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Keshmiri A. [Patellar tracking in knee arthroplasty]. ORTHOPADIE (HEIDELBERG, GERMANY) 2024; 53:93-99. [PMID: 38165439 DOI: 10.1007/s00132-023-04464-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/08/2023] [Indexed: 01/03/2024]
Abstract
Knee arthroplasty is a demanding procedure that, when carried out appropriately, results in significant pain relief and patient satisfaction. The success of the operation is influenced by many factors. The most important ones describe the implant design, the orientation of the components and the ligament tension. The patellofemoral joint is often neglected as an important part of the operation. Initially, complications in the area of the patellofemoral joint do not appear to be devastating, but in many cases, they lead to significant consequences for the patient, along with severe pain and limited mobility. The most common complications arise from patellar maltracking. This often occurs due to misplacement of the tibial and femoral components and the altered shape of the patella. If the placement of the components with regard to patellar tracking is considered, bony and/or soft tissue addressing measures remain to further optimize the movement of the patella. The following manuscript is dedicated to discussing causes to avoid patellar maltracking and improve clinical outcomes.
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Affiliation(s)
- Armin Keshmiri
- MVZ im Helios, Helene-Weber-Allee 19, 80637, München, Deutschland.
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Greimel F, Maderbacher G, Baier C, Krieg B, Zeman F, Grifka J, Keshmiri A. Medial Open Wedge High tibial Osteotomy (MOWHTO) does not relevantly alter patellar kinematics: a cadaveric study. Arch Orthop Trauma Surg 2022; 142:13-21. [PMID: 32816055 PMCID: PMC8732930 DOI: 10.1007/s00402-020-03578-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 08/16/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to quantify the influence of medial open wedge high tibial osteotomy on patellar kinematics using optical computer navigation, as anterior knee pain infrequently occurs postoperatively and the reason is still being unknown. METHODS Ten medial open wedge high tibial osteotomies at supratuberosity level in 5 full body specimens were performed. The effect of the surgical procedure on patellar kinematics, measured at 5 and 10 degrees of leg alignment correction angle, was analyzed and compared to native patellar kinematics during passive motion-regarding patella shift, tilt, epicondylar distance and rotation. Linear mixed models were used for statistical analysis, a two-sided p value of ≤ 0.05 was considered statistically significant. RESULTS Tilt behavior, medial shift and epicondylar distance did not show a significant difference regarding natural patellar kinematics at both osteotomy levels. Both osteotomy correction angles showed a significant less external rotation of the patella (p < 0.001, respectively) compared to natural kinematics. CONCLUSIONS Except less external rotation of the patella, medial open wedge high tibial osteotomy does not seem to relevantly alter patellar alignment during passive motion. Future clinical studies have to prove the effect of MOWHTO on patellar kinematics measured in this experimental setup, especially regarding its influence on anterior knee pain.
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Affiliation(s)
- Felix Greimel
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany.
| | - Guenther Maderbacher
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - Clemens Baier
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - Bernd Krieg
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - Florian Zeman
- Center for Clinical Studies, University Medical Center of Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Joachim Grifka
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - Armin Keshmiri
- Orthopaedic Center in Helios, Helene-Weber-Allee 19, 80637, München, Germany
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Worlicek M, Moser B, Maderbacher G, Zentner R, Zeman F, Grifka J, Keshmiri A. The influence of varus and valgus deviation on patellar kinematics in healthy knees: An exploratory cadaver study. Knee 2017; 24:711-717. [PMID: 28532997 DOI: 10.1016/j.knee.2017.04.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 03/20/2017] [Accepted: 04/18/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patellofemoral instability may lead to osteoarthritis, anterior knee pain, and patellar luxation. The purpose of this study was to conduct an exploratory investigation into the difference of patellar kinematics of healthy knees during extension/flexion cycles in neutral, varus and valgus alignment. METHODS The three-dimensional patellar kinematics of 10 lower extremities of whole body cadavers were examined during passive motion, in neutral position, and under valgus and varus stress. Kinematics was recorded by means of an optical computer navigation system. RESULTS The study samples did not significantly differ with regard to mediolateral patellar shift and epicondylar distance. Varus stress led to significantly higher external rotation than valgus stress (P=0.04) and to a significantly higher lateral patellar tilt than neutral position (P=0.016) and valgus stress (P=0.016). No difference was found between valgus stress and neutral position. CONCLUSION Analysis of tibiofemoral alignment alone is insufficient for predicting patellar kinematics.
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Affiliation(s)
- Michael Worlicek
- University of Regensburg, Department of Orthopedic Surgery, Asklepios Medical Center, Bad Abbach, Germany.
| | - Benedikt Moser
- Department of Trauma Surgery and Orthopedic Surgery, Medical Center Traunstein, Germany
| | - Günther Maderbacher
- University of Regensburg, Department of Orthopedic Surgery, Asklepios Medical Center, Bad Abbach, Germany
| | - Raphael Zentner
- Faculty of Mathematics, University of Regensburg, Regensburg, Germany
| | - Florian Zeman
- Center of Clinical Studies, University of Regensburg, Regensburg, Germany
| | - Joachim Grifka
- University of Regensburg, Department of Orthopedic Surgery, Asklepios Medical Center, Bad Abbach, Germany
| | - Armin Keshmiri
- Department of Orthopedic Surgery, ISAR Medical Center Munich, Munich, Germany
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Webb JE, Yang HY, Collins JE, Losina E, Thornhill TS, Katz JN. The Evolution of Implant Design Decreases the Incidence of Lateral Release in Primary Total Knee Arthroplasty. J Arthroplasty 2017; 32:1505-1509. [PMID: 28089467 DOI: 10.1016/j.arth.2016.11.050] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 11/28/2016] [Accepted: 11/30/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Appropriate balancing of the patellofemoral joint (PFJ) using a lateral release can help to prevent patellar instability in total knee arthroplasty (TKA). Contemporary total knee implant designs are characterized by enhanced trochlear geometry more similar to native knee anatomy to minimize instability and reduce utilization of a lateral release. METHODS We retrospectively reviewed consecutive TKA cases from a single senior surgeon's practice with 3 successive total knee designs: the Press-Fit Condylar (PFC), the Sigma, and the ATTUNE (DePuy, Warsaw, IN). We evaluated the use of lateral release with each implant type to determine if design changes have improved patellar stability, reducing the need for lateral release. We used multivariate analysis to determine the association between implant type and lateral release, adjusting for age, sex, preoperative alignment, and bearing type. RESULTS We evaluated 1991 records of primary TKAs performed from 1980-2015. As compared with the ATTUNE, the adjusted odds of lateral release were greater for patients receiving PFC implants (Odds ratio [OR] 6.35, 95% confidence interval [CI] 3.85,10.49) and Sigma implants (OR 2.02, 95% CI 1.26, 3.23). In addition, fixed bearing implants were associated with greater adjusted odds of lateral release (OR 1.80, 95% CI 1.24, 2.62). CONCLUSION We found that older knee implants were associated with higher use of lateral release, with successive designs the need for lateral release to balance the PFJ decreased. Continued design improvements to match the native knee anatomy may further improve the stability of the PFJ in future designs.
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Affiliation(s)
- Jonathan E Webb
- Department of Orthopedic Surgery, Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, Massachusetts
| | - Heidi Y Yang
- Department of Orthopedic Surgery, Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jamie E Collins
- Department of Orthopedic Surgery, Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, Massachusetts
| | - Elena Losina
- Department of Orthopedic Surgery, Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, Massachusetts; Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital Harvard Medical School, Boston, Massachusetts; Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Thomas S Thornhill
- Department of Orthopedic Surgery, Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jeffrey N Katz
- Department of Orthopedic Surgery, Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, Massachusetts; Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital Harvard Medical School, Boston, Massachusetts
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Huang CH, Hsu LI, Chang TK, Chuang TY, Shih SL, Lu YC, Chen CS, Huang CH. Stress distribution of the patellofemoral joint in the anatomic V-shape and curved dome-shape femoral component: a comparison of resurfaced and unresurfaced patellae. Knee Surg Sports Traumatol Arthrosc 2017; 25:263-271. [PMID: 25539687 DOI: 10.1007/s00167-014-3485-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 12/11/2014] [Indexed: 11/27/2022]
Abstract
PURPOSE Whether to resurface the patella in knee replacement remains a controversial issue. The geometrical design of the trochlear groove in the femoral component could play an important role in determining the stress distribution on the patellofemoral joint, but this has not been sufficiently reported on. This study attempted to determine the effect of implant design on contact mechanics by means of a finite element method. METHODS Two designs, an anatomical V-shape design (VSD) and a dome-shape design (DSD), for the anterior trochlear surface in a contemporary femoral component were chosen for examining the contact characteristics. The use and absence of patella resurfacing was simulated. The stress and strain distribution on the patellar bone and the polyethylene component were calculated for comparison. RESULTS Without patellar resurfacing, the maximal compressive strain in the patellar bone in the VSD model was about 20 % lower than the DSD model. On the other hand, with resurfacing, the maximal strain for the VSD model was 13.3 % greater than for DSD. Uneven stress distribution at the bone-implant interface was also noted for the two designs. CONCLUSION The femoral component with a V-shape trochlear groove reduced the compressive strain on the unresurfaced patella. If resurfacing the patella, the femoral component with a curved domed-shape design might reduce the strain in the remaining patellar bone. Uneven stress could occur at the bone-implant interface, so design modifications for improving fixation strength and medialization of the patellar button would be helpful in reducing the risk of peg fracture or loosening. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Chang-Hung Huang
- Biomechanics Research Laboratory, Mackay Memorial Hospital, No. 45, Mingsheng Rd, Tamshui District, New Taipei City, 25160, Taiwan.,Department of Physical Therapy and Assistive Technology, National Yang-Ming University, No. 155, Sec. 2, Li-Nung St., Taipei, 112, Taiwan.,Institute of Biomedical Engineering, National Yang-Ming University, Taipei, Taiwan
| | - Lin-I Hsu
- Biomechanics Research Laboratory, Mackay Memorial Hospital, No. 45, Mingsheng Rd, Tamshui District, New Taipei City, 25160, Taiwan
| | - Ting-Kuo Chang
- Biomechanics Research Laboratory, Mackay Memorial Hospital, No. 45, Mingsheng Rd, Tamshui District, New Taipei City, 25160, Taiwan.,Department of Orthopaedic Surgery, Mackay Memorial Hospital, Taipei, Taiwan
| | - Tai-Yuan Chuang
- Department of Orthopedic Surgery, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan
| | - Shih-Liang Shih
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, No. 155, Sec. 2, Li-Nung St., Taipei, 112, Taiwan.,Department of Orthopaedic Surgery, Zhong-Xing Branch of Taipei-City Hospital, Taipei, Taiwan
| | - Yung-Chang Lu
- Biomechanics Research Laboratory, Mackay Memorial Hospital, No. 45, Mingsheng Rd, Tamshui District, New Taipei City, 25160, Taiwan. .,Department of Orthopaedic Surgery, Mackay Memorial Hospital, Taipei, Taiwan. .,Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan.
| | - Chen-Sheng Chen
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, No. 155, Sec. 2, Li-Nung St., Taipei, 112, Taiwan.
| | - Chun-Hsiung Huang
- Biomechanics Research Laboratory, Mackay Memorial Hospital, No. 45, Mingsheng Rd, Tamshui District, New Taipei City, 25160, Taiwan.,Institute of Biomedical Engineering, National Yang-Ming University, Taipei, Taiwan.,Department of Orthopaedic Surgery, Mackay Memorial Hospital, Taipei, Taiwan
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Springorum HR, Baier C, Craiovan B, Maderbacher G, Renkawitz T, Grifka J, Keshmiri A. [Patella navigation in computer-assisted TKA : Intraoperative measurement of patellar kinematics. Video article]. DER ORTHOPADE 2016; 45:569-72. [PMID: 27357945 DOI: 10.1007/s00132-016-3285-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Patellofemoral maltracking is a relevant problem after total knee arthroplasty (TKA). Patella navigation is a tool that allows real time monitoring of patella tracking. MATERIAL This video contribution demonstrates the technique of patellofemoral navigation and a possible consequence of intraoperative monitoring. A higher postoperative lateral tilt is addressed with a widening of the lateral retinaculum in a particular manner. CONCLUSION In selected cases of patellofemoral problems, patella navigation is a helpful tool to evaluate patellofemoral tracking intraoperatively. Modifications of implant position and soft tissue measurements can then prevent postoperative patellofemoral maltracking.
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Affiliation(s)
- H-R Springorum
- Orthopädische Universitätsklinik Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland.
| | - C Baier
- Orthopädische Universitätsklinik Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - B Craiovan
- Orthopädische Universitätsklinik Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - G Maderbacher
- Orthopädische Universitätsklinik Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - T Renkawitz
- Orthopädische Universitätsklinik Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - J Grifka
- Orthopädische Universitätsklinik Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - A Keshmiri
- Orthopädische Universitätsklinik Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
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Eskinazi I, Fregly BJ. An Open-Source Toolbox for Surrogate Modeling of Joint Contact Mechanics. IEEE Trans Biomed Eng 2015; 63:269-77. [PMID: 26186761 DOI: 10.1109/tbme.2015.2455510] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
GOAL Incorporation of elastic joint contact models into simulations of human movement could facilitate studying the interactions between muscles, ligaments, and bones. Unfortunately, elastic joint contact models are often too expensive computationally to be used within iterative simulation frameworks. This limitation can be overcome by using fast and accurate surrogate contact models that fit or interpolate input-output data sampled from existing elastic contact models. However, construction of surrogate contact models remains an arduous task. The aim of this paper is to introduce an open-source program called Surrogate Contact Modeling Toolbox (SCMT) that facilitates surrogate contact model creation, evaluation, and use. METHODS SCMT interacts with the third-party software FEBio to perform elastic contact analyses of finite-element models and uses MATLAB to train neural networks that fit the input-output contact data. SCMT features sample point generation for multiple domains, automated sampling, sample point filtering, and surrogate model training and testing. RESULTS An overview of the software is presented along with two example applications. The first example demonstrates creation of surrogate contact models of artificial tibiofemoral and patellofemoral joints and evaluates their computational speed and accuracy, while the second demonstrates the use of surrogate contact models in a forward dynamic simulation of an open-chain leg extension-flexion motion. CONCLUSION SCMT facilitates the creation of computationally fast and accurate surrogate contact models. Additionally, it serves as a bridge between FEBio and OpenSim musculoskeletal modeling software. SIGNIFICANCE Researchers may now create and deploy surrogate models of elastic joint contact with minimal effort.
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