TKA design-integrated trochlea groove rotation reduces patellofemoral pressure

Woiczinski, Matthias; Kistler, Manuel; Schröder, Christian; Braun, Christian; Weber, Patrick; Müller, Peter E.; Jansson, Volkmar; Steinbrück, Arnd

doi:10.1007/s00167-018-5324-5

Cited by 16 publications

(11 citation statements)

References 57 publications

(86 reference statements)

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“…A literature retrieval has been conducted among studies published in recent years on the correlation between internal/external rotation of femoral prosthesis and patient satisfaction rate. Many researchers believe that internal rotation of femoral prosthesis has greater negative impacts on the surgery and during the surgery, a slight angle of external rotation is preferred so as to avoid internal rotation [3,9,10,13,26]. On the contrary, no articles had been identi ed that suggested greater negative effects of external rotation of femoral prosthesis.…”

Section: Discussionmentioning

confidence: 99%

Knee Joint Rotation Axis Is More Laterally Rotated and Valgus Than We Previously Thought

Zheng

Song

Luo

et al. 2021

Preprint

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Background: Currently, the patient satisfaction rate after receiving TKA is around 80% to 90% and there is still room for further improvement. With the aim to provide reference for improving TKA surgery, stereophotogrammetry was used in this study to evaluate knee joint kinematics.Methods: Multiple MRI images of knee joints flexed at 0, 10, 20... to 100 degrees were scanned in bilateral knees of 45 asymptomatic adult volunteers. After three-dimensional alignment of the femur, the displacement and rotation angles of the tibia flexed at different angles were measured. Contributing factors were tested using One-way ANOVA and chi-square test in SPSS 24.Results: 1)No contributing factors was found to influence rotation axis; 2) Within the range of motion at 0-100° of flexion, the rotation axis exhibited no significant displacement relative to the femur. 3) On the horizontal plane, the lateral rotation angle of knee joint axis was 4.91°±1.84°(3°~7°) relative to transepicondylar axis (TEA) and 7.84°±2.09° relative to posterior condylar axis (PCA); on the coronal plane, the valgus angle of knee joint axis was 3.38°±0.82°(2.5°~5°) relative to tibial plateau, and 6.53°±0.91°(5°~8°) relative to the perpendicular line of the lower limb force line. Conclusion: No contributing factors were found, but the rotation axis of the knee joint is more laterally rotated and valgus than previously thought. These findings may explain the research result of some current literatures, and may provide theoretical rationale for further improvement of knee prosthesis design.

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Section: Discussionmentioning

confidence: 99%

Knee Joint Rotation Axis Is More Laterally Rotated and Valgus Than We Previously Thought

Zheng

Song

Luo

et al. 2021

Preprint

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“…However, what must be emphasized is that the patellofemoral pressure distribution and patella tilting do have clinical effects [6, 15, 25, 31]. Among other things, the rotation of the femoral component increases the patellofemoral pressure and promotes patella tilting, thus leading to anterior knee pain according to TKA [2, 18, 22, 39].…”

Section: Discussionmentioning

confidence: 99%

The tibial cut influences the patellofemoral knee kinematics and pressure distribution in total knee arthroplasty with constitutional varus alignment

Faschingbauer

Hacker

Seitz

et al. 2019

Knee Surg Sports Traumatol Arthrosc

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PurposeThe current literature suggests that kinematic total knee arthroplasty (kTKA) may be associated with better outcome scores in patients with constitutional varus alignment. The underlying patellofemoral kinematic changes (patella tilting and patella tracking) and patellofemoral pressure distribution have not yet been described. The present study compared the effects of different tibial cuts, as used in kTKA, on patellofemoral knee kinematics and the pressure distribution, in addition to comparisons with the natural constitutional varus knee. Methods Seven cadaveric knee joints with constitutional varus alignment were examined in the native state and after 0°, 3°, or 6° tibial cut cruciate-retaining (CR)-TKA using an established knee joint simulator. The effects on patella rotation/ patella tilting, patellofemoral pressure, and patellofemoral length ratios (= patella tracking) were determined. In addition, the natural knee joint and different tibial cuts in CR-TKA were compared (Student's t test). Results In the patellofemoral joint, 6° CR-TKA was associated with the greatest similarity with the natural constitutional varus knee. By contrast, knees subjected to 0° CR-TKA exhibited the largest deviations of patellar kinematics. The smallest difference compared with the natural knee joint concerning patella tilting was found for 6° CR-TKA (mean 0.4°, p < 0.001), and the largest difference was noted for 0° CR-TKA (mean 1.7°, p < 0.001). Concerning patellofemoral pressure, 6° CR-TKA resulted in outcomes most similar to the natural knee joint, featuring a mean difference of 3 MPa. The largest difference from the natural knee joint was identified for 0° CR-TKA, with an average difference of 8.1 MPa (p < 0.001; total mean 17.7 MPa). Meanwhile, 3° and 6° CR-TKA induced medialization of the patella, with the latter inducing the largest medialization value of 4.5 mm at 90° flexion. Conclusions The improved outcome parameters in kTKA described in the literature could be attributable to the similar kinematics of the patellofemoral joint relative to the normal state. The current study confirmed the similar kinematics between the native constitutional varus knee joint and knee joints subjected to 3° or 6° CR-TKA (patellofemoral rotation/patella tilting and patella pressure). Conversely, there was pronounced medialization of the patella following 6° CR-TKA. Patella pressure and patella tilting are described in the literature as possible causes of anterior knee pain after TKA, whereas medialization of the patella, which is also influenced by other causes, might play a subordinate role. Level of evidence V, Biomechanical study.

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“… 60 – 62 While internal rotation increases the stress that contributes to anterior knee pain, external rotation of the trochlear groove and femoral component reduces the retro patellar tension and therefore decreases pain. 63 …”

Section: Component Malpositioningmentioning

confidence: 99%

Literature review of the causes of pain following total knee replacement surgery: prosthesis, inflammation and arthrofibrosis

Chung

Ali

et al. 2020

EFORT Open Reviews

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Adverse knee pain occurs in 10–34% of all total knee replacements (TKR), and 20% of TKR patients experience more pain post-operatively than pre-operatively. Knee pain is amongst the top five reasons for knee replacement revision in the United Kingdom. The number of TKRs is predicted to continue increasing due to the ageing population. A narrative literature review was performed on the different causes of pain following TKR. A database search on Scopus, PubMed, and Google Scholar was conducted to look for articles related to TKR, pain, and cause. Articles were selected based on relevance, publication date, quality of research and validation. Relevant sections were added to the review. One hundred and fourteen articles were identified and potential causes of TKR pain included: arthrofibrosis, aseptic loosening, avascular necrosis, central sensitization, component malpositioning, infection, instability, nerve damage, overstuffing, patellar maltracking, polyethylene wear, psychological factors and unresurfaced patella. It is important to tailor our approach to address the individual causes of pain. Certain controllable risk factors can be managed pre-operatively to minimize post-operative pain. Risk factors help to predict adverse pain outcomes and identify specific causes. There are multiple causes of pain following TKR. Some factors will require further extensive studies, and as pain is a commonly attributed reason for TKR revision, its underlying aetiologies should be explored. Understanding these factors helps to develop effective methods for diagnosis, prevention and management of TKR pain, which help to improve patient outcomes. Cite this article: EFORT Open Rev 2020;5:534-543. DOI: 10.1302/2058-5241.5.200031

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TKA design-integrated trochlea groove rotation reduces patellofemoral pressure

Cited by 16 publications

References 57 publications

Knee Joint Rotation Axis Is More Laterally Rotated and Valgus Than We Previously Thought

Knee Joint Rotation Axis Is More Laterally Rotated and Valgus Than We Previously Thought

The tibial cut influences the patellofemoral knee kinematics and pressure distribution in total knee arthroplasty with constitutional varus alignment

Literature review of the causes of pain following total knee replacement surgery: prosthesis, inflammation and arthrofibrosis

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