Patellar resection during total knee arthroplasty: effect on bone strain and fracture risk

Lie, Denny; Gloria, N.; Amis, Andrew A.; Lee, B. P. H.; Yeo, Seng Jin; Chou, Siaw Meng

doi:10.1007/s00167-004-0508-6

Cited by 35 publications

(26 citation statements)

References 36 publications

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“…In addition, a thin patella resulting from over-resection has had poor strain characteristics, which may contribute to early failure [14,19]. Our primary aim was to investigate whether a reliable relationship could be found between the thickness of the patella and any of its other dimensions.…”

Section: Discussionmentioning

confidence: 99%

The Width:thickness Ratio of the Patella

Iranpour

Merican

Amis

et al. 2008

Clinical Orthopaedics &Amp; Related Research

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Establishing the appropriate size of the patellar implant-bone composite is one of the important steps ensuring functional success in arthroplasty. Conventionally, the patella is measured intraoperatively and its thickness is used to guide the depth of resection. However, in a diseased joint, this may not reflect the native patellar thickness. We studied the relationship between the patellar thickness and various patellar dimensions on threedimensional reconstructed computed tomographic scans from 37 normal adult knees. Patellar width correlated with thickness. The average patellar width:thickness ratio was 2.0 (standard deviation, 0.106; 95% confidence interval,

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Section: Discussionmentioning

confidence: 99%

The Width:thickness Ratio of the Patella

Iranpour

Merican

Amis

et al. 2008

Clinical Orthopaedics &Amp; Related Research

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“…In vivo (Carpenter et al, 2009;Sharma et al, 2012), in vitro (Lie et al, 2005;Matsuda et al, 1997;Merican et al, 2014) and in silico (Amirouche et al, 2013;Fitzpatrick et al, 2011;Takahashi et al, 2012) studies have shown that TKA leads to significant changes in patellar kinematics, forces acting on the patella, and resulting bone strain in comparison with the intact knee. One of the possible causes of these changes can be related to a surgical technique influencing the positioning of the prosthetic components, their rotation around the joint axes, and the amount of bone cut.…”

Section: Introductionmentioning

confidence: 99%

“…Several numerical and in vitro studies showed that reduction of patellar thickness can lead to increase of patellar bone strain (Amirouche et al, 2013;Fitzpatrick et al, 2013;Lie et al, 2005), thus increasing risk of the patellar fracture and possibly contributing to AKP symptoms (Draper et al, 2012;Ho et al, 2014). However, these studies were conducted on cadaveric knees.…”

Section: Introductionmentioning

confidence: 99%

A patient-specific model of total knee arthroplasty to estimate patellar strain: A case study

Latypova

Arami

Becce³

et al. 2016

Clinical Biomechanics

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Background: Inappropriate patellar cut during total knee arthroplasty can lead to patellar complications due to increased bone strain. In this study, we evaluated patellar bone strain of a patient who had a deeper patellar cut than the recommended. Methods: A patient-specific model based on patient preoperative data was created. The model was decoupled into two levels: knee and patella. The knee model predicted kinematics and forces on the patella during squat movement. The patella model used these values to predict bone strain after total knee arthroplasty. Mechanical properties of the patellar bone were identified with micro-finite element modeling testing of cadaveric samples. The model was validated with a robotic knee simulator and postoperative X-rays. For this patient, we compared the deeper patellar cut depth to the recommended one, and evaluated patellar bone volume with octahedral shear strain above 1%. Findings: Model predictions were consistent with experimental measurements of the robotic knee simulator and postoperative X-rays. Compared to the recommended cut, the deeper cut increased the critical strain bone volume, but by less than 3% of total patellar volume. Interpretation: We thus conclude that the predicted increase in patellar strain should be within an acceptable range, since this patient had no complaints 8 months after surgery. This validated patient-specific model will later be used to address other questions on groups of patients, to eventually improve surgical planning and outcome of total knee arthroplasty.

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“…Previous studies have measured strain in the patella, using strain as a measure of risk for patellar fracture and component loosening 9–11. In these experimental cadaveric studies, anterior surface strain was measured using a uniaxial strain gage in specimen sample sizes of between 8 and 20 knees.…”

mentioning

confidence: 99%

“…A strain gage can provide a localized measure of bone strain, but does not fully characterize the strain distribution throughout the volume of bone. For example, Lie et al10 measured a compressive anterior cortex strain in full extension and hypothesized that this would result in a corresponding tensile strain on the posterior resected surface.…”

mentioning

confidence: 99%

Comparison of patellar bone strain in the natural and implanted knee during simulated deep flexion

Fitzpatrick

Baldwin

Ali

et al. 2010

Journal Orthopaedic Research

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Instances of anterior knee pain and patellar fracture are significant complications following total knee replacement (TKR). Bone strain measured in the patella can provide an indication of patellar fracture risk and may also be related to anterior knee pain. The objective of this study was to develop subject-specific finite element models of the patellofemoral (PF) joint including density-mapped material properties to gain insight into the patellar bone strain distribution in the natural and implanted knee. In eight subjects, the volume of bone experiencing strains >0.5% in the implanted condition was ∼200% larger, on average, than the natural condition. An inverse relationship with a correlation of −0.74 was established between postoperative bone volume and strain in the implanted specimens, suggesting that patellar geometry may be a useful indicator of postoperative strain. Comparing strains between regions (superior, inferior, medial, and lateral), it was found that although highly strained bone was evenly distributed between medial and lateral regions in the natural case, the implanted specimens demonstrated significantly larger volumes of highly strained bone medially as a result of substantially lower modulus bone in the medial compartment. Understanding distributions of PF strain may aid in preoperative identification of those patients at risk for patellar fracture or anterior knee pain, guidance regarding altered component placement for at-risk patients, and design of components considering the implications of PF load transfer and patellar strain distribution.

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Patellar resection during total knee arthroplasty: effect on bone strain and fracture risk

Cited by 35 publications

References 36 publications

The Width:thickness Ratio of the Patella

The Width:thickness Ratio of the Patella

A patient-specific model of total knee arthroplasty to estimate patellar strain: A case study

Comparison of patellar bone strain in the natural and implanted knee during simulated deep flexion

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