Patella alta and patellar subluxation might lead to early failure with inlay patello-femoral joint arthroplasty

Beckmann, Johannes; Merz, Cornelia; Huth, Jochen; Rath, Björn; Schnurr, Christoph; Thienpont, Emmanuel

doi:10.1007/s00167-018-4965-8

Cited by 21 publications

(24 citation statements)

References 38 publications

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“…Therefore, patella alta cannot be compensated by this specific implant. This problem has also been observed in another study by Beckmann et al [2]. In their series of 20 patients treated with the HemiCAP® Wave prosthesis, 11 patients underwent revision surgery for recurrent pain and "clunk" phenomenon.…”

Section: Discussionsupporting

confidence: 61%

“…All patients were revised using an onlay-type prosthesis and pain as well as function improved postoperatively. The authors, therefore, concluded that inlay PFA should be considered contraindicated in patients with patella alta and that an onlay PFA system reaching further proximal should be considered [2]. It must be noted, however, that it remains unknown to what extend a larger implant can compensate for patella alta.…”

Section: Discussionmentioning

confidence: 99%

“…Another important reason leading to failure especially in the early postoperative course is unaddressed patellar maltracking [2,17,43,51]. Given the complex interaction between dynamic muscle action, passive soft-tissue restrains, surface geometry of the patellofemoral joint, and limb alignment, patellofemoral maltracking is commonly seen as a multifactorial problem [20,22,28].…”

Section: Introductionmentioning

confidence: 99%

“…In the native knee, patella alta and a lateralized tibial tuberosity are wellaccepted risk factors for painful patellofemoral maltracking and instability [19,22,46,47]. Although a treatment algorithm to address tibiofemoral and/or patellofemoral malalignment in combination with PFA has been proposed [27], the relevance of these parameters in patients undergoing PFA remains largely unknown and warrants further investigation [2].…”

Section: Introductionmentioning

confidence: 99%

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Preoperative patellofemoral anatomy affects failure rate after isolated patellofemoral inlay arthroplasty

Feucht

Lutz

Ketzer

et al. 2020

Arch Orthop Trauma Surg

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Purpose To analyze whether preoperative patellofemoral anatomy is associated with clinical improvement and failure rate after isolated patellofemoral arthroplasty (PFA) using a modern inlay-type trochlear implant. Methods Prospectively collected 24 months data of patients treated with isolated inlay PFA (HemiCAP® Wave, Arthrosurface, Franklin, MA, USA) between 2009 and 2016, and available digitalized preoperative imaging (plain radiographs in three planes and MRI) were retrospectively analyzed. All patients were evaluated using the WOMAC score, Lysholm score, and VAS pain. Patients revised to TKA or not achieving the minimal clinically important difference (MCID) for the total WOMAC score or VAS pain were considered failures. Preoperative imaging was analyzed regarding the following aspects: Tibiofemoral OA, patellofemoral OA, trochlear dysplasia (Dejour classification), patellar height (Insall–Salvati index [ISI]; Patellotrochlear index [PTI]), and position of the tibial tuberosity (TT–TG and TT–PCL distance). Results A total of 41 patients (61% female) with a mean age of 48 ± 13 years could be included. Fifteen patients (37%) were considered failures, with 5 patients (12%) revised to TKA and 10 patients (24%) not achieving MCID for WOMAC total or VAS pain. Failures had a significantly higher ISI, and a significantly lower PTI. Furthermore, the proportion of patients with a pathologic ISI (> 1.2), a pathologic PTI (< 0.28), and without trochlear dysplasia were significantly higher in failures. Significantly greater improvements in clinical outcome scores were observed in patients with a higher preoperative grade of patellofemoral OA, ISI ≤ 1.2, PTI ≥ 0.28, TT–PCL distance ≤ 21 mm, and a dysplastic trochlea. Conclusion Preoperative patellofemoral anatomy is significantly associated with clinical improvement and failure rate after isolated inlay PFA. Less improvement and a higher failure rate must be expected in patients with patella alta (ISI > 1.2 and PTI < 0.28), absence of trochlear dysplasia, and a lateralized position of the tibial tuberosity (TT–PCL distance > 21 mm). Concomitant procedures such as tibial tuberosity transfer may, therefore, be considered in such patients. Level of evidence Level III, retrospective analysis of prospectively collected data.

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Section: Discussionsupporting

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Preoperative patellofemoral anatomy affects failure rate after isolated patellofemoral inlay arthroplasty

Feucht

Lutz

Ketzer

et al. 2020

Arch Orthop Trauma Surg

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“…Two studies from 2019, concerning the same inlay implant, obtained controversial results. While one showed promising results with a survival rate of 91% at 2 years and 83% at 5 years [ 55 ], the other found a high failure rate of these inlay prostheses [ 56 ]. Many patients had to be revised after 28 months and converted into an onlay prosthesis because of persistent pain and clunck phenomenon.…”

Section: Resultsmentioning

confidence: 99%

Contemporary knee arthroplasty: one fits all or time for diversity?

Beckmann,

Meier,

Benignus

et al. 2021

Arch Orthop Trauma Surg

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Introduction Total knee arthroplasty (TKA) has historically been the preferred solution for any type of knee osteoarthritis, independently of the number of compartments involved. In these days of patient-specific medicine, mono-compartmental disease could also be approached with a more individualized treatment, such as partial knee arthroplasty (PKA). Off-the-shelf (OTS) implants are often the compromise of averages and means of a limited series of anatomical parameters retrieved from patients and the pressure of cost control by limited inventory. Personalized medicine requires respect and interest for the individual shape and alignment of each patient. Materials and methods A Pubmed and Google Scholar search were performed with the following terms: “patient-specific knee” and “arthroplasty” and “custom implant” and “total knee replacement” and “partial knee replacement” and “patellofemoral knee replacement” and “bicompartmental knee replacement”. The full text of 90 articles was used to write this narrative review. Results Unicondylar, patellofemoral and bicompartmental knee arthroplasty are successful treatment options, which can be considered over TKA for their bone and ligament sparing character and the superior functional outcome that can be obtained with resurfacing procedures. For TKA, where compromises dominate our choices, especially in patients with individual variations of their personal anatomy outside of the standard, a customized implant could be a preferable solution. Conclusion TKA might not be the only solution for every patient with knee osteoarthritis, if personalized medicine wants to be offered. Patient-specific mono-compartmental resurfacing solutions, such as partial knee arthroplasty, can be part of the treatment options proposed by the expert surgeon. Customized implants and personalized alignment options have the potential to further improve clinical outcome by identifying the individual morphotype and respecting the diversity of the surgical population.

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Patella height influences patellofemoral contact and kinematics following cruciate‐retaining total knee replacement

Tischer

Geier

Lutter

et al. 2022

Journal Orthopaedic Research

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The role of patella height is discussed controversially in total knee arthroplasty (TKA). Therefore, this computational study aims to systematically analyze the biomechanical effect of different patella heights on patellofemoral (PF) forces and kinematics after cruciate-retaining (CR) TKA. We implemented a CR bicondylar TKA with a dome patellar button in a validated dynamic musculoskeletal multibody model of a male human knee joint. Retropatellar dynamics (contact force [N], shear force[N], patellar shift [mm], tilt [°], and rotation [°]) were evaluated during dual-limb squat motion (flexion from 0°to 90°) with simulated active muscle forces and the effects of different patella heights (Blackburne-Peel [BP] ratio of 0.39, 0.49, 0.65, 0.85, 1.01, and 1.1 were systematically examined). As active knee flexion increased, PF contact force also increased. Patella alta (BP = 1.1) resulted in higher PF contact forces compared to normal patella height (BP = 0.65) by up to 16%. Contrarily, patella baja was associated with decreased PF forces by 7%. Compared to patella baja (BP = 0.39), patella alta (BP = 1.1) considerably increased the contact force by up to 25%. Different patellar heights mainly affected PF shear forces during early knee flexion. Concerning PF kinematics, patella alta (BP = 1.1) yielded a greater lateral tilt of more than 4°and higher patellar rotation by up to 3°during deep knee flexion, compared to normal patella height (BP = 0.65). Our computational study indicates that patella alta is associated with the highest PF contact and shear force after the implantation of a CR bicondylar TKA. This should be considered in PF disorders following TKA.

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Patella alta and patellar subluxation might lead to early failure with inlay patello-femoral joint arthroplasty

Abstract: Level IV.

Cited by 21 publications

References 38 publications

Preoperative patellofemoral anatomy affects failure rate after isolated patellofemoral inlay arthroplasty

Preoperative patellofemoral anatomy affects failure rate after isolated patellofemoral inlay arthroplasty

Contemporary knee arthroplasty: one fits all or time for diversity?

Patella height influences patellofemoral contact and kinematics following cruciate‐retaining total knee replacement

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