Understanding the patellofemoral joint in total knee arthroplasty

Matz, Jacob; Lanting, Brent A.; Howard, James L.

doi:10.1503/cjs.001617

Cited by 64 publications

(49 citation statements)

References 54 publications

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“…Therefore, our study covers the clinically most relevant TKR type. Our data indicate that the thickness of the analyzed dome-shaped patellar component affects PF contact forces, patellar tilt, and patellar rotation which has also been reported by other research groups [6,8,43]. In this regard, it was found that a higher retropatellar loading due to an increase in the thickness of the patellar component might contribute to anterior knee pain after TKR [6,44].…”

Section: Discussionsupporting

confidence: 85%

“…Furthermore, the difference in patellar component designs and the size of the patellar component are factors that influence the PF dynamics [28,37,38]. Regarding patellar resurfacing, the all polyethylene dome-shaped patellar component is currently the most common used design [8,28]. Therefore, our study covers the clinically most relevant TKR type.…”

Section: Discussionmentioning

confidence: 99%

“…In this regard, it was found that a higher retropatellar loading due to an increase in the thickness of the patellar component might contribute to anterior knee pain after TKR [6,44]. These higher forces can be explained by the increasing strain of the PF ligaments and can have a similar effect to overstuffing the PF joint which leads to anterior knee pain in some cases [8]. Although reduced patellar component thickness was beneficial due to a decreased PF contact force, it is important to avoid an excessively thin patellar component due to the risk of patellar maltracking and decreased PF ligament forces [46].…”

Section: Discussionmentioning

confidence: 99%

“…The patellofemoral (PF) joint represents a crucial part after total knee arthroplasty, and persistent PF pain remains a common postoperative complication with or without patellar resurfacing [5][6][7]. Complications include anterior knee pain, patellar maltracking, fracture, and patellar component loosening [8][9][10]. In this context, patella resurfacing is an important intraoperative factor: in the USA, more than 80% of primary TKRs are performed with this technique [11].…”

Section: Introductionmentioning

confidence: 99%

“…Instead, studies have revealed that the optimum position of the patellar component remains controversial [5,28,33,43,49], although evidently important for the postoperative outcome [28]. Some research groups have recommended medialization [8,41,48,50,52], while others have suggested centralization [32]. Moreover, biomechanical studies analyzing the superior-inferior position of the patellar component have reported contradictory findings [5,32,33,48], indicating a lack of understanding of this issue [5,49].…”

Section: Introductionmentioning

confidence: 99%

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Musculoskeletal Multibody Simulation Analysis on the Impact of Patellar Component Design and Positioning on Joint Dynamics after Unconstrained Total Knee Arthroplasty

Kebbach

Darowski

Krueger³

et al. 2020

Materials

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Patellofemoral (PF) disorders are considered a major clinical complication after total knee replacement (TKR). Malpositioning and design of the patellar component impacts knee joint dynamics, implant fixation and wear propagation. However, only a limited number of studies have addressed the biomechanical impact of the patellar component on PF dynamics and their results have been discussed controversially. To address these issues, we implemented a musculoskeletal multibody simulation (MMBS) study for the systematical analysis of the patellar component’s thickness and positioning on PF contact forces and kinematics during dynamic squat motion with virtually implanted unconstrained cruciate-retaining (CR)-TKR. The patellar button thickness clearly increased the contact forces in the PF joint (up to 27%). Similarly, the PF contact forces were affected by superior–inferior positioning (up to 16%) and mediolateral positioning (up to 8%) of the patellar button. PF kinematics was mostly affected by the mediolateral positioning and the thickness of the patellar component. A medialization of 3 mm caused a lateral patellar shift by up to 2.7 mm and lateral patellar tilt by up to 1.6°. However, deviations in the rotational positioning of the patellar button had minor effects on PF dynamics. Aiming at an optimal intraoperative patellar component alignment, the orthopedic surgeon should pay close attention to the patellar component thickness in combination with its mediolateral and superior–inferior positioning on the retropatellar surface. Our generated MMBS model provides systematic and reproducible insight into the effects of patellar component positioning and design on PF dynamics and has the potential to serve as a preoperative analysis tool.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Musculoskeletal Multibody Simulation Analysis on the Impact of Patellar Component Design and Positioning on Joint Dynamics after Unconstrained Total Knee Arthroplasty

Kebbach

Darowski

Krueger³

et al. 2020

Materials

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Saddle‐shaped rotating knee prosthesis outperforms low contact stress knee: A short‐term retrospective comparative study

Itoh,

Itou,

Kuwashima

et al. 2024

J. exp. orthop.

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PurposeThis retrospective comparative study aimed to compare the native patellar alignment and clinical outcomes of the Rotating Concave–Convex (ROCC) knee, which features a saddle‐shaped rotating platform (RP) insert and a deep trochlea, versus the low contact stress (LCS) knee, which has favourable long‐term outcomes and features an anatomically shaped trochlea and a cruciate‐sacrificing RP insert. We hypothesized that the deeper trochlea of the ROCC would further stabilize the native patella, resulting in superior clinical outcomes compared to LCS‐RP.MethodsConsecutive patients who underwent patellar‐nonresurfacing primary total knee arthroplasty (TKA) using ROCC or LCS‐RP were retrospectively reviewed. Patients with over 1‐year post‐TKA follow‐up were included. Patients with neurologic disorders affecting knee function or additional ipsilateral knee surgery before evaluation were excluded. Patellar alignment was evaluated using the patella tilting angle (PTA), patella shift (PS), and the ratio of patella fitting depth into the trochlea (F) on axial radiographs. Primary and secondary outcomes were evaluated using the patellar score assessing patellofemoral function and Knee Injury and Osteoarthritis Outcome Score. Multiple regression analyses were performed with primary and secondary outcomes as dependent variables.ResultsThe analysis included 113 ROCC knees and 94 LCS‐RP knees (median follow‐up: 25 months, follow‐up rate: 92.3%). For ROCC and LCS‐RP, respectively, the mean PTA was 0.3 (3.2)° and 4.3 (2.9)°; PS was 0.5 (1.8) and 2.0 (2.5) mm; and F was 29.6 (8.1)% and 21.4 (6.5)% (all p < 0.001). On multivariate analysis, ROCC positively affected both primary and secondary outcomes (p = 0.004 and 0.0003–0.02, respectively).ConclusionAt short‐term follow‐up, ROCC stabilized the patella further horizontally, centrally, and deeply into the trochlea, thus outperforming LCS‐RP clinically. Orthopaedic surgeons should consider these potential advantages when selecting TKA models, especially those featuring cruciate‐sacrificing RP mechanisms in patellar‐nonresurfacing procedures.Level of EvidenceIII. Retrospective comparative study.

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Personalized alignment techniques better restore the native trochlear groove compared to systematic alignment techniques in total knee arthroplasty

Orsi,

Shatrov,

Plaskos

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe relationship between constitutional coronal alignment and implant positioning on trochlear groove restoration in total knee arthroplasty (TKA) is poorly understood. This study aimed to determine whether the choice of alignment philosophy significantly affects the restoration of the trochlea groove.MethodsSixty‐one imageless robotic TKAs performed by a single orthopaedic surgeon were retrospectively reviewed. In each case, the entire native trochlea was digitized to generate the native femoral anatomy, and implants were planned according to a functional alignment (FA) technique. Final implant position was recorded using the validated bone resection planes from the navigation system. Simulated femoral component positions were generated according to previously described alignment techniques: mechanical alignment (MA), gap balancing (GB), kinematic alignment (KA), restricted kinematic alignment (rKA) and restricted inverse kinematic alignment (riKA). Trochlear angle (TA), trochlear under/overstuffing and mediolateral sulcus offset were compared between the six simulated alignment techniques, as well as the final implanted technique. Further analyses investigated the effect of preoperative coronal alignment on trochlear position. Comparisons were assessed with an analysis of variance and Welch's t‐tests or Wilcoxon's rank‐sum tests with Bonferroni corrections.ResultsThe implanted and simulated techniques all resulted in greater TA valgus compared to the native groove (p < 0.001). The implanted technique, KA and rKA were closer to the native TA than GB, MA and riKA (p > 0.001). All alignment philosophies understuffed the native trochlea groove. KA and rKA understuffed less than all other techniques (p < 0.001), and GB understuffed more than all other techniques (p < 0.001). In extension, all techniques shifted the trochlear sulcus laterally, while in flexion, they medialized it. These effects were most prominent in GB and MA.ConclusionPersonalized alignment techniques such as KA and rKA, which consider variations in individual anatomy, best restore the native patellar groove compared to systematic alignment techniques when using a standardized femoral component.Level of EvidenceLevel III, retrospective review.

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Understanding the patellofemoral joint in total knee arthroplasty

Cited by 64 publications

References 54 publications

Musculoskeletal Multibody Simulation Analysis on the Impact of Patellar Component Design and Positioning on Joint Dynamics after Unconstrained Total Knee Arthroplasty

Musculoskeletal Multibody Simulation Analysis on the Impact of Patellar Component Design and Positioning on Joint Dynamics after Unconstrained Total Knee Arthroplasty

Saddle‐shaped rotating knee prosthesis outperforms low contact stress knee: A short‐term retrospective comparative study

Personalized alignment techniques better restore the native trochlear groove compared to systematic alignment techniques in total knee arthroplasty

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