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Kefala V, Ali AA, Hamilton LD, Mannen EM, Shelburne KB. Effects of Weight-Bearing on Tibiofemoral, Patellofemoral, and Patellar Tendon Kinematics in Older Adults. Front Bioeng Biotechnol 2022; 10:820196. [PMID: 35497367 PMCID: PMC9048742 DOI: 10.3389/fbioe.2022.820196] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/08/2022] [Indexed: 11/26/2022] Open
Abstract
Quantification of natural knee kinematics is essential for the assessment of joint function in the diagnosis of pathologies. Combined measurements of tibiofemoral and patellofemoral joint kinematics are necessary because knee pathologies, such as progression of osteoarthritis and patellar instability, are a frequent concern in both articulations. Combined measurement of tibiofemoral and patellofemoral kinematics also enables calculation of important quantities, specifically patellar tendon angle, which partly determines the loading vector at the tibiofemoral joint and patellar tendon moment arm. The goals of this research were to measure the differences in tibiofemoral and patellofemoral kinematics, patellar tendon angle (PTA), and patellar tendon moment arm (PTMA) that occur during non-weight-bearing and weight-bearing activities in older adults. Methods: High-speed stereo radiography was used to measure the kinematics of the tibiofemoral and patellofemoral joints in subjects as they performed seated, non-weight-bearing knee extension and two weight-bearing activities: lunge and chair rise. PTA and PTMA were extracted from the subject’s patellofemoral and tibiofemoral kinematics. Kinematics and the root mean square difference (RMSD) between non-weight-bearing and weight-bearing activities were compared across subjects and activities. Results: Internal rotation increased with weight-bearing (mean RMSD from knee extension was 4.2 ± 2.4° for lunge and 3.6 ± 1.8° for chair rise), and anterior translation was also greater (mean RMSD from knee extension was 2.2 ± 1.2 mm for lunge and 2.3 ± 1.4 mm for chair rise). Patellar tilt and medial–lateral translation changed from non-weight-bearing to weight-bearing. Changes of the patellar tendon from non-weight-bearing to weight-bearing were significant only for PTMA. Conclusions: While weight-bearing elicited changes in knee kinematics, in most degrees of freedoms, these differences were exceeded by intersubject differences. These results provide comparative kinematics for the evaluation of knee pathology and treatment in older adults.
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Affiliation(s)
- Vasiliki Kefala
- Department of Mechanical and Materials Engineering, University of Denver, Denver, CO, United States
| | - Azhar A Ali
- Department of Mechanical and Materials Engineering, University of Denver, Denver, CO, United States
- Stryker Orthopedics, Kalamazoo, MI, United States
| | - Landon D Hamilton
- Department of Mechanical and Materials Engineering, University of Denver, Denver, CO, United States
| | - Erin M Mannen
- Department of Mechanical and Materials Engineering, University of Denver, Denver, CO, United States
- Department of Mechanical and Biomedical Engineering, Boise State University, Boise, ID, United States
| | - Kevin B Shelburne
- Department of Mechanical and Materials Engineering, University of Denver, Denver, CO, United States
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Held MB, Gazgalis A, Sarpong NO, Geller JA, Shah RP, Cooper HJ. Management of the Patella During Total Knee Arthroplasty. JBJS Rev 2021; 9:01874474-202109000-00011. [PMID: 34516451 DOI: 10.2106/jbjs.rvw.21.00054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» The optimal management of the patella during total knee arthroplasty (TKA) remains a controversial topic with no consensus. » Patellar management techniques during TKA include patellar retention or resurfacing with or without patellaplasty, as well as circumferential denervation and partial lateral facetectomy (PLF). » Special considerations such as patient age, etiology of disease, implant design, and surgeon preference should be accounted for when determining optimal management. » We recommend that most patellae be circumferentially denervated, regardless of whether they are resurfaced, as the potential benefits outweigh the small associated risks. » Evidence demonstrates improved functional outcomes with the addition of PLF to nonresurfaced patellae. There is currently a paucity of evidence of this technique with respect to resurfaced patellae. » Patellar resurfacing adds additional costs and health-care resources that should be considered in the decision-making process.
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Affiliation(s)
- Michael B Held
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY
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Başarır K, Karaca MO, Armangil M, Yıldız Y, Esmer T, Esmer AF. Patellar bone stock after extra-articular knee resection preserving extensor mechanism: A cadaveric study. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2020; 54:507-510. [PMID: 33155560 DOI: 10.5152/j.aott.2020.19275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study aimed to evaluate the thickness of the remaining patellar bone stock following extra-articular knee resection (EKR) preserving the extensor mechanism in human cadaveric knee joints. METHODS A total of 14 human cadaveric knee joints (8 men and 2 women) were dissected, and the patellar thickness from the joint capsule insertion to the anterior cortex of the patella was measured using an electronic caliper. The mean age of the cadavers was 37 years (range=28-50). Measurements were performed by an anatomist and an orthopedic surgeon. As the total number of the cadavers was not enough to show the patellar thickness with sampling (sex and age), we endeavored to supplement the content with magnetic resonance images (MRI). Accordingly, the patellar bone thickness was also measured on axial MRI scans of 100 adult and 25 pediatric knees of patients (71 women and 54 men; mean age=36 years; age range=7-67 years) admitted to our hospital in whom meniscal tears were suspected. The rate of specimens with remaining patellar thickness of less than 10 mm after presumed resection was evaluated. The macroscopic measurements in cadavers and MRI measurements in adult knees were compared statistically. RESULTS The mean thickness of the residual patellar bone of the cadaver dissections following a presumed EKR preserving the extensor mechanism was 8.2 mm (range=3.4-15.8). Additionally, in 71.4% (10/14) of the cadaveric knees, the thickness of residual patellar bone was less than 10 mm. In MRI scans, the average thickness of residual patella after presumed resection was 8.6 mm (range: 3.6-16) in adult knees and 6.9 mm (range: 3.4-10) in pediatric knees, and the residual patellar thickness less than 10 mm after presumed resection was determined in 72% of all MRI scans. Macroscopic measurements in cadaveric knees were statistically similar to MRI scan measurements in adult knees (p=0.765, Mann-Whitney U test). CONCLUSION Evidence from this study revealed that the thickness of the remaining patellar bone stock after EKR preserving the extensor mechanism may be low. A preoperative assessment with MRI can guide the surgeon to select the appropriate method for knee resection in order to prevent from the complications of resected patella.
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Affiliation(s)
- Kerem Başarır
- Department of Orthopaedic and Traumatology, Ankara University, İbn-i Sina Hospital, Ankara, Turkey
| | - Mustafa Onur Karaca
- Department of Orthopedics and Traumatology, Ankara University, School of Medicine, Ankara, Turkey
| | - Mehmet Armangil
- Department of Orthopedics and Traumatology, Ankara University, School of Medicine, Ankara, Turkey
| | - Yusuf Yıldız
- Department of Orthopedics and Traumatology, Ankara University, School of Medicine, Ankara, Turkey
| | - Tülin Esmer
- Department of Anatomy, Ankara University, School of Medicine, Ankara, Turkey
| | - Ali Fırat Esmer
- Department of Anatomy, Ankara University, School of Medicine, Ankara, Turkey
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Mannen EM, Ali AA, Dennis DA, Haas BD, Rullkoetter PJ, Shelburne KB. Influence of Component Geometry on Patellar Mechanics in Posterior-Stabilized Rotating Platform Total Knee Arthroplasty. J Arthroplasty 2019; 34:974-980. [PMID: 30777625 DOI: 10.1016/j.arth.2019.01.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 12/10/2018] [Accepted: 01/05/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Patellofemoral complications may cause pain and discomfort, sometimes leading to revision surgery for total knee arthroplasty patients, and patellar implant design has an impact on function of the reconstructed knee. The purpose of this in vivo biomechanics study was to understand the kinematic, functional, strength, and patient-reported outcome data of patients with anatomic and dome patellar implants. METHODS Satisfactory age-matched, gender-matched, and body mass index-matched patients who underwent rotating-platform total knee arthroplasty from one joint replacement system with either dome (n = 16) or anatomic (n = 16) patellar components were tested in a human motion laboratory using high-speed stereoradiography during an unweighted seated knee extension and a weight-bearing lunge activity. Patellar kinematics, range of motion, strength, and patient-reported outcomes were compared between subjects with anatomic or dome component geometry. RESULTS Both groups of patients achieved similar functional knee range of motion and reported similar outcomes and satisfaction. On average, patients with the anatomic component had 36% greater extensor strength compared with dome subjects. Patients with anatomic patellar components demonstrated significantly greater flexion of the patella relative to the femur and lower external rotation during the weighted lunge activity. CONCLUSIONS Relative to the modified dome geometry, patients with anatomic patellar geometry achieved greater patellar flexion which may better replicate normal patellar motion. Patients with anatomic implants may regain more extensor strength compared to patients with dome implants due to geometric differences in the patellar component designs.
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Affiliation(s)
- Erin M Mannen
- Department of Mechanical and Materials Engineering, University of Denver, Denver, CO; Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Azhar A Ali
- Department of Mechanical and Materials Engineering, University of Denver, Denver, CO
| | | | | | - Paul J Rullkoetter
- Department of Mechanical and Materials Engineering, University of Denver, Denver, CO
| | - Kevin B Shelburne
- Department of Mechanical and Materials Engineering, University of Denver, Denver, CO
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Patellar bone strain after total knee arthroplasty is correlated with bone mineral density and body mass index. Med Eng Phys 2019; 68:17-24. [PMID: 30979584 DOI: 10.1016/j.medengphy.2019.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 03/15/2019] [Accepted: 03/31/2019] [Indexed: 11/20/2022]
Abstract
Patella-related complications after total knee arthroplasty (TKA) remain a major clinical concern. Previous studies have suggested that increased postoperative patellar bone strain could be related to such complications, but there is limited knowledge on patellar strain after TKA. The objective of this study was to predict patellar bone strain after TKA and evaluate correlations with various preoperative data. Fourteen TKA patients with a minimum follow-up of one year were included in this study. Using preoperative CT datasets, preoperative planning, and postoperative X-rays, a method is presented to generate patient-specific finite element models after virtual TKA. Patellar kinematics and forces were predicted during a squat movement, and patellar bone strain was evaluated at 60° of knee flexion. Strain varied greatly among patients, but was strongly negatively correlated (r = -0.85, p < 0.001) with bone mineral density (BMD) and moderately positively (r = 0.54, p = 0.05) with body mass index (BMI). The BMI/BMD ratio explained 87% of strain, and should be further investigated as a potential risk factor for clinical complications. This study represents a preliminary step towards the identification of patients at risk of patellar complications after TKA.
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Ali AA, Mannen EM, Rullkoetter PJ, Shelburne KB. In vivo comparison of medialized dome and anatomic patellofemoral geometries using subject-specific computational modeling. J Orthop Res 2018; 36:1910-1918. [PMID: 29411900 PMCID: PMC6081258 DOI: 10.1002/jor.23865] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 01/15/2018] [Indexed: 02/04/2023]
Abstract
Successful outcome following total knee arthroplasty (TKA) with patella resurfacing is partly determined by the restoration of patellofemoral (PF) function and recovery of the quadriceps mechanism. The current study compared two patellar TKA geometries (medialized dome and anatomic) to determine their impact on PF mechanics and quadriceps function. In-vivo, subject-specific patellar mechanics were evaluated using a sequential experimental and modeling approach. First, stereo radiography, marker-based motion capture, and force plate data were collected for TKA patients (10 dome, 10 anatomic) performing a knee extension and lunge. Second, subject-specific, whole-body, musculoskeletal models, including 6 degrees-of-freedom (DOF) knee joint kinematics, were created for each subject and activity to predict quadriceps forces. Last, finite element models of each subject and activity were created to predict PF kinematics, patellar loading, moment arm, and patellar tendon angle. Differences in mechanics between dome and anatomic patients were highlighted during load-bearing (lunge) activity. Anatomic subjects demonstrated greater PF flexion angles (avg. 11 ± 3°) compared to dome subjects during lunge. Similar to the natural knee, contact locations on the patella migrated inferior to superior as the knee flexed in anatomic subjects, but remained relatively superior in dome subjects. Differences in kinematics and contact location likely contributed to altered mechanics with anatomic subjects presenting greater load transfer from the quadriceps to the patellar tendon in deep flexion (>75°), and dome subjects demonstrating larger contact forces during lunge. Although there was substantial patient variability, evaluations of PF mechanics suggested improved quadriceps function and more natural kinematics in the anatomic design. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1910-1918, 2018.
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Affiliation(s)
- Azhar A. Ali
- Center for Orthopaedic Biomechanics, University of Denver, Denver, CO, USA
| | - Erin M. Mannen
- Center for Orthopaedic Biomechanics, University of Denver, Denver, CO, USA
| | | | - Kevin B. Shelburne
- Center for Orthopaedic Biomechanics, University of Denver, Denver, CO, USA
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The role of the patellar tendon angle and patellar flexion angle in the interpretation of sagittal plane kinematics of the knee after knee arthroplasty: A modelling analysis. Knee 2018; 25:240-248. [PMID: 29501390 DOI: 10.1016/j.knee.2018.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 01/05/2018] [Accepted: 01/15/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Many different measures have been used to describe knee kinematics. This study investigated the changes of two measures, the patellar tendon angle and the patellar flexion angle, in response to variations in the geometry of the knee due to surgical technique or implant design. METHODS A mathematical model was developed to calculate the equilibrium position of the extensor mechanism for a particular tibiofemoral position. Calculating the position of the extensor mechanism allowed for the determination of the patellar tendon angle and patellar flexion angle relationships to the knee flexion angle. The model was used to investigate the effect of anterior-posterior position of the femur, change in joint line, patellar thickness (overstuffing, understuffing), and patellar tendon length; these parameters were varied to determine the effect on the patellar tendon angle/knee flexion angle and patellar flexion angle/knee flexion angle relationships. RESULTS The patellar tendon angle was a good indicator of anterior-posterior femoral position and change in patellar thickness, and the patellar flexion angle a good indicator of change in joint line, and patellar tendon length. CONCLUSIONS The patellar tendon angle/knee flexion angle relationship was found to be an effective means of identifying abnormal kinematics post-knee arthroplasty. However, the use of both the patellar tendon angle and patellar flexion angle together provided a more informative overview of the sagittal plane kinematics of the knee.
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8
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Yang CC, Dennis DA, Davenport PG, Kim RH, Miner TM, Johnson DR, Laz PJ. Patellar component design influences size selection and coverage. Knee 2017; 24:460-467. [PMID: 27916578 DOI: 10.1016/j.knee.2016.10.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 07/27/2016] [Accepted: 10/19/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patellofemoral (PF) complications following total knee arthroplasty continue to occur. Outcomes are influenced by implant design, size and alignment in addition to patient factors. The objective of this study was to assess the effect of implant design, specifically round versus oval dome patellar components, on size selected and bony coverage in a population of 100 patients. METHODS Intraoperative assessments of patella component size were performed using surgical guides for round and oval designs. Digital images of the resected patellae with and without guides were calibrated and analyzed to measure bony coverage. Lastly, the medial-lateral location of the median ridge was assessed in the native patella and compared to the positioning of the apex of the patellar implants. RESULTS In 82% of subjects, a larger oval implant was selected compared to a round. Modest, but statistically significant, differences were observed in selected component coverage of the resected patella: 82.7% for oval versus 80.9% for round. Further, positioning of the apex of oval patellar components reproduced the median ridge of the native patella more consistently than for round components. CONCLUSIONS These findings characterized how implant design influenced size selection and coverage in a population of patients. The ability to "upsize" with oval dome components led to increases in bony coverage and better replication of the median ridge compared to round components. Quantifying the interactions between implant design, sizing and coverage for a current implant system in a population of patients supports surgical decision-making and informs the design of future implants.
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Affiliation(s)
- Charlie C Yang
- Colorado Joint Replacement, Centura Health Porter Adventist Hospital, 2535 South Downing Street, Suite 100, Denver, CO 80210, USA
| | - Douglas A Dennis
- Colorado Joint Replacement, Centura Health Porter Adventist Hospital, 2535 South Downing Street, Suite 100, Denver, CO 80210, USA; Center for Orthopaedic Biomechanics, University of Denver, 2390 South York Street, Denver, CO 80208, USA
| | - Patrick G Davenport
- Center for Orthopaedic Biomechanics, University of Denver, 2390 South York Street, Denver, CO 80208, USA
| | - Raymond H Kim
- Colorado Joint Replacement, Centura Health Porter Adventist Hospital, 2535 South Downing Street, Suite 100, Denver, CO 80210, USA; Center for Orthopaedic Biomechanics, University of Denver, 2390 South York Street, Denver, CO 80208, USA
| | - Todd M Miner
- Colorado Joint Replacement, Centura Health Porter Adventist Hospital, 2535 South Downing Street, Suite 100, Denver, CO 80210, USA
| | - Derek R Johnson
- Denver-Vail Orthopedics, 8101 Lowry Blvd #260, Denver, CO 80230, USA
| | - Peter J Laz
- Center for Orthopaedic Biomechanics, University of Denver, 2390 South York Street, Denver, CO 80208, USA.
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Stryker LS, Odum SM, Springer BD, Fehring TK. Role of Patellofemoral Offset in Total Knee Arthroplasty: A Randomized Trial. Orthop Clin North Am 2017; 48:1-7. [PMID: 27886678 DOI: 10.1016/j.ocl.2016.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Total knee arthroplasty occasionally does not meet expectations. This randomized clinical trial assessed the effect of restoration of the native patellofemoral height on clinical outcomes. Group I underwent standard patellar bone resection; group II underwent modified patellar bone resection that adjusted the amount of anterior condylar bone removed and the anterior flange thickness. There were no differences in anterior knee pain, Western Ontario and McMaster Universities Arthritis Index scores, or Knee Injury and Osteoarthritis Outcome Score scores. Patellofemoral compartment height restoration versus patellar height alone does not appear to significantly reduce pain or improve function.
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Affiliation(s)
- Louis S Stryker
- Joint Reconstruction, Department of Orthopaedic Surgery and Rehabilitation, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, MSC-7774, San Antonio, TX 78229, USA
| | - Susan M Odum
- OrthoCarolina Research Institute, 2001 Vail Avenue, Suite 300, Charlotte, NC 28207, USA
| | - Bryan D Springer
- OrthoCarolina Hip & Knee Center, 2001 Vail Avenue, Suite 200A, Charlotte, NC 28207, USA.
| | - Thomas K Fehring
- OrthoCarolina Hip & Knee Center, 2001 Vail Avenue, Suite 200A, Charlotte, NC 28207, USA
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10
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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: 16] [Impact Index Per Article: 2.3] [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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Latypova A, Pioletti D, Terrier A. Importance of trabecular anisotropy in finite element predictions of patellar strain after Total Knee Arthroplasty. Med Eng Phys 2017; 39:102-105. [DOI: 10.1016/j.medengphy.2016.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 10/19/2016] [Accepted: 10/23/2016] [Indexed: 11/26/2022]
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12
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Latypova A, Maquer G, Elankumaran K, Pahr D, Zysset P, Pioletti DP, Terrier A. Identification of elastic properties of human patellae using micro-finite element analysis. J Biomech 2016; 49:3111-3115. [DOI: 10.1016/j.jbiomech.2016.07.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 07/22/2016] [Accepted: 07/26/2016] [Indexed: 11/27/2022]
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13
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Increase of patellofemoral height has decreased maximum knee flexion after total knee arthroplasty of posterior cruciate-substituting prosthesis in a clinical series. J Orthop Sci 2016; 21:458-462. [PMID: 27030643 DOI: 10.1016/j.jos.2016.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 02/23/2016] [Accepted: 02/29/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Biomechanical studies in vitro suggested that patellofemoral (PF) stuffing would cause knee flexion restriction after total knee arthroplasty (TKA). We investigated the effect of anterior PF stuffing on the postoperative knee flexion after cemented TKA of posterior cruciate-substituting (PS) design. METHODS A retrospective review of 140 primary TKAs for osteoarthritis with an average age of 68.5 was conducted. The patella was resurfaced. The height of PF joint and the patella thickness were evaluated radiographically, preoperatively and 2-year postoperatively. RESULTS The maximum flexion angle was 129.7° (standard deviation: SD 16.9) pre-operatively and 129.3° (SD 11.9) 2-year postoperatively. The increase in height was associated with the differences in maximum flexion angle between preoperatively and postoperatively (R = 0.254 P < 0.01). The patella thickness change did not show any significant influences. CONCLUSION The increase in patellofemoral volume has decreased range of motion after total knee arthroplasty of posterior cruciate-substituting prosthesis.
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Latypova A, Arami A, Becce F, Jolles-Haeberli B, Aminian K, Pioletti DP, Terrier A. A patient-specific model of total knee arthroplasty to estimate patellar strain: A case study. Clin Biomech (Bristol, Avon) 2016; 32:212-9. [PMID: 26651475 DOI: 10.1016/j.clinbiomech.2015.11.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 11/19/2015] [Accepted: 11/19/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Inappropriate patellar cut during total knee arthroplasty can lead to patellar complications due to increased bone strain. In this study, we evaluated patellar bone strain of a patient who had a deeper patellar cut than the recommended. METHODS A patient-specific model based on patient preoperative data was created. The model was decoupled into two levels: knee and patella. The knee model predicted kinematics and forces on the patella during squat movement. The patella model used these values to predict bone strain after total knee arthroplasty. Mechanical properties of the patellar bone were identified with micro-finite element modeling testing of cadaveric samples. The model was validated with a robotic knee simulator and postoperative X-rays. For this patient, we compared the deeper patellar cut depth to the recommended one, and evaluated patellar bone volume with octahedral shear strain above 1%. FINDINGS Model predictions were consistent with experimental measurements of the robotic knee simulator and postoperative X-rays. Compared to the recommended cut, the deeper cut increased the critical strain bone volume, but by less than 3% of total patellar volume. INTERPRETATION We thus conclude that the predicted increase in patellar strain should be within an acceptable range, since this patient had no complaints 8 months after surgery. This validated patient-specific model will later be used to address other questions on groups of patients, to eventually improve surgical planning and outcome of total knee arthroplasty.
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Affiliation(s)
- Adeliya Latypova
- Ecole Polytechnique Fédérale de Lausanne (EPFL), Laboratory of Biomechanical Orthopedics, Lausanne, Switzerland
| | - Arash Arami
- Ecole Polytechnique Fédérale de Lausanne (EPFL), Laboratory of Movement Analysis and Measurement, Lausanne, Switzerland
| | - Fabio Becce
- Lausanne University Hospital (CHUV), Department of Diagnostic and Interventional Radiology, Lausanne, Switzerland
| | | | - Kamiar Aminian
- Ecole Polytechnique Fédérale de Lausanne (EPFL), Laboratory of Movement Analysis and Measurement, Lausanne, Switzerland
| | - Dominique P Pioletti
- Ecole Polytechnique Fédérale de Lausanne (EPFL), Laboratory of Biomechanical Orthopedics, Lausanne, Switzerland
| | - Alexandre Terrier
- Ecole Polytechnique Fédérale de Lausanne (EPFL), Laboratory of Biomechanical Orthopedics, Lausanne, Switzerland.
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15
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Smoger LM, Fitzpatrick CK, Clary CW, Cyr AJ, Maletsky LP, Rullkoetter PJ, Laz PJ. Statistical modeling to characterize relationships between knee anatomy and kinematics. J Orthop Res 2015; 33:1620-30. [PMID: 25991502 PMCID: PMC4591110 DOI: 10.1002/jor.22948] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 05/13/2015] [Indexed: 02/04/2023]
Abstract
The mechanics of the knee are complex and dependent on the shape of the articular surfaces and their relative alignment. Insight into how anatomy relates to kinematics can establish biomechanical norms, support the diagnosis and treatment of various pathologies (e.g., patellar maltracking) and inform implant design. Prior studies have used correlations to identify anatomical measures related to specific motions. The objective of this study was to describe relationships between knee anatomy and tibiofemoral (TF) and patellofemoral (PF) kinematics using a statistical shape and function modeling approach. A principal component (PC) analysis was performed on a 20-specimen dataset consisting of shape of the bone and cartilage for the femur, tibia and patella derived from imaging and six-degree-of-freedom TF and PF kinematics from cadaveric testing during a simulated squat. The PC modes characterized links between anatomy and kinematics; the first mode captured scaling and shape changes in the condylar radii and their influence on TF anterior-posterior translation, internal-external rotation, and the location of the femoral lowest point. Subsequent modes described relations in patella shape and alta/baja alignment impacting PF kinematics. The complex interactions described with the data-driven statistical approach provide insight into knee mechanics that is useful clinically and in implant design.
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Affiliation(s)
- Lowell M. Smoger
- Center for Orthopaedic Biomechanics, University of Denver, Denver, CO, USA
| | | | - Chadd W. Clary
- Center for Orthopaedic Biomechanics, University of Denver, Denver, CO, USA,University of Kansas, Lawrence, KS, USA,DePuy Synthes, Warsaw, IN, USA
| | - Adam J. Cyr
- Center for Orthopaedic Biomechanics, University of Denver, Denver, CO, USA,University of Kansas, Lawrence, KS, USA
| | | | | | - Peter J. Laz
- Center for Orthopaedic Biomechanics, University of Denver, Denver, CO, USA
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16
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Effect of patellar thickness on early results of total knee replacement with patellar resurfacing. Knee Surg Sports Traumatol Arthrosc 2014; 22:3093-9. [PMID: 25145946 DOI: 10.1007/s00167-014-3235-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 08/11/2014] [Indexed: 01/17/2023]
Abstract
PURPOSE Patellar thickness is a concern in total knee replacement with patellar resurfacing because of the risk of patellar fracture or implant loosening. The aim of this study was to evaluate if patellar thickness is related to clinical outcome in the absence of patellar fracture or implant loosening. METHODS Early results of 169 patients who underwent total knee replacement with patellar resurfacing were reviewed to assess the effect of patellar thickness on clinical outcome. The mean follow-up was 13 months. The range of motion, Knee Society Score, Function Score and WOMAC Score were assessed preoperatively, at day 0, 6 months and 1 year. Radiographs were assessed for patellar fracture or implant loosening. RESULTS Thirty-one percent of all patients had preoperative thickness <21 mm. Seven percent had <12 mm residual thickness after patellar cut, all were female. Twenty-three percent had ≥1 mm increase of thickness after surgery. Radiographs did not show any patellar fracture or implant loosening. However, preoperative patellar thickness <21 mm had poorer gain in range of motion at 1 year. Preoperative range of motion had greater influence on postoperative range of motion than preoperative patellar thickness. Residual thickness <12 mm had lower gain in WOMAC score at 1 year and an increase in thickness ≥1 mm postoperatively was associated with lower gain in WOMAC score at 6 months. CONCLUSIONS Early results of patellar resurfacing with preoperative thickness <21 mm or residual thickness <12 mm were found to be inferior even in the absence of patellar fracture or implant loosening. Conservative cutting resulting in 1 mm increase in thickness was also found to have inferior clinical results. LEVEL OF EVIDENCE II.
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17
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Galbusera F, Freutel M, Dürselen L, D'Aiuto M, Croce D, Villa T, Sansone V, Innocenti B. Material models and properties in the finite element analysis of knee ligaments: a literature review. Front Bioeng Biotechnol 2014; 2:54. [PMID: 25478560 PMCID: PMC4235075 DOI: 10.3389/fbioe.2014.00054] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 10/27/2014] [Indexed: 11/13/2022] Open
Abstract
Knee ligaments are elastic bands of soft tissue with a complex microstructure and biomechanics, which are critical to determine the kinematics as well as the stress bearing behavior of the knee joint. Their correct implementation in terms of material models and properties is therefore necessary in the development of finite element models of the knee, which has been performed for decades for the investigation of both its basic biomechanics and the development of replacement implants and repair strategies for degenerative and traumatic pathologies. Indeed, a wide range of element types and material models has been used to represent knee ligaments, ranging from elastic unidimensional elements to complex hyperelastic three-dimensional structures with anatomically realistic shapes. This paper systematically reviews literature studies, which described finite element models of the knee, and summarizes the approaches, which have been used to model the ligaments highlighting their strengths and weaknesses.
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Affiliation(s)
| | - Maren Freutel
- Center of Musculoskeletal Research Ulm (ZMFU), Institute of Orthopedic Research and Biomechanics, Ulm University , Ulm , Germany
| | - Lutz Dürselen
- Center of Musculoskeletal Research Ulm (ZMFU), Institute of Orthopedic Research and Biomechanics, Ulm University , Ulm , Germany
| | - Marta D'Aiuto
- Department of Chemistry, Materials and Chemical Engineering, Politecnico di Milano , Milan , Italy
| | - Davide Croce
- Department of Chemistry, Materials and Chemical Engineering, Politecnico di Milano , Milan , Italy
| | - Tomaso Villa
- IRCCS Istituto Ortopedico Galeazzi , Milan , Italy ; Department of Chemistry, Materials and Chemical Engineering, Politecnico di Milano , Milan , Italy
| | - Valerio Sansone
- IRCCS Istituto Ortopedico Galeazzi , Milan , Italy ; Department of Orthopaedic, Università degli Studi di Milano , Milan , Italy
| | - Bernardo Innocenti
- BEAMS Department (Bio Electro and Mechanical Systems), École Polytechnique de Bruxelles, Université Libre de Bruxelles , Brussels , Belgium
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