Does patellofemoral congruence following total knee arthroplasty correlate with pain or function? Intraoperative arthroscopic assessment of 30 cases

Senioris, Antoine; Saffarini, Mo; Rahali, Said; Malekpour, Louis; Dujardin, F.; Courage, Olivier

doi:10.21037/atm.2016.07.21

Cited by 10 publications

(8 citation statements)

References 25 publications

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“…Previous studies have shown that the fit of the femoral prosthesis and patella affects the clinical outcome of the patellofemoral joint [ 26 ]. When the patellar and femoral prosthesis fit is poor, it may lead to severe wear and tear, especially in patients who have not undergone patellar replacement and may lead to more severe symptoms of anterior knee pain.…”

Section: Discussionmentioning

confidence: 99%

The effect of femoral prosthesis design on patellofemoral contact stresses in total knee arthroplasty: a case–control study with mid-term follow-up minimum 3-year follow-up

Kong,

Lin,

Kang

et al. 2023

J Orthop Surg Res

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Background To investigate the differences in postoperative patellofemoral pressures and patellar tracking during at least three years of follow-up in patients using three prostheses of different designs in total knee arthroplasty (TKA) without patellar resurfacing. Methods: Radiographic investigations The study included 401 patients who had a total of 480 knee prostheses implanted without patellar resurfacing. The prostheses used were Genesis II (external rotation design of femoral prosthesis), Triathlon (design with deep trochlear grooves), and Gemini MK II (deepening of trochlear groove and lateral condylar protrusion that closely follows the anatomical shape). The patients' patellar tracking was assessed by measuring patellar tilt and displacement during postoperative follow-up. Furthermore, postoperative knee function and pain were evaluated through range of motion, Knee Society scores (KSS), and Forgotten Joint Score (FJS) to compare the different groups. Finite element analysis Constructing a finite element model of the knee joint of a normal volunteer after total knee arthroplasty using different prostheses for nonpatellar replacement. The three models' von Mises stress distribution heat map, peak contact pressure, and patellar transverse displacement were compared at 30°, 60°, and 90°, respectively. Results: Radiographic investigations A total of 456 knees of 384 patients were investigated at a 3-year follow-up after TKA without patellar resurfacing. There were no significant differences in patellar tracking between the three groups. Patients with all three prostheses demonstrated favorable clinical outcomes at 3 years postoperatively, with no statistically significant differences in knee scores (91.9 vs 92.3 vs 91.8) or range of motion (127.9° vs 128.5° vs 127.7°) between the groups. However, there was a significant difference between Genesis II and Gemini MK II in the Forgotten Joint Score (59.7 vs 62.4). Patients with persistent postoperative anterior knee pain were present in all three groups (16 vs 12 vs 10), but the incidence was not significantly different. Finite element analysis The von Mises stress distribution heat map showed that during flexion, the patellofemoral stresses were mainly concentrated on the lateral side of the prosthesis side, and the contact site gradually shifted downward with increasing flexion angle. At the same time, the peak contact stress of the patellofemoral joint increased with the gradual increase in the flexion angle. Genesis II, with a wider and shallower trochlear groove, showed greater patellofemoral stresses and lateral patellar displacement after TKA without patellar resurfacing. The Gemini MK II with a deeper trochlear groove and slightly protruding lateral condyle is more in line with anatomical design, with smaller patellofemoral joint pressure and better patellar tracking. Conclusions In TKA without patellar resurfacing, a prosthesis with a deeper trochlear groove, a slightly higher lateral femoral condyle, and a more anatomically designed knee that better matches the patellar morphology should be a better choice.

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Section: Discussionmentioning

confidence: 99%

The effect of femoral prosthesis design on patellofemoral contact stresses in total knee arthroplasty: a case–control study with mid-term follow-up minimum 3-year follow-up

Kong,

Lin,

Kang

et al. 2023

J Orthop Surg Res

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“…Some recent studies have reported the effect of TKA on patellar shape and clinical outcomes. Senioris et al [26] followed up 30 patients for an average of 14 months after they had an uncemented mobile-bearing TKA and reported that there was a strong correlation between patellar shape and patellofemoral congruence, but these elements had no correlation with the clinical outcomes. However, Ait-Si-Selmi et al [27] analyzed the correlation between clinical outcomes and preoperative patellar shape or postoperative patellar orientation of 144 patients, following them up for more than a year after performing a cemented PS TKA without patellar resurfacing.…”

Section: Discussionmentioning

confidence: 99%

The effect of patellar facet angle on patellofemoral alignment and arthritis progression in posterior-stabilized total knee arthroplasty without patellar resurfacing

Kim¹,

Lee²,

Huh³

2020

Knee Surg & Relat Res

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Background: The purpose of this study was to evaluate the effect of patellar facet angle on pre-and postoperative patellofemoral alignment and the progress of arthritis of the patellofemoral joint in posterior-stabilized total knee arthroplasty (PS TKA) without patellar resurfacing. Methods: Patients who had a PS TKA for a varus osteoarthritic knee who were followed up for more than 2 years were included in this study. The radiologic and clinical outcomes were compared between 72 knees (group A) whose patellar facet angle was greater than 126°(> 126°) and 32 knees (group B) whose patellar facet angle was smaller than or equal to 126°(≤ 126°). For the radiologic assessment, the Kellgren-Lawrence grade, mechanical femorotibial angle, Insall-Salvati ratio, patellar tilt angle, patellar displacement and the osteosclerosis of the patellar ridge were evaluated. The range of motion (ROM) and patient-reported outcomes (the Knee Society knee score, the Knee Society function score, the Feller patellar score, and the Kujala patellofemoral score) were used for the clinical assessment. Results: The preoperative patellar tilt angle was 9.8°(standard deviation [SD] 5.5) and 14.6°(SD 4.1) in group A and group B, respectively, a significant difference (p < 0.001). Other preoperative radiologic parameters and preoperative patient-reported outcomes and ROM showed no significant difference between the two groups (all parameters (p > 0.05). At the last-follow-up, 22 knees (30.6%) showed progression of osteosclerosis of the patellar ridge in group A and 13 knees (40.6%) showed progression of osteosclerosis in group B (p = 0.371). The postoperative radiologic and clinical outcomes showed no significant difference between the two groups (all parameters, p > 0.05). Conclusions: Although a narrow patellar facet angle was related to an increase of lateral tilting of the patella, it showed no impact on the preoperative clinical assessment. The radiologic and clinical outcomes evaluated after the PS TKA showed no statistical difference according to the patellar shape. Although the patellar shape evaluated by the patellar facet angle can partially affect the preoperative patellofemoral alignment, this study result indicated insignificant clinical relevance of the patellar shape in the PS TKA.

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“…Recent studies suggested that patellar shape [28, 35] and alignment [27, 29] are associated with clinical outcomes of TKA regardless of patellar resurfacing. The present study partially confirmed these findings as only patellar shape was found to be associated with clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Narkbunnam et al [27] associated patellar tilt angles > 5° and lateral patellar displacement > 5 mm with worse outcomes in TKA with patellar resurfacing. However, in a series of TKA without patellar resurfacing, Inoue et al [21] found that knees with patella facet angles < 126° had a greater risk of developing anterior knee pain, whereas Senioris et al [35] found patellar morphology and congruence to be strongly related, but not associated with clinical outcome. 1 3 New generation patella-friendly trochlear designs [33] have led several authors to question the associated costs and complications associated with systematic patellar resurfacing [40,43].…”

Section: Introductionmentioning

confidence: 99%

Patellar facet ratio affects knee pain, stair climbing and stair descent after TKA without patellar resurfacing

Aït-Si-Selmi

Marie-Hardy

O’Loughlin

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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PurposeTo determine whether knee pain or functional impairment after total knee arthroplasty (TKA) without patellar resurfacing are correlated with preoperative patellar morphology or postoperative patellar orientation. The hypotheses were that patellar shape, increased tilt and lateral displacement would be associated with pain and functional impairment. MethodsFrom a consecutive series of 152 knees that received a cemented postero‐stabilized TKA, the Oxford Knee Score (OKS) and the Knee injury and Osteoarthritis Outcome Score (KOOS) were collected at a minimum follow‐up of 12 months. Uni‐ and multi‐variable linear regression analyses were performed to determine associations between the collected clinical scores and patient demographics and patellar morphology, measured from pre‐ and post‐operative frontal, lateral and skyline view radiographs. ResultsThe OKS was 75 ± 23, whereas the KOOS pain, stair climbing, and descent were respectively 77 ± 24, 3.9 ± 1.1 and 3.8 ± 1.2. OKS was not associated with any radiographic outcomes, whereas KOOS pain was better for knees with larger medial patellar facets. The KOOS stair climbing and descent were also better for knees with larger medial patellar facets. ConclusionThe findings of this study partly confirm the hypotheses that pain and functional impairments after TKA without patellar resurfacing are associated with patellar shape. No association was revealed between postoperative patellar orientation and function nor pain. Quantitative consideration of patellar congruency could therefore prevent pain and improve function after TKA without patellar resurfacing. Level of evidenceRetrospective study, Level III.

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Does patellofemoral congruence following total knee arthroplasty correlate with pain or function? Intraoperative arthroscopic assessment of 30 cases

Cited by 10 publications

References 25 publications

The effect of femoral prosthesis design on patellofemoral contact stresses in total knee arthroplasty: a case–control study with mid-term follow-up minimum 3-year follow-up

The effect of femoral prosthesis design on patellofemoral contact stresses in total knee arthroplasty: a case–control study with mid-term follow-up minimum 3-year follow-up

The effect of patellar facet angle on patellofemoral alignment and arthritis progression in posterior-stabilized total knee arthroplasty without patellar resurfacing

Patellar facet ratio affects knee pain, stair climbing and stair descent after TKA without patellar resurfacing

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