Guiding Device for the Patellar Cut in Total Knee Arthroplasty: Design and Validation

Rex, Erica; Gaudelli, C.; Illical, Emmanuel M.; Person, John G.; Arlt, K; Wylant, Barry; Anglin, Carolyn

doi:10.3390/bioengineering5020038

Cited by 4 publications

(1 citation statement)

References 11 publications

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“…Based on a rigorous and extensive shape analysis of the patella, a peg configuration was derived to achieve the surgeons' desired resection plane relative to specific contact points on the anterior surface. By analysing numerous alternative configurations on the 18 patellae, the best peg configuration consisted of a 16 mm equilateral triangle centred on the patella, which has been adopted into and successfully tested on two prototype surgical devices [ 17 , 18 ]. The resulting configuration could also benefit custom rapid-prototyped surgical guides (which have often been used for the femur and tibia), by working from similar contact points.…”

Section: Discussionmentioning

confidence: 99%

Shape Analysis of the Patellar Bone Surface and Cutting Plane for Knee Replacement Surgery

Rex

Werle

Burkart

et al. 2018

Computational and Mathematical Methods in Medicine

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Geometry of the patella (kneecap) remains poorly understood yet is highly relevant to performing the correct patellar cut to reduce pain and to improve function and satisfaction after knee replacement surgery. Although studies routinely refer to “parallel to the anterior surface” and “the patellar horizon,” a quantitative definition of these is lacking and significant variability exists between observers for this irregularly-shaped bone. A 2D-3D shape analysis technique was developed to determine the optimal device configuration for contacting the patellar surface. Axial and sagittal pseudo-X-rays were created from 18 computed tomography (CT) scans of cadaveric knees. Four expert surgeons reviewed three repetitions of the X-rays in randomized order, marking their desired cut plane and their estimate of the anterior surface. These 2D results were related back to the 3D model to create the desired plane. There was considerable variability in perceptions, with intra- and intersurgeon repeatability (standard deviations) ranging from 1.3° to 2.4°. The best configuration of contact points to achieve the desired cutting plane was three pegs centred on the patellar surface, two superior and one inferior, forming a 16 mm equilateral triangle. This configuration achieved predicted cut planes within 1° of the surgeon ranges on all 18 patellae. Implementing this, as was done in a subsequent prototype surgical device, should help improve the success and satisfaction of knee replacement surgery.

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Section: Discussionmentioning

confidence: 99%

Shape Analysis of the Patellar Bone Surface and Cutting Plane for Knee Replacement Surgery

Rex

Werle

Burkart

et al. 2018

Computational and Mathematical Methods in Medicine

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Deep 3D Convolutional Networks to Segment Bones Affected by Severe Osteoarthritis in CT Scans for PSI-Based Knee Surgical Planning

et al. 2020

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Dynamic Measurement of Patellofemoral Compression Forces: A Novel Method for Patient-Specific Patella Resurfacing in Total Knee Replacement

Brivio

Barrett²,

Gong³

et al. 2022

Applied Sciences

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Functional dissatisfaction following total knee replacement (TKR) is recorded as high as 20%. The majority of these patients report anterior knee pain (AKP) as the main source of dissatisfaction. Elevated patellofemoral compression forces and soft tissue extensor hood strain have been implicated in the generation of significant AKP. A novel method of assessing and measuring patellofemoral compression forces dynamically in the native and resurfaced patella for TKR in four different quadrants of the patella is described. Results are reported from an in vitro model and cadaveric studies in the native and resurfaced knee. Patellofemoral compression forces are shown to be characteristic and consistent over repeated assessments in the native knee. Placement of a TKR significantly alters this pattern. Furthermore, over-stuffing or under-stuffing the resurfaced patella also significantly alters the nature and magnitude of patellofemoral compression forces. These studies may lead to an improved understanding of the nature of AKP following TKR, and using this assessment tool presents an opportunity to more effectively balance the third space, reproduce the native patellofemoral forces, and subsequently reduce AKP following TKR.

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Guiding Device for the Patellar Cut in Total Knee Arthroplasty: Design and Validation

Cited by 4 publications

References 11 publications

Shape Analysis of the Patellar Bone Surface and Cutting Plane for Knee Replacement Surgery

Shape Analysis of the Patellar Bone Surface and Cutting Plane for Knee Replacement Surgery

Deep 3D Convolutional Networks to Segment Bones Affected by Severe Osteoarthritis in CT Scans for PSI-Based Knee Surgical Planning

Dynamic Measurement of Patellofemoral Compression Forces: A Novel Method for Patient-Specific Patella Resurfacing in Total Knee Replacement

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