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

Aït-Si-Selmi, Tarik; Marie-Hardy, Laura; O’Loughlin, Padhraig F.; Kobayashi, Kanae; Müller, Jacobus H.; Saffarini, Mo; Bonnin, Michel

doi:10.1007/s00167-020-05868-y

Cited by 11 publications

(4 citation statements)

References 47 publications

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“…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. They reported that the pain and functional impairment after TKA were correlated with patellar shape.…”

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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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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“…4) [5,12]. Furthermore, the lateral patellofemoral angle (LPFA) and the Caton-Deschamps index were evaluated [1,19]. The LPFA was used to evaluate the patellofemoral joint (Fig.…”

Section: Radiographic Evaluationmentioning

confidence: 99%

Improving radiographic patello-femoral tracking in total knee arthroplasty with the use of a flexion spacer: a case–control study

D’Elicio

Attanasio

Ruffo

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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Purpose The purpose of this study was to compare the efectiveness of a lexion spacer in the clinical and radiological outcomes of patients who underwent total knee arthroplasty (TKA) and to compare these patients to a group of patients subjected to the same type of surgery but without the use of a lexion spacer. It was hypothesized that patients who underwent TKA using a lexion spacer would have better clinical and radiological outcomes than those without a lexion spacer in both short-and medium-term follow-ups. Methods A consecutive series of patients undergoing TKA were included, yielding 20 patients in the study group. The control group was identiied from the consultant database of the senior author, yielding 21 patients who underwent the same operation. All 41 patients received a Vanguard Knee System (Zimmer-Biomet, Warsaw, Indiana, USA). Cases were deined as those patients who had undergone TKA using a lexion spacer device for gap balancing; controls were deined as patients who had undergone TKA without the support of a lexion spacer device. Patients were clinically and radiographically evaluated at two consecutive follow-ups: T 1 -13.1 ± 1.3 months and T 2 -108 ± 6 months. Clinical evaluation was performed using the Knee Society Scoring System and the Western Ontario, McMaster Universities Osteoarthritis Index score. Radiographic evaluation included the femoral angle (α), the tibial angle (β), the sagittal femoral (γ) angle and the tibial slope (δ). Furthermore, the lateral patellofemoral angle (LPFA) and the Caton-Deschamps index were evaluated. ResultsNo statistically signiicant clinical diferences were found between the two groups at T 1 and T 2 ; moreover, the clinical outcomes of the two groups were stable between the two follow-ups, with no signiicant improvement or worsening. Radiographic evaluation showed no diference in the two groups between T 1 and T 2 ; the only signiicant radiographic diference between the two groups concerned the LPFA (both at 30° and 60°) at each follow-up, which was signiicantly greater in cases than in controls (p = 0.001). Conclusions The current study demonstrates that the use of a lexion spacer signiicantly improves radiographic patellofemoral tracking, although no signiicant clinical diferences were found between the two groups. Level of evidence Case-control study, level III.

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“…These include new alignment philosophies that aim to respect patient phenotypes, as well as patient‐specific instrumentation and computer‐assisted technologies that aim to improve implant positioning. Residual pain after TKA is reported by 8–27% of patients, and remains a major source of dissatisfaction [8, 25], potentially due to soft‐tissue impingements in knees with prosthetic overhang or under‐coverage [3, 4, 7], implant overstuffing [13] or over‐voluming [31], as well as patellar maltracking [1, 9].…”

Section: Introductionmentioning

confidence: 99%

Custom total knee arthroplasty combined with personalised alignment grants 94% patient satisfaction at minimum follow-up of 2 years

Gousopoulos

Dobbelaere

Ratano

et al. 2023

Knee Surg Sports Traumatol Arthrosc

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PurposeThe purpose was to report detailed patient-reported outcome measures (PROMs) and satisfaction rates for computed tomography (CT)-based custom TKA at minimum follow-up of 2 years. The hypothesis was that custom TKA combined with 'personalised alignment' would yield equivalent or better PROMs compared to values reported in systematic reviews and meta-analyses on of-the-shelf (OTS) TKA. Methods Of an initial cohort of 150 custom TKAs, four died (unrelated to surgery), one required a revision, and ive refused participation, leaving 140 patients for analysis. Patients completed pre-and post-operative PROMs (Oxford Knee Score (OKS), Forgotten Joint Score (FJS), Knee injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster osteoarthritis index (WOMAC)) as well as overall level of satisfaction. Proportions that attained a patient acceptable symptom state (PASS) were calculated for OKS and FJS. Clinical indings were compared to the average scores reported for PROMs in recent systematic reviews and/or meta-analyses on OTS TKA. Descriptive statistics were used to summarise the clinical indings as means, standard deviations (SD) and ranges, or numbers and percentages. Results At mean follow-up 33.5 ± 4.5 months, 94% (135/143) were either satisied or very satisied. Proportions that achieved PASS were 89% for OKS (120/135), and 85% for FJS (118/139). Median OKS, WOMAC and KOOS Symptoms and Pain scores were all within the 4th quartile of medians reported in systematic reviews and/or meta-analyses. Conclusions At a minimum follow-up of two years following custom TKA combined with 'personalised alignment', 94% of patients were either satisied or very satisied, and the PASS criteria were achieved in 89% for OKS and 85% for FJS, all of which compare favourably to published outcomes of OTS TKA. Direct comparisons to the literature may not be appropriate, however, considering the heterogeneity of patient demographics and alignment techniques. Randomised controlled trials with suicient statistical power are needed to corroborate these indings and generalise them to unselected TKA patients. Level of evidence IV, retrospective cohort study.

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

Cited by 11 publications

References 47 publications

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

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

Improving radiographic patello-femoral tracking in total knee arthroplasty with the use of a flexion spacer: a case–control study

Custom total knee arthroplasty combined with personalised alignment grants 94% patient satisfaction at minimum follow-up of 2 years

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