Retropatellar contact characteristics before and after total knee arthroplasty

Fuchs, Susanne; Skwara, Adrian; Tibesku, Carsten O.; Rosenbaum, Dieter

doi:10.1016/s0968-0160(02)00045-5

Cited by 35 publications

(38 citation statements)

References 15 publications

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“…Seven specimens were tested in this study which is a comparable number to other studies with similar questions [12,13,18,23,31]. However due to the number of specimens tested a type II error might not be fully excluded in our study.…”

Section: Discussionmentioning

confidence: 91%

“…It is noteworthy that they only performed static measurements in six different flexion angles in five specimens. Fuchs et al analyzed retropatellar pressure distribution in four different knee positions between 45°and 120° [13]. The joint contact area was subdivided into 9 areas and showed an increasingly load in the central areas of the retropatellar surface, however without identifying the anatomical ridge of the patella.…”

Section: Discussionmentioning

confidence: 99%

“…Especially on the ridge there was a highly significant increase of the retropatellar pressure of about 109% in maximum flexion after TKA compared to natural knee. This increasing patellofemoral contact forces might lead to anterior knee pain in vivo [9,11-13]. Interesting is that with higher flexion grades the central retropatellar pressure increases in TKA whereas in natural knee central retropatellar pressure is constantly decreasing (Figure 7).…”

Section: Discussionmentioning

confidence: 99%

“…Regarding anterior knee pain several authors emphasize that the postoperative outcome is rather influenced by femoral component design than by retropatellar resurfacing [7,9,10]. It is assumed that excessive postoperative retropatellar pressure contributes to a great extent to postoperative patella problems [9,11-13]. In vitro studies with cadaver knees are a successful method to analyze this pressure distribution [12,14], and were also used to investigate retropatellar contact patterns in this study.…”

Section: Introductionmentioning

confidence: 99%

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Patellofemoral contact patterns before and after total knee arthroplasty: an in vitro measurement

et al. 2013

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BackgroundPatellofemoral complications are one of the main problems after Total Knee Arthroplasty (TKA). Retropatellar pressure distribution after TKA can contribute to these symptoms. Therefore we evaluated retropatellar pressure distribution subdivided on the ridge, medial and lateral surface on non-resurfaced patella before and after TKA. Additionally, we analyzed axial femorotibial rotation and quadriceps load before and after TKA.MethodsSeven fresh frozen cadaver knees were tested in a force controlled knee rig before and after TKA (Aesculap, Tuttlingen, Germany, Columbus CR) while isokinetic flexing the knee from 20° to 120° under weight bearing. Ridge, medial and lateral retropatellar surface were defined and pressure distribution was dynamically measured while quadriceps muscles and hamstring forces were applied. Aside axial femorotibial rotation and quadriceps load was recorded.ResultsThere was a significant change of patella pressure distribution before and after TKA (p = 0.004). In physiological knees pressure distribution on medial and lateral retropatellar surface was similar. After TKA the ridge of the patella was especially in higher flexion grades strongly loaded (6.09 +/−1.31 MPa) compared to the natural knee (2.92 +/−1.15 MPa, p < 0.0001). Axial femorotibial rotation showed typical internal rotation with increasing flexion both before and after TKA, but postoperatively it was significantly lower. The average amount of axial rotation was 3.5° before and after TKA 1.3° (p = 0.001). Mean quadriceps loading after implantation of knee prosthesis did not change significantly (575 N ±60 N in natural knee and after TKA 607 N ±96 N; p = 0.28).ConclusionsThe increased retropatellar pressure especially on the ridge may be one important reason for anterior knee pain after TKA. The trochlea of the femoral component might highly influence the pressure distribution of the non-resurfaced retropatellar surface. Additionally, lower axial femorotibial rotation after TKA might lead to patella maltracking. Changing the design of the prosthesis or a special way of patella shaping might increase the conformity of the patella to trochlea to maintain natural contact patterns.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Patellofemoral contact patterns before and after total knee arthroplasty: an in vitro measurement

et al. 2013

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“…Moreover, this lateral shifting of femur could also affect the tracking of patella during flexion. The changed patella‐femoral (PF) pressure or forces will finally result in many PE joint problems, such as persistent anterior knee pain, early aseptic loosening, increased or abnormal polyethylene wear et al…”

Section: Discussionmentioning

confidence: 99%

Articular contact kinematics of the knee before and after a cruciate retaining total knee arthroplasty

Hosseini

Tsai

et al. 2014

Journal Orthopaedic Research

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Accurate knowledge of tibiofemoral articular contact kinematics of the knee after total knee arthroplasty (TKA) is important for understanding the intrinsic knee biomechanics and improving the longevity of the components. The objective of this study was to compare the in vivo articular contact kinematics of the knees with end-stage medial osteoarthritis (OA) during a weightbearing, single leg lunge activity before and after a posterior cruciate retaining TKA (CR-TKA) using a dual fluoroscopic imaging technique. We found that the CR-TKA resulted in more posterior contact positions on the tibial surface and a reduced range of motion in the medial and lateral compartments. The distances between medial and lateral contact locations in the CR-TKA knees were statistically larger than the OA knees. The articular contact centers have shifted from medial side of the tibial plateau pre-operatively to the lateral side after operation. This study indicated that the CR-TKA resulted in significant changes in contact kinematics of the knees in both anteroposterior and mediolateral directions. Keywords: TKA; knee osteoarthritis; fluoroscopy; in vivo kinematics; contact kinematics Contemporary total knee arthroplasty (TKA) aims to reduce pain and restore function of the knee with severe osteoarthritis (OA) and other end-stage knee joint diseases.1,2 Recently, many innovative component designs have been introduced to enhance knee joint flexion and improve longevity of the prosthesis. [3][4][5][6][7] Although satisfactory clinical follow up data has been reported, 1,8 there are also data showing persistent difficulties or pain during motion in patients postoperatively. 1,9 Polyethylene wear related problems have been reported to be a leading cause for re-operation. 1,8,[10][11][12] Various factors, such as component design and surgical implantation, have been attributed to post-operative complications. 10,11,13 Abnormal knee kinematics following TKA has been thought to alter intrinsic knee joint biomechanics and lead to suboptimal patient satisfaction. 10 Numerous studies have been conducted to investigate the kinematics of the knee after TKA.3,14-18 Early studies performed investigation of TKA kinematics using motion analysis system to quantify the 6DOF kinematics of the TKA knees and compared the data to normal knees. 19,20 Many studies also used cadaveric specimens to compare the TKA kinematics with that of native knees under controlled conditions. 21,22 In-vivo articular contact forces have been measured using implanted force sensors. 23,24 Recently, fluoroscopic imaging technique has been widely used to investigate medial and lateral condyle motions of the knee after TKAs.18,25-27 While these studies greatly improved our knowledge on TKA biomechanics, the changes on articular contact locations after TKA compared to those measured on the knee before operation have not been reported. This information could provide further insight on how intrinsic biomechanics of the knee is altered after the surgery.Therefore, the obj...

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Posterior stabilized TKA reduce patellofemoral contact pressure compared with cruciate retaining TKA in vitro

Becher

Heyse

Kron

et al. 2009

Knee Surg Sports Traumatol Arthrosc

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Increased patellofemoral contact pressure was described after total knee arthroplasty (TKA). Aim of this in vitro study was to compare the influence of a posterior stabilized (PS) design in comparison to a cruciate retaining (CR) design on patellofemoral contact pressure. Patellofemoral area contact pressure, peak contact pressure and the centre of pressure motion were determined in eight fresh frozen human cadaveric specimens using a Tekscan sensor (K-Scan 4000). A robotic knee simulator was used simulating an isokinetic knee extension cycle from 120 degrees of flexion to full extension. All knees were tested in a first test cycle after implantation of a CR design and in a second test cycle after replacement by a PS design, both using a 11 mm PE inlay (Genesis II, Smith & Nephew, Memphis, TN, USA). The patella remained unresurfaced. A paired sampled t test to compare mean values (significance, P < or = 0.05) was used for statistical analysis. After implantation of the PS design, average patellofemoral area contact pressure was significantly lower (P < or = 0.006) compared with the CR design (PS: 3.58 +/- 1.25 MPa; CR: 4.31 +/- 1.40 MPa). Accordingly, average patellofemoral peak contact pressure decreased significantly (P < or = 0.02) with the PS design (6.12 +/- 2.37 MPa) in comparison with the CR design (7.17 +/- 2.41 MPa). On average, the centre of pressure motion was more physiological with the PS design compared to the CR design over the complete extension cycle. However, this was not significant. In conclusion, the data suggest less patellofemoral contact pressure of a posterior stabilized TKA design in comparison to a cruciate retaining design.

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Retropatellar contact characteristics before and after total knee arthroplasty

Cited by 35 publications

References 15 publications

Patellofemoral contact patterns before and after total knee arthroplasty: an in vitro measurement

Patellofemoral contact patterns before and after total knee arthroplasty: an in vitro measurement

Articular contact kinematics of the knee before and after a cruciate retaining total knee arthroplasty

Posterior stabilized TKA reduce patellofemoral contact pressure compared with cruciate retaining TKA in vitro

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