The trochlea is medialized by total knee arthroplasty: An intraoperative assessment in 61 patients

Meijerink, Huub J; Barink, M.; Loon, C. J. M. van; Schwering, P. J. A.; Donk, Roland; Malefijt, M.C. de Waal

doi:10.1080/17453670610013529

Cited by 19 publications

(28 citation statements)

References 16 publications

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“…Thus, if such a component is positioned in the midline of a distal femur in which the native sulcus lies laterally, the prosthetic sulcus will be medialized with respect to the native sulcus. The prosthetic sulcus would then cause the patella to track laterally [5][6][7][8]11]. This in turn would lead to abnormal tracking patterns and higher stresses on the patella.…”

Section: Discussionmentioning

confidence: 99%

The femoral sulcus in total knee arthroplasty

Krishna¹,

Bartlett

2009

Knee Surg Sports Traumatol Arthrosc

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The position of the femoral sulcus relative to the midline of the distal femoral resection in total knee arthroplasty (TKA) was studied to determine if centralized placement of the femoral component on the distal femur was justified in terms of aligning the prosthetic sulcus with the native femoral sulcus. The location of the femoral sulcus was studied in 112 consecutive patients undergoing TKA. The mean sulcus position was 0.7 mm lateral to the midline of the distal femoral resection (SD 1.4, 95% CI, 0.5-1.0 mm). However, the variation in sulcus positions ranged from 4 mm medial to 4 mm lateral to the midline. The mean sulcus position in valgus knees was 1.0 mm lateral to the midline (SD 1.8), and that in varus knees was 0.7 mm lateral to the midline (SD 1.2) (P = 0.501). It appears prudent to centre the femoral component on the native sulcus rather than the midline of the distal femoral resection, so as to ensure accurate alignment of the prosthetic sulcus with the native sulcus and to encourage normal patella tracking.

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Section: Discussionmentioning

confidence: 99%

The femoral sulcus in total knee arthroplasty

Krishna¹,

Bartlett

2009

Knee Surg Sports Traumatol Arthrosc

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“…Mediolateral changes may result from a shift in the groove location due to one of several reasons: translation or axial rotation of the femoral component; changes in the soft-tissue tensions; or medialization or lateralization of the patellar component. Two recent studies have reported routine (i.e., unintended) medialization of the femoral groove due to arthroplasty [50,51]. Changes in spin were probably due to either the realignment of the leg as a result of the arthroplasty, or a change in the Q-angle based on the alignment of the components.…”

Section: Discussionmentioning

confidence: 99%

In vivopatellar kinematics during total knee arthroplasty

Anglin

et al. 2008

Computer Aided Surgery

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Patellar maltracking after total knee arthroplasty often results in complications, including anterior knee pain, instability and impingement, and is therefore better resolved intraoperatively. Many factors can affect patellar kinematics during knee replacement, including component position, implant design, joint alignment, and soft tissue tensions. However, to our knowledge, the impact of arthroplasty on patellar kinematics has not been previously reported in vivo. A computer-assisted surgery (CAS) system was developed to measure the pre-arthroplasty patellar kinematics, display the distance between this path and the surface of the planned femoral component, and compare the post-arthroplasty path to the pre-arthroplasty path. Three surgeons from three centers used this CAS system to measure the in vivo pre-and post-arthroplasty kinematics of 18 patients. There was a small, but consistent, proximal shift in the tibial joint lines (mean: 4.2 mm), resulting in pseudo patella-baja, i.e., relatively more distal contact of the patella on the femoral component. This led to significant changes in proximodistal and anteroposterior patellar positioning as well as patellar flexion following arthroplasty (p50.008). Mediolateral shift, tilt and internal/external spin had the greatest magnitudes of change (mean: 4.1 mm, 4.6 and 4.6 , respectively) relative to their mean pre-arthroplasty ranges (averaging 2.1 mm, 5.8 and 5.8 , respectively); however, these changes were distributed almost equally medially and laterally, indicating no surgical bias in any one direction. Female patients had more lateral tilt on average than male patients throughout flexion (p50.004 post-arthroplasty, p50.03 prearthroplasty, in later flexion), as well as other kinematic differences; there may therefore be potential for improving overall kinematic results by focusing on gender differences during research, design and surgery. This study demonstrated the feasibility of using a CAS system to measure patellofemoral kinematics. Intraoperative awareness of patellar tracking, including knowledge of the tibiofemoral joint line, could have an impact on the surgical plan and thereby improve the postoperative outcome.

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“…previous studies hypothesized that this high rate of patellofemoral complications might be linked to the medialization of the prosthetic femoral groove typical of this implant [24]. In a different study, Meijerink et al [25] noted a trend toward lateral tracking of the patella in early flexion when using the pFC Sigma prosthesis. Because of these issues, a new pFC Sigma pS System (De puy, Warsaw, USA) was introduced in 2009, with new instrumentation and a peculiar femoral design.…”

Section: Discussionmentioning

confidence: 94%

The effects of femoral component design on the patello-femoral joint in a PS total knee arthroplasty

Indelli

Marcucci

Pipino

et al. 2013

Arch Orthop Trauma Surg

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without need of reoperation for any reason was 98 % at 3 years minimum follow-up; two reoperations were done for removal of fibromatous intra-articular tissue ("Clunk syndrome"). There were no revisions for septic or aseptic loosening of the components. The mean rOM improved from 104° preoperatively to 115° (97°-132°) postoperatively: postoperative flexion was 120° or more in 58 % of the knees. Severe anterior knee pain was present in 9 % of patients. radiographic evaluation showed 90 knees with a tibio-femoral anatomical axis between 8° and 2° of valgus (±3° from the intraoperative goal). CT evaluation of 30 consecutive knees showed that the femoral component positioning in relationship to the trans-epicondylar axis had only 2.80° of external rotation (±2.10°) with respect to a planned external rotation of 3°. This difference was statistically significant. Conclusions Although the pFC Sigma pS system provides good and predictable results for tricompartmental arthritis of the knee, anterior mechanism complications still represent a reason for dissatisfaction in a substantial group of patients.

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The trochlea is medialized by total knee arthroplasty: An intraoperative assessment in 61 patients

Abstract: Our findings indicate that the trochlea is medialized by TKA. Because a conscious medialization of the femoral component in a TKA produces abnormal patellar tracking patterns, further investigations will be needed to analyze the clinical consequences of this medialization of the trochlea.

Cited by 19 publications

References 16 publications

The femoral sulcus in total knee arthroplasty

The femoral sulcus in total knee arthroplasty

In vivopatellar kinematics during total knee arthroplasty

The effects of femoral component design on the patello-femoral joint in a PS total knee arthroplasty

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