The influence of compressive forces across the patellofemoral joint on patient-reported outcome after bi-cruciate stabilized total knee arthroplasty

Abstract

Aims Patellofemoral problems are a common complication of total knee arthroplasty. A high compressive force across the patellofemoral joint may affect patient-reported outcome. However, the relationship between patient-reported outcome and the intraoperative patellofemoral contact force has not been investigated. The purpose of this study was to determine whether or not a high intraoperative patellofemoral compressive force affects patient-reported outcome. Patients and Methods This prospective study included 42 patients (42 knees) with varus-type osteoarthritis who underwent a bi-cruciate stabilized total knee arthroplasty and in whom the planned alignment was confirmed on 3D CT. Of the 42 patients, 36 were women and six were men. Their mean age was 72.3 years (61 to 87) and their mean body mass index (BMI) was 24.4 kg/m 2 (18.2 to 34.3). After implantation of the femoral and tibial components, the compressive force across the patellofemoral joint was measured at 10°, 30°, 60°, 90°, 120°, and 140° of flexion using a load cell (Kyowa Electronic Instruments Co., Ltd., Tokyo, Japan) manufactured in the same shape as the patellar implant. Multiple regression analyses were conducted to investigate the relationship between intraoperative patellofemoral compressive force and patient-reported outcome two years after implantation. Results No patient had anterior knee pain after total knee arthroplasty. The compressive force across the patellofemoral joint at 140°of flexion was negatively correlated with patient satisfaction (R 2 = 0.458; β = –0.706; p = 0. 041) and Forgotten Joint Score-12 (FJS-12; R 2 = .378; β = –0.636; p = 0. 036). The compressive force across the patellofemoral joint at 60° of flexion was negatively correlated with the patella score (R 2 = 0.417; β = –0.688; p = 0. 046). Conclusion Patient satisfaction, FJS-12, and patella score were affected by the patellofemoral compressive force at 60° and 140° of flexion. Reduction of the patellofemoral compressive forces at 60° and 140° of flexion angle during total knee arthroplasty may improve patient-reported outcome, but has no effect on anterior knee pain.

Effect of manual lymph drainage for up to 10 days after total knee arthroplasty: Arandomized controlled trial

“…Two reports of potential relevance describe Western patients who underwent TKA ; however, the mean body mass index (BMI) of those patients was 27.9 kg/m 2 and 29.9 kg/m 2 in the respective studies 14,15) . According to other previous studies, BMIs are vastly different for Japanese patients (24.4 kg/m 2 ) who have undergone TKA 17) .…”

Influence of Patella Thickness on Patellofemoral Pressure in Total Knee Arthroplasty

“…The advantage of this study is very accurate measurements of patellofemoral pressure with various patella component thicknesses. There are various methods for measuring patellofemoral joint pressure [8][9][10][11][12][13][14][15][16]. In the method of measuring pressure by placing a sensor between the patellofemoral joint, the pressure sensor may shift, and the patellofemoral joint pressure may be increased due to the thickness of the pressure sensor [8,9,11,12].…”

“…In the method of measuring pressure by placing a sensor between the patellofemoral joint, the pressure sensor may shift, and the patellofemoral joint pressure may be increased due to the thickness of the pressure sensor [8,9,11,12]. On the other hand, with a pressure sensor built into the patella, patellofemoral joint pressure can be measured accurately [13][14][15]. However, because the osteotomy and joint capsule sutures are redone when changing the patellar thickness, the conditions are not constant.…”

“…With respect to patellofemoral joint pressure, it is still in its infancy and no commercially available device capable of measuring patellofemoral joint pressure is available on the market to date. Various studies have been conducted on patellofemoral joint pressure by incorporating thin pressure sensors into implants and using nite element methods and inverse dynamics to analyze the pressure at the patellofemoral joint [8][9][10][11][12][13][14][15][16]. The clinical signi cance of patellofemoral joint pressure remains unclear, but it may be associated with, for example, implant wear, loosening, and anterior knee joint pain [5,6,14].…”

Erratum to “Greater postoperative relatively medial loose gap at 90° of flexion for varus knees improves patient-reported outcome measurements in anatomical bi-cruciate retaining total knee arthroplasty” [The Knee 27(5) (2020) 1534–1541]”

“…The absolute differences in the prosthetic alignment between the preoperative 3DCT plan and postoperative 3DCT image were measured using the following six parameters: coronal, sagittal, and axial alignment of the femoral and tibial prostheses. Prosthetic alignment differences greater than 3°between preoperative 3DCT plan and postoperative 3DCT image were considered as outliers [15]. The test-retest reliability was found to be strong (interclass correlation coefficient (0.983 (0.920-0.989)), and intraclass correlation coefficient (0.963 (0.937-0.982)).…”