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Kleeman-Forsthuber LT, Owens JM, Johnson RM, Clary CW, Elkins JM, Dennis DA. Clinical and Computational Evaluation of an Anatomic Patellar Component. J Arthroplasty 2024; 39:S70-S79. [PMID: 38735546 DOI: 10.1016/j.arth.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 05/01/2024] [Accepted: 05/02/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND Anatomic patellar components for total knee arthroplasty (TKA) have demonstrated favorable in vivo kinematics. A novel failure mechanism in TKA patients with an anatomic patellar component was observed prompting an investigation to identify patient- and implant-related factors associated with suboptimal performance. METHODS A retrospective evaluation was performed comparing 100 TKA patients with an anatomic patellar component to 100 gender-, age-, and body mass index-matched patients with a medialized dome component. All surgeries were performed with the same posterior-stabilized TKA system with minimum of 1-year follow-up. Several radiographic parameters were assessed. A separate computational evaluation was performed using finite-element analysis, comparing bone strain energy density through the patella bone remnant. RESULTS Patients with an anatomic patellar component had significantly higher rates of anterior knee pain (18 versus 2%, P < .001), chronic effusions (18 versus 2%, P < .001), and superior patellar pole fragmentation (36 versus 13%, P < .001) compared to those with a dome component. Radiographically, the anatomic group demonstrated more lateral patellar subluxation (2.3 versus 1.1 mm, P < .001) and lateral tilt (5.4 versus 4.0 mm, P = .013). Furthermore, there were more revisions in the anatomic group (7 versus 3, P = .331). On computational evaluation, all simulations demonstrated increased bone strain energy density at the superior patellar pole with the anatomic patella. Resection thickness <13 mm resulted in over 2-fold higher strain energy density, and negative resection angle of 7° resulted in 6-fold higher superior pole strain energy. CONCLUSIONS Patients with an anatomic patellar component showed higher rates of anterior knee pain, chronic effusion, and superior pole fragmentation compared to patients with a dome patella, with higher superior patellar pole strain energy confirmed on computational evaluation. Avoiding higher resection angles and excessive patellar resection may improve the performance and survivorship of the anatomic patella.
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Affiliation(s)
| | - Jessell M Owens
- Swift Institute, Sparks, Nevada; Colorado Joint Replacement, Denver, Colorado
| | | | - Chadd W Clary
- Center for Orthopaedic Biomechanics, University of Denver, Denver, Colorado
| | - Jacob M Elkins
- Department of Orthopaedics, University of Iowa, Iowa City, Iowa
| | - Douglas A Dennis
- Colorado Joint Replacement, Denver, Colorado; Department of Bioengineering, University of Tennessee, Knoxville, Tennessee; Denver University, Denver, Colorado; Department of Orthopaedics, University of Colorado School of Medicine, Denver, Colorado
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Jungwirth-Weinberger A, List K, Bechler U, Hanreich C, Rueckl S, Boettner F. Patella component diameters of 38 mm and up might be associated with higher revision rates after patella resurfacing. J Orthop Surg Res 2023; 18:325. [PMID: 37106469 PMCID: PMC10141901 DOI: 10.1186/s13018-023-03705-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/13/2023] [Indexed: 04/29/2023] Open
Abstract
PURPOSE Patellar resurfacing is considered the standard of care for total knee arthroplasty in the USA. Complications of patella resurfacing include aseptic loosening or patella fractures and can threaten the integrity of the extensor mechanism. The goal of this study was to report on patella button revision rates in posterior stabilized total knee arthroplasty. MATERIAL AND METHODS Between 01/2010 and 08/2016 patella buttons were implanted in 1056 patients (267 men and 550 women) as part of a posterior stabilized total knee arthroplasty. RESULTS Of 1056 cases, 35 cases (14 women, 15 men, 5 bilateral, 3.3%) showed early loosening at a mean 52.5 months postoperatively. Patella components of 38 mm or larger diameters showed a significantly higher loosening rate than the 29, 32, 35 mm buttons (p < 0.01). Mean BMI of patients identified with aseptic loosening was 31.7 kg/m2, mean age at time of revision surgery was 63.3 years. All of the patients with loosening of the patella button required revision surgery; in 33 cases an exchange of the button was performed, in two cases a removal of the button and patellar bone grafting was indicated. No complications occurred after revision surgery. CONCLUSION The current study reports a 3.3% patella loosening rate during this mid-term follow-up. Size 38 mm and larger patella components showed a significantly higher revision rate than smaller buttons and the authors advise caution when using large diameter patella components.
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Affiliation(s)
| | - Kilian List
- Hospital for Special Surgery, New York, USA
- Orthopädische Klinik König-Ludwig-Haus, Würzburg, Germany
| | - Ulrich Bechler
- Hospital for Special Surgery, New York, USA
- Universitätsklinik Hamburg-Eppendorf, Hamburg, Germany
| | - Carola Hanreich
- Hospital for Special Surgery, New York, USA
- Inselspital, Bern, Switzerland
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Maniar RN, Maniar AR, Mishra A, Sanghavi N. Decreased Trochlear Length Associated with Increased Anterior Knee Pain Following Total Knee Arthroplasty: A New Anatomical Perspective. J Arthroplasty 2023; 38:S109-S113. [PMID: 36996948 DOI: 10.1016/j.arth.2023.03.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 03/16/2023] [Accepted: 03/19/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Anterior Knee Pain (AKP) and patello-femoral crepitus (PFCr) continue to plague total knee arthroplasty (TKA) patients despite advances and modifications to implant design and surgical techniques. We present our study of the femoral trochlear length measurement pre- and post-implantation and its association with AKP/PFCr and clinical scores. METHODS Using computer navigation, we obtained several measurements in 263 TKA (posterior-stabilized) patients, which included femoral native trochlear measurement (NTM) and difference in trochlear length (DTL) between implant and native trochlea. We report their association with Knee Society Score (KSS), Western Ontario McMaster University Arthritic Index(WOMAC), and AKP/PFCr at 1 year postoperatively. RESULTS Mean KSS and WOMAC Scores were significantly worse in patients who had AKP (P=0.005 and P=0.002 respectively). Receiver Operating Characteristic (ROC curve) showed a statistically significant association between native trochlear measurement and AKP (Area under the curve[AUC] =0.609, P=0.014). Lower the native trochlear measurement, greater was the incidence of AKP. Analysis of the ROC curve identified the cut-off value of NTM to be ≤ 25.5 with sensitivity of 76.7(95% Confidence Interval (CI)- 57.7 - 90.1) and specificity of 46.9(95%CI- 41.9 - 55.1). Patients who had NTM of ≤25.5 had an odds ratio of 3.09 to have AKP. The DTL ranged from 7.4 to 32.1 millimeters, indicating that post-implantation there was lengthwise overstuffing along the trochlea in every patient. CONCLUSION We found that the shorter the native femoral trochlea and greater the difference between implanted and native trochlea, the higher was the occurrence of AKP. A mismatch in trochlear measurement pre- and post-implantation resulted in lengthwise overstuffing in the anterior knee causing AKP and PFCr.
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Affiliation(s)
- Rajesh N Maniar
- Head, Department of Orthopaedics, Lilavati hospital and Research Centre, Bandra (West), Mumbai-400050, India; Consultant Orthopaedic Surgeon, Breach Candy Hopital Trust 60 A, Bhulabhai Desai, Marg, Mumbai-400026, India.
| | - Adit R Maniar
- Fellow in Adult Hip and Knee Reconstruction, University of Western Ontario, London Health Sciences Centre, London Canada.
| | - Abhinav Mishra
- Trauma and Joint Replacement Consultant, Department of Orthopaedics, Shriram Care Hospital Ameri Road, Nehru Nagar, Bilaspur, Chhattisgarh 495001; KIMS superspeciality hospital Magarpara Road near Agrasen Square, Bilaspur, Chhattisgarh 495001.
| | - Nishant Sanghavi
- Clinical Assistant, Breach Candy Hospital and Trust, 60A, Bhulabhai Desai Marg, Cumballa Hill, Mumbai- 400026, India.
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Does total contact of the patella with the femoral trochlea during no thumb test significantly reduce anterior knee pain? Knee 2019; 26:1338-1347. [PMID: 31405630 DOI: 10.1016/j.knee.2018.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 08/11/2018] [Accepted: 09/05/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Complications such as anterior knee pain (AKP) and crepitus continue to be causes of dissatisfaction after total knee arthroplasty (TKA). This prospective study aimed to study the significance of total patellar contact with the femoral trochlea of the implant, with the no thumb test during trial reduction, and its effect on reducing AKP. METHODS Between 2014 and 2016, 445 patellofemoral joints (M:F 126:319, age 45-80 years) and their contact with the trochlea of the femoral component were graded at trial reduction without lateral retinaculum release (Grades I, Ia, II, III based on existing publications). The aim was to restore all patellae to pre-operative thickness. Posterior stabilized implants with a domed patella were used in all cases. The Knee Society Score (KSS) and Visual Analogue Scale (VAS) score were noted at follow up between 12 and 24 months after surgery. RESULTS AKP was significantly lower with 100% patellofemoral contact. The KSS and VAS had statistically significant P-values of 0.021 and 0.025 in Grade I and Ia contact, respectively. Better results were achieved where patellar thickness was restored in Grades I and Ia with P-values of 0.041 and 0.046 for VAS change and 0.038 and 0.044 for KSS change, respectively. CONCLUSION At follow up, superior results were obtained where there was a complete patellofemoral contact at trial reduction in Grade I and Grade Ia, and when other confounding factors such as patellar thickness and normal rotation of the femoral and tibial components were standardized. To minimize AKP it is imperative to have total patellar contact with the femoral trochlea.
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White PB, Sharma M, Siddiqi A, Satalich JR, Ranawat AS, Ranawat CS. Role of Anatomical Patella Replacement on Anterior Knee Pain. J Arthroplasty 2019; 34:887-892. [PMID: 30712993 DOI: 10.1016/j.arth.2019.01.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 12/12/2018] [Accepted: 01/06/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Anterior knee pain (AKP) remains a complex issue affecting patient satisfaction after total knee arthroplasty. Several radiographic parameters have been shown to be causative factors with various designs. The aim of this study is to evaluate the known radiographic parameters of AKP and clinical outcomes (ie, AKP) in the setting of a modern prosthesis with an anatomic patella button. METHODS Between July 2012 and December 2013, 90 total knee arthroplasties received 3 skyline views taken at 30°, 45°, and 60°. A patient-administered questionnaire was administered at 2-year follow-up to assess the incidence of AKP, painless noise, and satisfaction. Radiographs were analyzed for patellofemoral overstuffing, patellar tilt, and patellar displacement, and evaluated the patella resection angle. RESULTS On the patient-administered questionnaire, 10 (11.1%) patients reported AKP of a mild-to-moderate nature. Thirty-one had the best view at 30 Merchant views, 24 had best views at 45, and 35 had best views at 60. We found that patellar resection angle correlated with AKP (odds ratio 1.21, P = .044) and painless noise (odds ratio 1.22, P = .034). Patellar displacement and patellofemoral stuffing did not correlate with AKP or painless noise. No radiographic measurements correlated with changes in Knee Society Score pain or function scores or range of motion. CONCLUSION We found that a patellar resection angle correlated with the incidence of AKP and painless noise at 2-year follow-up. We failed to find any correlation with patellofemoral overstuffing, patellar displacement, or patellar tilt with clinical outcomes. We recommend the use of 3 Merchant views to fully evaluate the patellofemoral joint.
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Affiliation(s)
| | - Mrinal Sharma
- Orthopaedic Surgery, BLK Super Specialty Hospital, New Delhi, Delhi, India
| | - Ahmed Siddiqi
- Orthopaedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA
| | - James R Satalich
- Virginia Commonwealth University School of Medicine, Richmond, VA
| | - Amar S Ranawat
- Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
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Yuan F, Sun Z, Wang H, Chen Y, Yu J. Clinical and radiologic outcomes of two patellar resection techniques during total knee arthroplasty: a prospective randomized controlled study. INTERNATIONAL ORTHOPAEDICS 2018; 43:2293-2301. [PMID: 30539221 DOI: 10.1007/s00264-018-4264-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 12/03/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE A cutting guide technique for patella resurfacing in total knee arthroplasty was expected to result in less patellofemoral syndromes. The aim of this study was to identify differences in the patellofemoral function, clinical outcomes, and radiographic parameters between the freehand and cutting guide patellar resection techniques in patients undergoing total knee arthroplasty. METHODS A prospective randomized controlled trial was conducted. The study was registered in a public trials registry (International Standard Randomized Trial No. NCT02268097). One-hundred total knee arthroplasties in 100 patients were randomly allocated into one of the two groups, and their results were followed for a mean of 28 months (range, 18 to 38 months) in a double-blind (both patient and evaluator), prospective study. Evaluation was performed by an independent observer using patellofemoral functional capacity, the Knee Society clinical rating system, the Western Ontario and McMaster Universities Osteoarthritis Indices, and radiographic examination. RESULTS In total, 14% of the patients were lost to follow-up. There was no difference in the incidence of anterior knee pain between the two groups. No patients received or required revisions. There was a significant difference in the outliers of lateral patellar tilt between the freehand and cutting guide groups (> 10°) (p = 0.036); however, the mean value of lateral patellar tilt did not differ significantly. There were no differences between groups with respect to the 30 seconds stair climbing test, complications, the Knee Society clinical rating system, the Western Ontario and McMaster Universities Osteoarthritis Indices, patient satisfaction, physical examination, hip-knee-ankle angle, lateral patellar displacement, or the Insall-Salvati ratio. Meanwhile, gender, age, weight, height, body mass index, pre-operative Knee Society scores, and pre-operative range of motion were not found to be related to the development of anterior knee pain. CONCLUSIONS Cutting guide technique group did not yield lower incidence of anterior knee pain. More outliers of lateral patellar tilt were observed in the freehand technique group. Overall, all patients in both groups had identical results in terms of patellofemoral functional capacity, clinical outcomes, and other radiographic results.
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Affiliation(s)
- Fuzhen Yuan
- Institution of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, No. 49 North, Garden Road, Haidian, Beijing, 100191, China
| | - Zewen Sun
- Institution of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, No. 49 North, Garden Road, Haidian, Beijing, 100191, China
| | - Haijun Wang
- Institution of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, No. 49 North, Garden Road, Haidian, Beijing, 100191, China
| | - Yourong Chen
- Institution of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, No. 49 North, Garden Road, Haidian, Beijing, 100191, China
| | - Jiakuo Yu
- Institution of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, No. 49 North, Garden Road, Haidian, Beijing, 100191, China.
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Nodzo SR, Kasparek M, Rueckl K, Boettner F. The location of the medial parapatellar arthrotomy influences intraoperative patella tracking. Knee Surg Sports Traumatol Arthrosc 2018; 26:1786-1791. [PMID: 29128877 DOI: 10.1007/s00167-017-4779-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 10/30/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE The medial parapatellar arthrotomy (MPPA) is a commonly utilized surgical approach; however, the placement of the arthrotomy and its influence on intraoperative patellar tracking has not been evaluated. METHODS Six knees from three fresh frozen cadavers with transthoracic amputations were operated on. All underwent standard posterior stabilized total knee arthroplasty using a medial parapatellar approach placed at the border of the vastus medialis oblique (VMO)-quadriceps junction. Patellae were resurfaced in the standard fashion. All patellae tracked normally with the first arthrotomy placed at the junction of the VMO-quadriceps tendon using the "no touch" technique. Measurement of patellar lift-off from the implant surface of the medial aspect of the trochlea on the femoral component was made at 50°, 75°, and 90° of flexion and a merchant view radiograph taken to evaluate radiographic patellar tilt. To simulate a more lateral placement of the MPPA, a 5-6 mm slice of quadriceps tendon was then removed from the lateral aspect of the tendon from the patellar insertion to the most proximal portion of the arthrotomy. This simulated a 5-6 mm more lateral placement of the parapatellar arthrotomy. The same measurements and radiographs were taken as described previously. Two more times the same size slices was removed from the quadriceps tendon with subsequent measurements and radiographs obtained. RESULTS The mean patellar lift-off with the first arthrotomy was 0 ± 0 mm for 50°, 75°, and 90° of flexion. The mean lift with the second arthrotomy was 2 ± 2, 3 ± 3, and 4 ± 3 mm respectively. The third arthrotomy had a mean patellar lift-off of 3 ± 2, 4 ± 3, and 8 ± 2 mm respectively, while the fourth arthrotomy had a mean lift-off of 6 ± 2, 8 ± 2, and 9 ± 4 mm. There was a significant correlation between percentage of quadriceps cut at 1 cm above the superior pole of the patella and patellar lift-off at 50° (R 2 = 0.70; p < 0.0001), 75° (R 2 = 0.68; p < 0.0001), and 90° (R 2 = 0.68; p < 0.0001) of flexion. CONCLUSION The location of the MPPA has a significant influence on intraoperative assessment of patellar tracking. An MPPA more lateral in the quadriceps tendon may independently influence the patellar tilt observed intraoperatively and should be taken into consideration when evaluating intraoperative patella tracking. An understanding of the independent influence the MPPA has on patellar tracking may decrease the need for lateral release if the surgeon notes the MPPA was made more than 5-10 mm from the junction of the VMO-quadriceps tendon junction.
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Affiliation(s)
- Scott R Nodzo
- Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
| | - Maximilian Kasparek
- Department of Orthopedic Surgery, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Kilian Rueckl
- Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Friedrich Boettner
- Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
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Jhurani A, Agarwal P, Aswal M, Saxena P, Singh N. Safety and Efficacy of 6.2 mm Patellar Button in Resurfacing Less than 20 mm Thin Patella: A Matched Pair Analysis. Knee Surg Relat Res 2018; 30:153-160. [PMID: 29843200 PMCID: PMC5990234 DOI: 10.5792/ksrr.17.097] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 03/16/2018] [Accepted: 03/22/2018] [Indexed: 01/19/2023] Open
Abstract
Purpose Restoring the native patellar thickness after patellar resurfacing provides optimal function of the knee after arthroplasty and minimises complications related to the patellofemoral articulation. The aim of this study was to assess the usefulness of a thin patellar button (6.2 mm) in patients with a patella thickness of less than 20 mm during total knee arthroplasty. Materials and Methods This is a retrospective case control study. A total of 54 female patients with an intraoperative patellar thickness of <20 mm, resurfaced with a patellar button of 6.2 mm in thickness were identified (group 1). They were matched with 54 patients with a patellar thickness of 20–23 mm, resurfaced with a patellar button of 8 mm (group 2), based on age, sex, body mass index, and deformity. A clinical and radiological evaluation was done at a minimum 2-year follow-up. Results The preoperative mean patellar thickness was 18.94±1.07 mm and was restored to 19.06±0.79 mm in group 1, as compared to 21.63±0.99 mm and 21.72±0.99 mm in group 2. The mean postoperative range of motion was 122.22°±9.25° in group 1 and 123.52°±8.72° in group 2 (p=0.13). No patellar bone or button related complications were observed in any patient in either group. Conclusions The 6.2 mm thin patella is useful to restore the native thickness in patients with a patellar thickness of less than 20 mm without risk of button fracture, loosening or overstuffing.
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Affiliation(s)
- Anoop Jhurani
- Department of Orthopedics, Joint Replacement Surgery Research Unit, Fortis Escorts Hospital, Jaipur, India
| | - Piyush Agarwal
- Department of Orthopedics, Joint Replacement Surgery Research Unit, Fortis Escorts Hospital, Jaipur, India
| | - Mukesh Aswal
- Department of Orthopedics, Joint Replacement Surgery Research Unit, Fortis Escorts Hospital, Jaipur, India
| | - Purvi Saxena
- Department of Orthopedics, Joint Replacement Surgery Research Unit, Fortis Escorts Hospital, Jaipur, India
| | - Nidhi Singh
- Department of Orthopedics, Joint Replacement Surgery Research Unit, Fortis Escorts Hospital, Jaipur, India
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Comparison of patellofemoral outcomes after TKA using two prostheses with different patellofemoral design features. Knee Surg Sports Traumatol Arthrosc 2017; 25:3747-3754. [PMID: 27511217 DOI: 10.1007/s00167-016-4264-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 08/02/2016] [Indexed: 12/18/2022]
Abstract
PURPOSE The purpose of the present study was to compare the clinical and radiographic results after TKA using two prostheses with different sagittal patellofemoral design features, including outcomes related to compatibility of the patellofemoral joint. METHODS The clinical and radiographic results of 81 patients (100 knees) who underwent TKA using the specific prosthesis (group A) were compared with those in a control group who underwent TKA using the other prosthesis (group B). The presence of anterior knee joint pain, patellar crepitation, and patellar clunk syndrome was also checked. RESULTS The function score and maximum flexion angle at the last follow-up were slightly better in group A than those in group B (92.0 ± 2.3 vs. 90.6 ± 4.2) (133.6° ± 8.4° vs. 129.6° ± 11.4°). Anterior knee pain was observed in 6 knees and patellar crepitation in four knees in group A. In group B, these symptoms were observed in 22 knees and 18 knees, respectively. There was no patellar clunk syndrome in either group. The alignment was corrected with satisfactory positioning of components. The patellar height remained unchanged after TKA in the two groups. The differences between preoperative and postoperative patellar tilt angle and patellar translation were small. CONCLUSION When comparing the clinical and radiographic results after TKA using two prostheses with different sagittal patellofemoral design features, TKA using the specific prosthesis provided satisfactory results with less clinical symptoms related to the patellofemoral kinematics with TKA using the other prosthesis. LEVEL OF EVIDENCE III.
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Park CN, White PB, Meftah M, Ranawat AS, Ranawat CS. Diagnostic Algorithm for Residual Pain After Total Knee Arthroplasty. Orthopedics 2016; 39:e246-52. [PMID: 26811953 DOI: 10.3928/01477447-20160119-06] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 07/22/2015] [Indexed: 02/03/2023]
Abstract
Although total knee arthroplasty is a successful and cost-effective procedure, patient dissatisfaction remains as high as 50%. Postoperative residual knee pain after total knee arthroplasty, with or without crepitation, is a major factor that contributes to patient dissatisfaction. The most common location for residual pain after total knee arthroplasty is anteriorly. Because residual pain has been associated with an un-resurfaced patella, this review includes only registry data and total knee arthroplasty with patella replacement. Some suggest that the pathogenesis of residual knee pain may be related to mechanical stimuli that activate free nerve endings around the patellofemoral joint. Various etiologies have been implicated in residual pain, including (1) low-grade infection, (2) midflexion instability, and (3) component malalignment with patellar maltracking. Less common causes include (4) crepitation and patellar clunk syndrome; (5) patellofemoral symptoms, including overstuffing and avascular necrosis of the patella; (6) early aseptic loosening; (7) hypersensitivity to metal or cement; (8) complex regional pain syndrome; and (9) pseudoaneurysm. Because all of these conditions can lead to residual pain, identifying the etiology can be a difficult diagnostic challenge. Often, patients with persistent pain and normal findings on radiographs and laboratory workup may benefit from a diagnostic injection or further imaging. However, up to 10% to 15% of patients with residual pain may have unexplained pain. This literature review summarizes the findings on the causes of residual pain and presents a diagnostic algorithm to facilitate an accurate diagnosis for residual pain after total knee arthroplasty.
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Huang G, Xia J, Wang S, Wei Y, Wu J, Chen F, Chen J, Shi J. Total knee arthroplasty using trochlear groove as guide for position of femoral component in severe knee osteoarthritis. BMC Surg 2016; 16:33. [PMID: 27216144 PMCID: PMC4877803 DOI: 10.1186/s12893-016-0148-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 04/30/2016] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Apart from transepicondylar axis, the native femoral sulcus was also reported to be used as a guide for the femoral component position in total knee arthroplasty (TKA). However, it was not shown in patients with severe knee osteoarthritis. This study was conducted to compare the position of trochlear groove in patients with and without osteoarthritis, and to assess whether trochlear groove could be used as a guide for position of femoral component in TKA for severe knee osteoarthritis. METHODS Total 50 severe knee osteoarthritis patients (Kellgren Lawrence grade 3 or 4) who underwent TKA were included. Meanwhile, 50 patients who underwent arthroscopic surgery without osteoarthritis were included as control. The distance from trochlear groove to the midpoint of a virtual anterior condyle osteotomy line (parallel to the posterior condyle line) (a-b) was recorded by radiological and surgical measurements. Midpoint of transepicondylar axis and trochlear groove were used as guide for placing prosthesis model in TKA, respectively. No-thumb test was performed to assess the patellar tracking. The position of femoral component was finally performed using trochlear groove as guide in TKA. RESULTS Value of "a-b" was significantly different between osteoarthritic and control knees (P = 0.008). During the placement of prosthesis model, similar patellar tracking was detected between using midpoint of transepicondylar axis and trochlear groove as guide (P > 0.05). After placing femoral component using trochlear groove as guide, most patients obtained good patellofemoral congruence with pneumatic tourniquet inflated (n = 43) or deflated (n = 5), and good patellofemoral congruence was also obtained by lateral patellar retinaculum release in two patients. CONCLUSION Despite the shifting of trochlear groove caused by severe knee osteoarthritis, trochlear groove can be used as a guide for position of femoral component, with equivalent patellar tracking compared with transepicondylar axis.
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Affiliation(s)
- Gangyong Huang
- Department of Orthopaedic Surgery, Huashan Hospital Fudan University, 12th Wulumuqi Middle Road, Shanghai, 200040, China
| | - Jun Xia
- Department of Orthopaedic Surgery, Huashan Hospital Fudan University, 12th Wulumuqi Middle Road, Shanghai, 200040, China.
| | - Siqun Wang
- Department of Orthopaedic Surgery, Huashan Hospital Fudan University, 12th Wulumuqi Middle Road, Shanghai, 200040, China
| | - Yibing Wei
- Department of Orthopaedic Surgery, Huashan Hospital Fudan University, 12th Wulumuqi Middle Road, Shanghai, 200040, China
| | - Jianguo Wu
- Department of Orthopaedic Surgery, Huashan Hospital Fudan University, 12th Wulumuqi Middle Road, Shanghai, 200040, China
| | - Feiyan Chen
- Department of Orthopaedic Surgery, Huashan Hospital Fudan University, 12th Wulumuqi Middle Road, Shanghai, 200040, China
| | - Jie Chen
- Department of Orthopaedic Surgery, Huashan Hospital Fudan University, 12th Wulumuqi Middle Road, Shanghai, 200040, China
| | - Jingsheng Shi
- Department of Orthopaedic Surgery, Huashan Hospital Fudan University, 12th Wulumuqi Middle Road, Shanghai, 200040, China
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Aprato A, Risitano S, Sabatini L, Giachino M, Agati G, Massè A. Cementless total knee arthroplasty. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:129. [PMID: 27162779 DOI: 10.21037/atm.2016.01.34] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Interest for uncemented total knee arthroplasty (TKA) has greatly increased in recent years. This technique, less used than cemented knee replacement in the last decades, sees a revival thanks an advance in prosthetic design, instrumentation and operative technique. The related literature in some cases shows conflicting data on survival and on the revision's rate, but in most cases a success rate comparable to cemented TKA is reported. The optimal fixation in TKA is a subject of debate with the majority of surgeons favouring cemented fixation.
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Affiliation(s)
- Alessandro Aprato
- 1 A.O.U. San Luigi Gonzaga, Regione Gonzole 10, 10043 Orbassano, Torino, Italy ; 2 University of Study of Torino, Via Giuseppe Verdi, 8, Torino, Italy ; 3 Orthopaedics and Traumatology Città della Scienza e della Salute - CTO, University of Torino, via Zuretti 29, 10126 Torino, Italy
| | - Salvatore Risitano
- 1 A.O.U. San Luigi Gonzaga, Regione Gonzole 10, 10043 Orbassano, Torino, Italy ; 2 University of Study of Torino, Via Giuseppe Verdi, 8, Torino, Italy ; 3 Orthopaedics and Traumatology Città della Scienza e della Salute - CTO, University of Torino, via Zuretti 29, 10126 Torino, Italy
| | - Luigi Sabatini
- 1 A.O.U. San Luigi Gonzaga, Regione Gonzole 10, 10043 Orbassano, Torino, Italy ; 2 University of Study of Torino, Via Giuseppe Verdi, 8, Torino, Italy ; 3 Orthopaedics and Traumatology Città della Scienza e della Salute - CTO, University of Torino, via Zuretti 29, 10126 Torino, Italy
| | - Matteo Giachino
- 1 A.O.U. San Luigi Gonzaga, Regione Gonzole 10, 10043 Orbassano, Torino, Italy ; 2 University of Study of Torino, Via Giuseppe Verdi, 8, Torino, Italy ; 3 Orthopaedics and Traumatology Città della Scienza e della Salute - CTO, University of Torino, via Zuretti 29, 10126 Torino, Italy
| | - Gabriele Agati
- 1 A.O.U. San Luigi Gonzaga, Regione Gonzole 10, 10043 Orbassano, Torino, Italy ; 2 University of Study of Torino, Via Giuseppe Verdi, 8, Torino, Italy ; 3 Orthopaedics and Traumatology Città della Scienza e della Salute - CTO, University of Torino, via Zuretti 29, 10126 Torino, Italy
| | - Alessandro Massè
- 1 A.O.U. San Luigi Gonzaga, Regione Gonzole 10, 10043 Orbassano, Torino, Italy ; 2 University of Study of Torino, Via Giuseppe Verdi, 8, Torino, Italy ; 3 Orthopaedics and Traumatology Città della Scienza e della Salute - CTO, University of Torino, via Zuretti 29, 10126 Torino, Italy
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13
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Jia Z, Chen C, Wu Y, Ding F, Tian X, Li W, Wang D, He Q, Ruan D. No difference in clinical outcomes after total knee arthroplasty between patellar eversion and non-eversion. Knee Surg Sports Traumatol Arthrosc 2016; 24:141-7. [PMID: 25274093 DOI: 10.1007/s00167-014-3351-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 09/22/2014] [Indexed: 01/14/2023]
Abstract
PURPOSE Multiple surgical techniques in minimally invasive total knee arthroplasty (TKA) are associated with clinical differences. However, whether patellar eversion impairs clinical outcomes remains controversial. We conducted a systematic review of randomized controlled trials (RCTs) to provide current understanding on this topic. METHODS A literature search of the PubMed, Embase, and Cochrane library databases was performed to identify RCTs comparing patellar eversion with patellar non-eversion (PN). Two authors independently selected the studies, assessed methodological quality, and extracted data. RESULTS Five RCTs involving 379 knees were included. The results revealed no significant differences in functional scores, pain, quality of life, quadriceps strength, patellar height, alignment, or complication rate between patellar eversion and PN. Power analysis showed that the power of the individual study and meta-analysis ranged from 5.0 to 70.8%, with the exception of the power of alignment and patellar height in two of the individual studies, which was 100.0 and 99.9%, respectively. CONCLUSIONS Based on the current evidence, patellar eversion during TKA could not definitely lead to inferior postoperative outcomes. Patellar eversion and patellar non-eversion could achieve similar clinical outcomes. LEVEL OF EVIDENCE Systematic review and meta-analysis, Level I.
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Affiliation(s)
- Zhiwei Jia
- Department of Orthopaedics, Navy General Hospital, No. 6, Fucheng Road, Beijing, 100048, China
| | - Chun Chen
- Department of Orthopaedics, Navy General Hospital, No. 6, Fucheng Road, Beijing, 100048, China.,The Third Clinical Medical College, Southern Medical University, Guangzhou, China
| | - Yaohong Wu
- Department of Orthopaedics, Navy General Hospital, No. 6, Fucheng Road, Beijing, 100048, China.,The Third Clinical Medical College, Southern Medical University, Guangzhou, China
| | - Fan Ding
- Department of Orthopaedics, Wuhan Pu'Ai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xu Tian
- Graduate College, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Wei Li
- Department of Orthopaedics, Navy General Hospital, No. 6, Fucheng Road, Beijing, 100048, China
| | - Deli Wang
- Department of Orthopaedics, Navy General Hospital, No. 6, Fucheng Road, Beijing, 100048, China
| | - Qing He
- Department of Orthopaedics, Navy General Hospital, No. 6, Fucheng Road, Beijing, 100048, China
| | - Dike Ruan
- Department of Orthopaedics, Navy General Hospital, No. 6, Fucheng Road, Beijing, 100048, China.
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14
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Prevention of pseudo-patella baja during total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2015; 23:3601-6. [PMID: 25178535 DOI: 10.1007/s00167-014-3257-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 08/20/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Pseudo-patella baja (PPB) is a surgical complication that can arise from total knee arthroplasty and occurs when the patella tendon is not shortened but the level of the femorotibial joint line is elevated. The goal of this study was to assess the performance of a technique specifically designed to prevent the occurrence of PPB and its radiological results. METHODS Ninety-nine patients undergoing total knee arthroplasty were included. Patients were divided into a non-correction group and a correction group. The correction group were applied an additional metal block in order to reduce the excess resection of the distal femur. To evaluate PPB, the change in the pre- and postoperative joint line was measured using the modified Blackburne-Peel Index (BPI). RESULTS In the non-correction group, 68 of 74 cases showed an occurrence of PPB (92 %), in the correction group, 6 of 57 cases showed an occurrence of PPB (11 %). The preoperative-modified BPI of the non-correction group was not significantly different from that of the correction group (0.6 ± 0.1 vs. 0.6 ± 0.2). The modified BPI decreased significantly in the non-correction group after TKA (0.6 ± 0.1 vs. 0.2 ± 0.1, p < 0.05). However, the modified BPI did not change significantly in the correction group after TKA (0.6 ± 0.2 vs. 0.6 ± 0.2). CONCLUSION The comparison of preoperative and postoperative radiological results showed that our intervention maintained the joint line without elevation. We proposed an effective method to prevent various complications due to the joint line elevation that occur in PPB. LEVEL OF EVIDENCE III.
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15
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Huang AB, Wang HJ, Yu JK, Yang B, Ma D, Zhang JY. Optimal patellar alignment with minimally invasive approaches in total knee arthroplasty after a minimum five year follow-up. INTERNATIONAL ORTHOPAEDICS 2015; 40:487-92. [PMID: 26162985 DOI: 10.1007/s00264-015-2896-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 06/20/2015] [Indexed: 12/18/2022]
Abstract
PURPOSE Patellofemoral syndrome is still a common complication after total knee arthroplasty (TKA). However, the effects of specific surgical approaches on patellar tracking and alignment remain incompletely understood. In this study, we compared patellar alignment in patients who underwent TKA via three different techniques. METHODS A total of 96 patients who completed a minimum follow-up of five years were involved in three groups: 30 patients were treated with the traditional medial parapatellar approach (MPP group), 35 patients were treated with the mini-medial parapatellar approach (MMP group) and 31 were treated with a quadriceps-sparing approach (QS group). Radiographic data for patellar alignment and clinical results were compared. RESULTS Patellar tilt and patellar displacement at the final follow-up evaluation differed significantly among the three groups [P < 0.01, analysis of variance (ANOVA)]. The MMP and QS groups exhibited more proper patellar alignment than the MPP group. The clinical results did not differ significantly among the groups (P > 0.05, ANOVA). In addition, there were no correlations between postoperative patellar alignment and clinical scores. CONCLUSIONS The results of this study indicate that TKA performed using minimally invasive approaches yields superior patellar alignment compared to the traditional MPP approach.
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Affiliation(s)
- Ai-Bing Huang
- Institute of Sports Medicine, Peking University Third Hospital, No. 49, North Garden Road, Haidian District, Beijing, 100191, China
| | - Hai-Jun Wang
- Institute of Sports Medicine, Peking University Third Hospital, No. 49, North Garden Road, Haidian District, Beijing, 100191, China
| | - Jia-Kuo Yu
- Institute of Sports Medicine, Peking University Third Hospital, No. 49, North Garden Road, Haidian District, Beijing, 100191, China.
| | - Bo Yang
- Institute of Sports Medicine, Peking University Third Hospital, No. 49, North Garden Road, Haidian District, Beijing, 100191, China
| | - Dong Ma
- Institute of Sports Medicine, Peking University Third Hospital, No. 49, North Garden Road, Haidian District, Beijing, 100191, China
| | - Ji-Ying Zhang
- Institute of Sports Medicine, Peking University Third Hospital, No. 49, North Garden Road, Haidian District, Beijing, 100191, China
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16
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Circumferential electrocautery of the patella in primary total knee replacement without patellar replacement: a meta-analysis and systematic review. Sci Rep 2015; 5:9393. [PMID: 25801456 PMCID: PMC4371101 DOI: 10.1038/srep09393] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 03/02/2015] [Indexed: 12/20/2022] Open
Abstract
The purpose of this meta-analysis and systematic review was to identify and assess whether circumferential electrocautery is useful for improving outcomes after primary total knee replacement(TKR). We searched MEDLINE, EMBASE, PubMed, SpringerLink, Web of Knowledge, OVID CINAHL, OVID EBM and Google Scholar and included articles published through January 2014. A total of 6 articles met the inclusion criteria. Of the 776 cases included in the analysis, 388 cases involved patellar denervation, and 388 cases were designated as the control group. The meta-analysis revealed no significant difference in the incidence of anterior knee pain (AKP, p = 0.18) or in the visual analogue scale score (VAS, p = 0.23) between the two groups. In addition, AKSS Function Score indicated no significant difference between the two groups (p = 0.28). However, the OKS (p = 0.02), patellar score (p = 0.01), AKSS-Knee Score (p = 0.004), range of motion (ROM, p < 0.0001) and WOMAC Score (p = 0.0003) indicated that circumpatellarelectrocautery improved clinical outcomes compared with non-electrocautery. The results indicate that circumferential electrocautery of the patella does not significantly improve AKP compared with non-electrocautery techniques but that circumferential electrocautery significantly improves patients' knee function after surgery. Therefore, we believe that circumferential electrocautery is beneficial to the outcome of primary TKR surgery without patellar replacement.
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17
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Ji HM, Ha YC, Baek JH, Ko YB. Advantage of minimal anterior knee pain and long-term survivorship of cemented single radius posterior-stabilized total knee arthroplasty without patella resurfacing. Clin Orthop Surg 2015; 7:54-61. [PMID: 25729519 PMCID: PMC4329533 DOI: 10.4055/cios.2015.7.1.54] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 04/07/2014] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The single radius total knee prosthesis was introduced with the advantage of reduced patellar symptoms; however, there is no long-term follow-up study of the same. The purpose of this study was to determine the survival rate of single radius posterior-stabilized total knee arthroplasty and patellofemoral complication rates in a consecutive series. METHODS Seventy-one patients (103 knees) who underwent arthroplasty without patellar resurfacing using a single radius posterior-stabilized total knee prosthesis were followed up for a minimum 10 years. Clinical evaluation using Knee Society knee and function scores and radiologic evaluation were performed at regular intervals. Anterior knee pain as well as patellofemoral complications were evaluated with a simple questionnaire. The Kaplan-Meier product-limit method was used to estimate survival. RESULTS Seventeen patients (23 knees) were excluded due to death (12 knees) or lost to follow-up (11 knees). Of the 80 knees enrolled, all femoral components and 78 tibial components were well fixed without loosening at final follow-up. Two revisions were performed because of tibial component loosening and periprosthetic joint infection. One patient with tibial component loosening refused to have revision surgery. No obvious tibial insert polyethylene wear was observed. The survivorships at 132 months were 96.7% using revision or pending revision as end points. Anterior knee pain was present in 6 patients (6 knees, 7.5%) at the latest follow-up. No patellofemoral complication requiring revision was encountered. CONCLUSIONS The single radius posterior-stabilized total knee prosthesis demonstrated an excellent minimum 10-year survivorship. The low rates of implant loosening and 7.5% of anterior knee pain as a patellofemoral complication are comparable with those reported for other modern total knee prosthesis.
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Affiliation(s)
- Hyung-Min Ji
- Department of Orthopedic Surgery, Ajou University Medical Center, Seoul, Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Ji-Hoon Baek
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Young-Bong Ko
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
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18
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Clarke HD, Spangehl MJ. Gender optimized patellar component designs are needed to better match female patellar anatomy. Knee 2014; 21:1250-3. [PMID: 25199711 DOI: 10.1016/j.knee.2014.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 06/19/2014] [Accepted: 08/06/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Avoidance of both over-resection of the native patella, and over-stuffing of the patello-femoral joint are advocated to reduce the risk of patellar complications following patellar resurfacing. Female gender, due to thinner native patella, and use of patellar prostheses from one specific manufacturer that were thicker for comparable diameters than the patellar prostheses from a second manufacturer were hypothesized to be risk factors for these undesirable technical outcomes. METHODS A retrospective review was undertaken of 803 consecutive knee replacements, performed by one surgeon, during which the same patellar resurfacing technique had been used, but with two different patellar implant designs. RESULTS Female gender, and use of one specific design of patella prostheses were associated with both increased risk of patellar over resection to ≤13mm residual patellar thickness, and creation of a patella construct that was thicker than the native patella (p<0.001). CONCLUSIONS Patellar prostheses design can contribute to compromises in surgical technique during patellar resurfacing in TKA in female patients with thinner patellae. Modifications to current patellar prosthesis dimensions may be considered to allow surgeons to more accurately resurface the thinner, native female patella. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Henry D Clarke
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, AZ, United States.
| | - Mark J Spangehl
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, AZ, United States
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19
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Rajshekhar K, Kumar M, Venugopal P, Chandy T. Patellar clunk in total knee arthroplasty using modified Sigma posterior stabilized femoral component. J Clin Orthop Trauma 2014; 5:211-4. [PMID: 25983500 PMCID: PMC4264035 DOI: 10.1016/j.jcot.2014.07.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 07/14/2014] [Indexed: 12/19/2022] Open
Abstract
AIM The purpose of this study was to evaluate the efficacy of the enhanced PS femoral component design released in 2008 by DePuy. The patellar clunk syndrome has been reported in a significant number of patients following total knee arthroplasty. Design modifications of the implant have been made to reduce the incidence of the patellar clunk, especially in the posterior substituted designs. METHODS 130 total knee replacements performed using the enhanced PS femoral components were followed-up with clinical and radiographic evaluations. RESULTS Patellar clunk was seen in 3 of the 130 knees (2%). This is much less than the incidence of patellar clunk reported until now. CONCLUSIONS Removal of the sharp ridge in the intercondylar groove in the newer implant seems to have been effective in reducing the incidence of the patellar clunk. It also indicates that the sharp ridge was the most probable cause of the clunk.
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Affiliation(s)
- K.T. Rajshekhar
- Consultant Orthopaedic & Joint Replacement Surgeon, HOSMAT Hospital, Bangalore, India,Corresponding author. HOSMAT Hospital, 45, McGrath Road, Bangalore – 25, India, 560025. Tel.: +91 80 25593796; +91 9008401444.
| | - M.N. Kumar
- Consultant Orthopaedic & Joint Replacement Surgeon, HOSMAT Hospital, Bangalore, India
| | - P. Venugopal
- Consultant Orthopaedic & Joint Replacement Surgeon, HOSMAT Hospital, Bangalore, India
| | - Thomas Chandy
- Chief of Orthopaedics, HOSMAT Hospital, Bangalore, India
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Patellar tracking and anterior knee pain are similar after medial parapatellar and midvastus approaches in minimally invasive TKA. Clin Orthop Relat Res 2013; 471:1654-60. [PMID: 23361929 PMCID: PMC3613550 DOI: 10.1007/s11999-012-2778-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Accepted: 12/20/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND Since the medial parapatellar (MPP) approach in conventional TKA can cause patellar maltracking and anterior knee pain, some orthopaedic surgeons use the midvastus (MV) approach instead of the MPP approach to reduce patellar maltracking. Minimally invasive surgical (MIS) TKA has been developed to limit the damage to the surrounding muscle and reduce the necessity of patellar eversion during surgery. Thus, MIS TKA might be associated with proper patellar tracking and a low incidence of anterior knee pain. However, this presumption has not been confirmed. QUESTIONS/PURPOSES We asked whether the incidence of patellar maltracking and anterior knee pain differed with the MV and MPP in association with MIS TKA. METHODS We prospectively followed 59 patients (60 knees) treated with 60 primary cemented MIS TKAs from August 2009 to September 2010. We randomized the patients into two groups: 30 who had a limited MPP approach and 30 who had a mini-MV approach. We recorded the occurrence of anterior knee pain, patellar tilting, and subluxation. The minimum followup was 12 months (mean, 18.03 months; range, 12.00-25.08 months). RESULTS We found no differences in anterior knee pain (two of 30, 7% versus two of 30, 7%), mean patellar tilt (3.4º ± 2.9º versus 3.0 ± 2.3º), and mean patellar subluxation (1.5 ± 1.1 mm versus 1.1 ± 0.7 mm) between the limited MPP and mini-MV groups, respectively. CONCLUSIONS MIS TKA using either the MPP or MV approach has a low incidence of patellar maltracking and anterior knee pain.
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Ranawat CS, Meftah M, Windsor EN, Ranawat AS. Cementless fixation in total knee arthroplasty. ACTA ACUST UNITED AC 2012; 94:82-4. [DOI: 10.1302/0301-620x.94b11.30826] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
There has been a recent increase in interest for non-cemented fixation in total knee arthroplasty (TKA), however the superiority of cement fixation is an ongoing debate. Whereas the results based on Level III and IV evidence show similar survivorship rates between the two types of fixation, Level I and II evidence strongly support cemented fixation. United Kingdom, Australia, Sweden, and New Zealand registry data show lower failure rates and greater usage of cemented than non-cemented fixation. Case series studies have also indicated greater functional outcomes and lower revision rates among cemented TKAs. Non-cemented fixation involves more patellofemoral complications, including increased susceptibility to wear due to a thinner polyethylene bearing on the cementless metal-backed component. The combination of results from registry data, prospective randomised studies, and meta-analyses support the current superiority of cemented fixation in TKAs.
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Affiliation(s)
- C. S. Ranawat
- Weill Medical College of Cornell University, 1300
York Avenue, New York, New
York 10065, USA
| | - M. Meftah
- Hospital for Special Surgery, 535
E. 70th Street, New York, New
York 10021, USA
| | - E. N. Windsor
- Hospital for Special Surgery, 535
E. 70th Street, New York, New
York 10021, USA
| | - A. S. Ranawat
- Weill Medical College of Cornell University, 1300
York Avenue, New York, New
York 10065, USA
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