, associated with an increase in elastic strains. This effect is particularly noticed in the implants supported by fixation pins. In addition, contact analyses evidenced that implant stability is best promoted without fixation pins. Such outcomes suggest that the alternative implant without fixation pins on the bone–femur interface can improve the protection of the femur after patellofemoral arthroplasty, assuming good cement fixation throughout the implant’s lifetime.

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Differences in the stress distribution in the distal femur between patellofemoral joint replacement and total knee replacement: a finite element study

Cited by 21 publications

References 38 publications

Biomechanical behaviour of cancellous bone on patellofemoral arthroplasty with Journey prosthesis: a finite element study

Biomechanical behaviour of cancellous bone on patellofemoral arthroplasty with Journey prosthesis: a finite element study

Patellofemoral Arthrosis and Patellofemoral Arthroplasty

Modelling and simulation of alternative designs for the femur–implant interface of Journey patellofemoral prosthesis

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