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Grela M, Barrett M, Kunutsor SK, Blom AW, Whitehouse MR, Matharu GS. Clinical effectiveness of patellar resurfacing, no resurfacing and selective resurfacing in primary total knee replacement: systematic review and meta-analysis of interventional and observational evidence. BMC Musculoskelet Disord 2022; 23:932. [PMID: 36273138 PMCID: PMC9587662 DOI: 10.1186/s12891-022-05877-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 09/26/2022] [Indexed: 11/10/2022] Open
Abstract
Background Patellar resurfacing is optional during total knee replacement (TKR). Some surgeons always resurface the patella, some never resurface, and others selectively resurface. Which resurfacing strategy provides optimal outcomes is unclear. We assessed the effectiveness of patellar resurfacing, no resurfacing, and selective resurfacing in primary TKR. Methods A systematic review and meta-analysis was performed. MEDLINE, Embase, Web of Science, The Cochrane Library, and bibliographies were searched to November 2021 for randomised-control trials (RCTs) comparing outcomes for two or more resurfacing strategies (resurfacing, no resurfacing, or selective resurfacing) in primary TKR. Observational studies were included if limited or no RCTs existed for resurfacing comparisons. Outcomes assessed were patient reported outcome measures (PROMs), complications, and further surgery. Study-specific relative risks [RR] were aggregated using random-effects models. Quality of the evidence was assessed using GRADE. Results We identified 33 RCTs involving 5,540 TKRs (2,727 = resurfacing, 2,772 = no resurfacing, 41 = selective resurfacing). One trial reported on selective resurfacing. Patellar resurfacing reduced anterior knee pain compared with no resurfacing (RR = 0.65 (95% CI = 0.44–0.96)); there were no significant differences in PROMs. Resurfacing reduced the risk of revision surgery (RR = 0.63, CI = 0.42–0.94) and other complications (RR = 0.54, CI = 0.39–0.74) compared with no resurfacing. Quality of evidence ranged from high to very low. Limited observational evidence (5 studies, TKRs = 215,419) suggested selective resurfacing increased the revision risk (RR = 1.14, CI = 1.05–1.22) compared with resurfacing. Compared with no resurfacing, selective resurfacing had a higher risk of pain (RR = 1.25, CI = 1.04–1.50) and lower risk of revision (RR = 0.92, CI = 0.85–0.99). Conclusions Level 1 evidence supports TKR with patellar resurfacing over no resurfacing. Resurfacing has a reduced risk of anterior knee pain, revision surgery, and complications, despite PROMs being comparable. High-quality RCTs involving selective resurfacing, the most common strategy in the UK and other countries, are needed given the limited observational data suggests selective resurfacing may not be effective over other strategies. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05877-7.
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Affiliation(s)
- Michal Grela
- Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Level 1 Learning and Research Building, Southmead Hospital, Westbury-On-Trym, Bristol, BS10 5NB, UK
| | - Matthew Barrett
- Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Level 1 Learning and Research Building, Southmead Hospital, Westbury-On-Trym, Bristol, BS10 5NB, UK
| | - Setor K Kunutsor
- Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Level 1 Learning and Research Building, Southmead Hospital, Westbury-On-Trym, Bristol, BS10 5NB, UK.,National Institute for Health Research Bristol Biomedical Research Centre, Bristol, UK
| | - Ashley W Blom
- Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Level 1 Learning and Research Building, Southmead Hospital, Westbury-On-Trym, Bristol, BS10 5NB, UK.,National Institute for Health Research Bristol Biomedical Research Centre, Bristol, UK
| | - Michael R Whitehouse
- Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Level 1 Learning and Research Building, Southmead Hospital, Westbury-On-Trym, Bristol, BS10 5NB, UK.,National Institute for Health Research Bristol Biomedical Research Centre, Bristol, UK
| | - Gulraj S Matharu
- Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Level 1 Learning and Research Building, Southmead Hospital, Westbury-On-Trym, Bristol, BS10 5NB, UK.
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Maney AJ, Koh CK, Frampton CM, Young SW. Usually, Selectively, or Rarely Resurfacing the Patella During Primary Total Knee Arthroplasty: Determining the Best Strategy. J Bone Joint Surg Am 2019; 101:412-420. [PMID: 30845035 DOI: 10.2106/jbjs.18.00389] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Surgeons may "usually" resurface the patella during total knee arthroplasty (TKA), "rarely" resurface, or "selectively" resurface on the basis of certain criteria. It is unknown which of these 3 strategies yields superior outcomes. Utilizing New Zealand Joint Registry data, we investigated (1) what proportion of surgeons employs each of the 3 patellar resurfacing strategies, (2) which strategy is associated with the lowest overall revision rate, and (3) which strategy is associated with the highest 6-month and 5-year Oxford Knee Score (OKS). METHODS Two hundred and three surgeons who performed a total of 57,766 primary TKAs from 1999 to 2015 were categorized into the 3 surgeon strategies on the basis of how often they resurfaced the patella during primary total knee arthroplasty; with "rarely" defined as <10% of the time, "selectively" as ≥10% to ≤90%, and "usually" as >90%. For each strategy, the cumulative incidence of all-cause revision was calculated and utilized to construct Kaplan-Meier survival curves. The mean 6-month and 5-year postoperative OKS for each group were utilized for comparison. RESULTS Overall, 57% of surgeons selectively resurfaced, 37% rarely resurfaced, and 7% usually resurfaced. The usually resurfacing group was associated with the highest mean OKS at both 6 months (38.57; p < 0.001) and 5 years postoperatively (41.34; p = 0.029), followed by the selectively resurfacing group (6-month OKS, 37.79; 5-year OKS, 40.87) and the rarely resurfacing group (6-month OKS, 36.92; 5-year OKS, 40.02). Overall, there was no difference in the revision rate per 100 component years among the rarely (0.46), selectively (0.52), or usually (0.46) resurfacing groups (p = 0.587). Posterior-stabilized TKAs that were performed by surgeons who selectively resurfaced had a lower revision rate (0.54) than those by surgeons who usually resurfaced (0.64) or rarely resurfaced (0.74; p < 0.001). CONCLUSIONS Usually resurfacing the patella was associated with improved patient-reported outcomes, but there was no difference in overall revision rates among the 3 strategies. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
| | - Chuan K Koh
- Department of Orthopaedic Surgery, Southland Hospital, Invercargill, New Zealand
| | | | - Simon W Young
- Department of Orthopaedic Surgery, North Shore Hospital, Auckland, New Zealand
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Iwata A, Sano Y, Wanaka H, Yamamoto S, Yano Y, Iwata H. Different improvement trends in gait function and quadriceps strength early after total knee arthroplasty. J Phys Ther Sci 2019; 31:57-62. [PMID: 30774206 PMCID: PMC6348170 DOI: 10.1589/jpts.31.57] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 10/07/2018] [Indexed: 01/12/2023] Open
Abstract
[Purpose] Improved quadriceps strength is a primary target of rehabilitation early after total knee arthroplasty. However, patients demonstrate varying improvement trends in gait function and quadriceps strength. This study evaluated the relationship between improvements in quadriceps strength and gait function. [Participants and Methods] The study included 49 patients who were scheduled to undergo unilateral total knee arthroplasty. Gait function, bilateral quadriceps strength, and pain were assessed in all patients. All assessments were performed preoperatively and at 2 and 3 weeks postoperatively. [Results] A significant correlation between gait function and the quadriceps strength on the operated side was observed preoperatively and 3 weeks postoperatively. The quadriceps strength on the non-operated side was significantly correlated with gait function at all time points. Multiple regression analysis showed that the quadriceps strength on the non-operated side was significantly associated with gait function, except the gait speed at 2 weeks. However, the quadriceps strength on the operated side was not observed to be an independent variable at all time points. [Conclusion] The quadriceps strength on the operated side is not an important determinant of gait function. It may be necessary to reconsider typical rehabilitation programs by focusing on the quadriceps strength on the operated side in patients undergoing total knee arthroplasty.
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Affiliation(s)
- Akira Iwata
- Department of Physical Therapy, Faculty of Comprehensive Rehabilitation, Osaka Prefecture University: 3-7-30 Habikino, Habikino city, Osaka 583-8555, Japan
| | - Yuki Sano
- Department of Rehabilitation, Osaka General Medical Center, Japan
| | - Hideyuki Wanaka
- Department of Rehabilitation, Osaka General Medical Center, Japan
| | - Saki Yamamoto
- Department of Physical Therapy, Faculty of Comprehensive Rehabilitation, Osaka Prefecture University: 3-7-30 Habikino, Habikino city, Osaka 583-8555, Japan
| | - Yuki Yano
- Department of Physical Therapy, Faculty of Comprehensive Rehabilitation, Osaka Prefecture University: 3-7-30 Habikino, Habikino city, Osaka 583-8555, Japan
| | - Hiroshi Iwata
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Japan
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Inoue A, Arai Y, Nakagawa S, Inoue H, Yoshihara Y, Yamazoe S, Kubo T. Differences in patellofemoral alignment as a result of patellar shape in cruciate-retaining total knee arthroplasty without patellar resurfacing at a minimum three-year follow-up. Knee 2017; 24:1448-1453. [PMID: 28974398 DOI: 10.1016/j.knee.2017.08.050] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 07/01/2017] [Accepted: 08/10/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Although the patellofemoral (PF) joint shape of the femoral implant in a particular prosthetic design is identical, the articular surface shape of the patella varies between individuals. The present study investigated the effects of patellar shape on the postoperative PF joint in a cruciate-retaining total knee arthroplasty (CR-TKA) without patellar resurfacing and with at least three years of follow-up. METHODS This study investigated 76 knees of 62 patients who underwent CR-TKA without patellar resurfacing for varus osteoarthritis. Shape of the patella was classified in terms of the patellar facet angle (angle formed by the medial and lateral articular surfaces) as measured on axial plain X-ray. Subjects were divided into Group A with patellar facet angle ≤126° (34 knees) and Group B with patellar facet angle >126° (42 knees). RESULTS Anterior knee pain (AKP) was evident in four knees in Group A and one knee in Group B. Postoperative lateral patellar tilt angle was significantly larger in Group A than in Group B. Progression of osteosclerosis in the patella was present in 12 knees in Group A and three knees in Group B. CONCLUSION This study found that for a patella with a small patellar facet angle, lateral tilt of the patella was significantly increased after TKA, and a high rate of osteosclerosis was evident at >3years after operation. Performing TKA without patellar resurfacing on a patella with a small patellar facet angle may entail a higher risk of postoperative AKP; pre-operative evaluation of the shape of the patella is therefore important.
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Affiliation(s)
- Atsuo Inoue
- Department of Orthopaedics, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto Japan; Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto Japan
| | - Yuji Arai
- Department of Sports and Para-Sports Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto Japan.
| | - Shuji Nakagawa
- Department of Sports and Para-Sports Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto Japan
| | - Hiroaki Inoue
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto Japan
| | - Yasushi Yoshihara
- Department of Orthopaedics, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto Japan; Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto Japan
| | - Shouichi Yamazoe
- Department of Orthopaedics, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto Japan; Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto Japan
| | - Toshikazu Kubo
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto Japan
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Iriuchishima T, Ryu K, Murakami T, Yorifuji H. The correlation between femoral sulcus morphology and osteoarthritic changes in the patello-femoral joint. Knee Surg Sports Traumatol Arthrosc 2017; 25:2715-2720. [PMID: 26040655 DOI: 10.1007/s00167-015-3662-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 05/27/2015] [Indexed: 01/30/2023]
Abstract
PURPOSE The purpose of this study was to reveal the correlation between the type of lesion and the depth of osteoarthritic (OA) changes in the patello-femoral (PF) joint and its bony morphological characteristics using computed tomography (CT) data. METHODS Eighty-seven cadaveric knees were included in this study with median age of 83 years (62-97). OA depth evaluation was performed following Outerbridge's classification. Patella OA lesions were classified macroscopically using Han's method: type (1) no or minimal lesion, type (2) medial facet lesion without involvement of the ridge, type (3) lateral facet lesion without involvement of the ridge, type (4) lesion involving the ridge only, type (5) medial facet lesion with involvement of the ridge, type (6) lateral facet lesion with involvement of the ridge, and type (7) global lesion. Femoral-side OA lesions in the PF joint were classified using a modified Chang's method. Type (1) no or minimal lesion, type (2) medial facet lesion, type (3) centre of patella groove lesion, type (4) lateral facet lesion, and type (5) global lesion. Whole-body CTs of all cadavers were taken before knee dissection. Using the CT data, patella morphology was evaluated following Wiberg's classification. Femoral sulcus angle (SA), sulcus depth (SD), and sulcus width (SW) were also measured using CT data. RESULTS The measured SA, SD, and SW were 144.8° ± 7.2°, 7.0 ± 1.6 mm and 3.4 ± 0.3 mm, respectively. When patella OA depth was divided into grades 1-2 (n = 30) and grades 3-4 (n = 57), the SD of grade 1-2 knees was 6.5 ± 1.3 mm, and the SD of grade 3-4 knees was 7.3 ± 1.6 mm, constituting a significant difference (p = 0.01). No significant difference in either SA or SW was observed between the two groups. Patella OA lesion, femoral-side OA lesion, and depth were not affected by SA, SD, or SW. Wiberg's classification also showed no significant correlation with PF-OA. CONCLUSION Deep SD was significantly correlated with the incidence of severe patella OA. Wiberg's classification, SA, and SW were not correlated with PF-OA. For clinical relevance, there is a risk of PF-OA progression in patients with deep SD, and treatment should be applied accordingly.
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Affiliation(s)
| | - Keinosuke Ryu
- Department of Orthopaedic Surgery, Nihon University Hospital, Tokyo, Japan
| | - Tohru Murakami
- Departments of Anatomy, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Hiroshi Yorifuji
- Departments of Anatomy, Gunma University Graduate School of Medicine, Gunma, Japan
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Yaari L, Kosashvili Y, Segal G, Shemesh S, Velkes S, Mor A, Debi R, Bernfeld B, Elbaz A. A Novel Non-Invasive Adjuvant Biomechanical Treatment for Patients with Altered Rehabilitation after Total Knee Arthroplasty: Results of a Pilot Investigation. Clin Orthop Surg 2015. [PMID: 26217465 PMCID: PMC4515459 DOI: 10.4055/cios.2015.7.2.191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Many factors contribute to suboptimal results after total knee arthroplasty (TKA) but little is known regarding the value of postsurgical rehabilitation after TKA. We examined the effects of an enhanced closed kinematic chain exercises program (AposTherapy) on gait patterns and clinical outcomes among patients with a lack of progress in their postsurgical rehabilitation. METHODS Twenty-two patients were prospectively followed during the study. Gait spatiotemporal parameters were measured at the initial evaluation, after 15 minutes of therapy, and after 3 months of therapy. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the short form (SF) 36 health survey were completed by patients before treatment and after 3 months of treatment. RESULTS The WOMAC and SF-36 scores improved significantly after 3 months of treatment. Gait velocity, single limb support, and step length of the operated leg improved significantly even after a single 15 minutes treatment. Normal gait velocity was observed in 36% of patients after 3 months of treatment. CONCLUSIONS A physiotherapy program that included enhanced closed kinematic chain biomechanical therapy was beneficial for patients who experienced a suboptimal rehabilitation course after TKA.
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Affiliation(s)
- Lee Yaari
- Department of Orthopedic Surgery, Rabin Medical Center, Petah Tikva, Israel
| | - Yona Kosashvili
- Department of Orthopedic Surgery, Rabin Medical Center, Petah Tikva, Israel
| | - Ganit Segal
- AposTherapy Research Group, Herzliya, Israel
| | - Shai Shemesh
- Department of Orthopedic Surgery, Rabin Medical Center, Petah Tikva, Israel
| | - Steven Velkes
- Department of Orthopedic Surgery, Rabin Medical Center, Petah Tikva, Israel
| | - Amit Mor
- AposTherapy Research Group, Herzliya, Israel
| | - Ronen Debi
- Department of Orthopedic Surgery, Barzilay Medical Center, Ashkelon, Israel
| | - Benjamin Bernfeld
- Department of Orthopedic Surgery, Carmel Medical Center, Haifa, Israel
| | - Avi Elbaz
- AposTherapy Research Group, Herzliya, Israel
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7
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Determinants of anterior knee pain following total knee replacement: a systematic review. Knee Surg Sports Traumatol Arthrosc 2014; 22:478-99. [PMID: 23160846 DOI: 10.1007/s00167-012-2294-x] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2012] [Accepted: 10/25/2012] [Indexed: 12/13/2022]
Abstract
PURPOSE Anterior knee pain (AKP) following total knee replacement (TKR) is both prevalent and clinically relevant. The purpose of this study was to systematically review the peer-reviewed literature, and to identify and assess the different modifiable and non-modifiable determinants that may be associated with the development of AKP in patients following primary TKR. METHODS A systematic computerized database search (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and Google Scholar) was performed in January 2012. The quality of the studies was assessed using the GRADE approach. RESULTS A total of 54 articles met the inclusion criteria. Variables that have been researched with regard to the prevalence of AKP include patient and knee-specific characteristics, prosthetic design, operative technique, treatment of the patella, and time of assessment. A weak correlation with AKP was found for specific retained presurgery gait patterns. A weak recommendation can be given for the use of femoral components with a posterior centre of rotation, resection of Hoffa's fat pad, patellar rim electrocautery, and preventing combined component internal rotation. The correlation between postsurgical AKP and the degree of patellar cartilage wear, tibial component bearing strategies, and patellar resurfacing is inconclusive. Due to substantial heterogeneity of the included studies, no meta-analysis was performed. CONCLUSIONS No single variable is likely to explain the differences in the reported rates of AKP, although variables leading to abnormal patellofemoral joint loading appear to be of special significance. LEVEL OF EVIDENCE III.
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Iriuchishima T, Ryu K, Aizawa S, Yorifuji H. Cadaveric assessment of osteoarthritic changes in the patello-femoral joint: evaluation of 203 knees. Knee Surg Sports Traumatol Arthrosc 2013; 21:2172-6. [PMID: 23212186 DOI: 10.1007/s00167-012-2308-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Accepted: 11/19/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE The purpose of this study was to determine the prevalence, type of lesion, and depth of osteoarthritic (OA) changes in the patello-femoral (PF) joint. METHODS Two hundred and three cadaveric knees were included in this study with median age of 84 years (54-97). Patella OA lesions were classified using Han's method: (Type 1) no or minimal lesion, (Type 2) medial facet lesion without involvement of the ridge, (Type 3) lateral facet lesion without involvement of the ridge, (Type 4) lesion involvement of the ridge, (Type 5) medial facet lesion with involvement of the ridge, (Type 6) lateral facet lesion with involvement of the ridge, (Type 7) global lesion. Femoral side OA lesions in the PF joint were classified using modified Chang's method: (Type 1) no or minimal lesion, (Type 2) medial facet lesion, (Type 3) centre of patella groove lesion, (Type 4) lateral facet lesion, (Type 5) global lesion. OA depth evaluation was performed following Outerbridge's classification. RESULTS OA lesions of the patella were observed as follows: (Type 1) 31%, (Type 2) 16%, (Type 3) 3%, (Type 4) 12%, (Type 5) 22%, (Type 6) 2%, (Type 7) 14%. Outerbridge's classification of over Grade 2 OA depth was observed in 75.9% of subjects. Femoral side OA lesions of the PF joint were observed as follows: (Type 1) 42%, (Type 2) 20%, (Type 3) 26%, (Type 4) 2%, (Type 5) 11%. Outerbridge's classification of over Grade 2 OA depth was observed in 58% of subjects. CONCLUSION Patella OA and femoral side OA in the PF joint occurred mainly on the medial side. Isolated OA in the lateral facet of the PF joint was exceedingly rare. Female subjects had a greater incidence of severe PF-OA than male subjects, and therefore, the physicians should pay attention when they treat the female subjects not to advance the PF-OA.
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Affiliation(s)
- Takanori Iriuchishima
- Department of Rehabilitation Medicine, Division of Rehabilitation Medicine, Gunma University Hospital, Showa-machi 3-39-15, Maebashi City, Gunma, Japan.
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9
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Li B, Bai L, Fu Y, Wang G, He M, Wang J. Comparison of clinical outcomes between patellar resurfacing and nonresurfacing in total knee arthroplasty: retrospective study of 130 cases. J Int Med Res 2013. [PMID: 23206460 DOI: 10.1177/030006051204000517] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To compare clinical outcomes between patellar resurfacing and nonresurfacing in total knee arthroplasty (TKA). METHODS Data from osteoarthritis patients who underwent TKA and were followed up for ≥ 9 years were analysed retrospectively. Patients were divided into two groups: patellar nonresurfacing group and patellar resurfacing group. In the nonresurfacing group, the partial lateral facet of the patella was removed, the patella was reshaped to match the trochlea of the femoral prosthesis and circumpatellar denervation was performed. In the resurfacing group, the patella was resurfaced with a cemented component. Clinical outcomes included incidence of anterior knee pain, Knee Society Score, patient satisfaction, revision rate and radiographic findings. RESULTS Of the 130 patients included, 71 were assigned to the nonresurfacing group and 59 to the resurfacing group. No significant between-group differences were observed for any clinical outcomes measured. The incidence of anterior knee pain was 14.1% (nonresurfacing group) and 5.1% (resurfacing group). The revision rate was 9.89% (nonresurfacing group) and 3.4% (resurfacing group). CONCLUSION Clinical outcomes for patellar nonresurfacing, including patelloplasty and circumpatellar denervation, are similar to those for patellar resurfacing, in TKA.
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Affiliation(s)
- B Li
- Department of Joint Surgery and Sports Medicine, Shengjing Hospital, China Medical University, Shenyang, Liaoning Province, China
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Iriuchishima T, Ryu K, Aizawa S, Yorifuji H, Shirakura K. Evaluation of the prevalence, lesion, and depth of osteoarthritic changes in the patella. Knee Surg Sports Traumatol Arthrosc 2012; 20:2460-4. [PMID: 22258656 DOI: 10.1007/s00167-012-1894-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2011] [Accepted: 01/10/2012] [Indexed: 01/30/2023]
Abstract
PURPOSE The aim of this study was to determine the prevalence, type of lesion, and depth of osteoarthritic (OA) changes in the patella. METHODS One hundred and forty-six cadaveric knees were included in this study with an median age of 83 years (54-97). Patella OA lesion was classified using Han's method: Type 1, no or minimal lesion; Type 2, medial facet lesion without involvement of the ridge; Type 3, lateral facet lesion without involvement of the ridge; Type 4, lesion involvement of the ridge; Type 5, medial facet lesion with involvement of the ridge, Type 6, lateral facet lesion with involvement of the ridge; and Type 7, Global lesion. The depth of OA evaluation was performed following Outerbridge's classification. RESULTS OA lesions were observed as follows: (Type 1) 31%, (Type 2) 16%, (Type 3) 3%, (Type 4) 12%, (Type 5) 22%, (Type 6) 2%, and (Type 7) 14%. Outerbridge's classification of over Grade 2 OA depth was observed in 63.7% of subjects. A significant difference of patella OA type in gender was observed. Severe patella OA occurred in female subjects. Greater depth of OA was observed in Types 5 and 7. Most OA occurred in the medial facet of the patella including the ridge. Isolated OA in the lateral facet of the patella was observed in only 2% of all knees. CONCLUSION There is a risk of patella OA in female subjects. Patella OA occurred mainly on the medial side. Isolated OA in the lateral facet of the patella was rare. 63.7% of subjects had patella OA. LEVEL OF EVIDENCE Controlled laboratory study, Level III.
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Affiliation(s)
- Takanori Iriuchishima
- Division of Rehabilitation Medicine, Gunma University Hospital, Maebashi City, Showa-Machi 3-39-15, Gunma, Japan
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He JY, Jiang LS, Dai LY. Is patellar resurfacing superior than nonresurfacing in total knee arthroplasty? A meta-analysis of randomized trials. Knee 2011; 18:137-44. [PMID: 20493712 DOI: 10.1016/j.knee.2010.04.004] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2010] [Revised: 03/10/2010] [Accepted: 04/23/2010] [Indexed: 02/02/2023]
Abstract
Conflicting results from abundant studies have made it unclear whether the patella should be resurfaced during total knee replacement. A meta-analysis was undertaken to pool the results of randomized controlled studies (RCTs) and to compare the outcomes and postoperative complications after total knee arthroplasty with patellar resurfacing or nonresurfacing. Sixteen RCTs including 3034 knees between 1966 and December 2009 were analyzed. Reoperation for patellofemoral problems was significantly more likely in the nonresurfacing group (P = 0.03). There was no difference between the two groups in terms of anterior knee pain rate, knee pain score, knee society score and knee function score. The results indicate that patellar resurfacing would reduce the risk of reoperation after total knee replacement, but it seems that the benefits are limited on other aspects, and the analysis of high-quality studies shows no advantage of resurfacing over nonresurfacoing group, even in the aspect of reoperation risk. More carefully and scientifically designed RCTs are beneficial and necessary to further prove the results.
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Affiliation(s)
- Ji-Ye He
- Department of Orthopaedic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
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Yoshida Y, Mizner RL, Ramsey DK, Snyder-Mackler L. Examining outcomes from total knee arthroplasty and the relationship between quadriceps strength and knee function over time. Clin Biomech (Bristol, Avon) 2008; 23:320-8. [PMID: 18060669 PMCID: PMC2293974 DOI: 10.1016/j.clinbiomech.2007.10.008] [Citation(s) in RCA: 198] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2007] [Revised: 08/31/2007] [Accepted: 10/17/2007] [Indexed: 02/07/2023]
Abstract
BACKGROUND Temporal-spatial gait parameters improve following total knee arthroplasty (TKA) but lower limb kinematics and moments fail to match those of age-matched healthy individuals. The aim of this study was to determine whether quadriceps strength, clinical measures of knee function, lower limb kinematics, and joint moments improve following arthroplasty and normalize over time. METHODS Twelve patients underwent total knee arthroplasty were tested at 3 and 12 months following surgery. Twelve matched controls were also tested. All underwent quadriceps strength testing and gait analysis to calculate knee joint kinematics and kinetics. Function was assessed using clinical tests and self-report. FINDINGS All clinical measures except for quadriceps strength significantly improved from 3 to 12 months. Gait asymmetry was observed at 3 months (lower stance times, peak knee flexion angle, range of motion and vertical ground reaction force), but ankle, knee and hip moments contributing to the total limb support moment were equivalent between legs. At 12 months, gait speed remained significantly slower than controls. Inter-limb differences in peak knee flexion angle and range of motion persisted. Greater hip and lower knee moments were evident in the operated limb, compared to the non-operated limb and controls. Quadriceps strength was positively correlated with faster times on the Time Up and Go and Stair Climbing Test and greater distances during the 6 Minute Walk test. INTERPRETATION Patients who have undergone TKA demonstrate improvements in function as measured by self-report and functional performance measures. Gait becomes more symmetric and quadriceps strength becomes stronger. Some approached the values of healthy control subjects. Important differences still remain however. The larger hip extensor contribution to the total support moment may be to compensate for the diminished knee extensor contribution during level walking. Since instrumented gait analysis and functional performance measures appear to reflect different aspects of recovery following total knee replacement, both should be considered when evaluating gait and function.
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Affiliation(s)
- Yuri Yoshida
- Department of Physical Therapy, Graduate Program in Biomechanics and Movement Sciences, and Center for Biomedical Engineering Research University of Delaware, Newark, DE 19716, USA
| | - Ryan L Mizner
- Department of Physical Therapy, Graduate Program in Biomechanics and Movement Sciences, and Center for Biomedical Engineering Research University of Delaware, Newark, DE 19716, USA, Department of Physical Therapy, Eastern Washington University, Spokane, WA 99202, USA
| | - Dan K Ramsey
- Department of Physical Therapy, Graduate Program in Biomechanics and Movement Sciences, and Center for Biomedical Engineering Research University of Delaware, Newark, DE 19716, USA, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY 14214, USA
| | - Lynn Snyder-Mackler
- Department of Physical Therapy, Graduate Program in Biomechanics and Movement Sciences, and Center for Biomedical Engineering Research University of Delaware, Newark, DE 19716, USA
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Xu C, Chu X, Wu H. Effects of patellar resurfacing on contact area and contact stress in total knee arthroplasty. Knee 2007; 14:183-7. [PMID: 17344046 DOI: 10.1016/j.knee.2007.01.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2006] [Revised: 12/25/2006] [Accepted: 01/22/2007] [Indexed: 02/02/2023]
Abstract
The objective of this study was to examine the effects of patellar resurfacing on patellofemoral joint contact pressure and contact area in total knee arthroplasty. We tested seven fresh-frozen cadaveric knees using a custom knee jig which permits the simulation of physiologic quadriceps loading. Before patellar resurfacing, the mean peak contact pressure of medial and lateral patellofemoral joints was less than 10 MPa at knee flexion angles of 30 degrees, 60 degrees and 90 degrees, that of medial and lateral patellofemoral joints were 11.63 MPa and 11.42 MPa at a knee flexion angle of 120 degrees respectively, and the mean contact area of patellofemoral joint ranged from 70 to 150 mm2. After patellar resurfacing, the mean peak contact pressure of medial and lateral patellofemoral joints ranged from 50 to 100 Mpa (P<0.05), which exceeds the yield strength of ultrahigh molecular weight polyethylene, and the mean contact area of patellofemoral joint reduced to 10-15 mm2 (P<0.05). The contact pressure of patellofemoral joint was lower than the yield strength of articular cartilage before patellar resurfacing. Our results indicate that the yield stress of UHMWPE is exceeded after patellar resurfacing.
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Affiliation(s)
- Changming Xu
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, 405 Feng Yang Road, Shanghai 200003, PR China
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14
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Berti L, Benedetti MG, Ensini A, Catani F, Giannini S. Clinical and biomechanical assessment of patella resurfacing in total knee arthroplasty. Clin Biomech (Bristol, Avon) 2006; 21:610-6. [PMID: 16516359 DOI: 10.1016/j.clinbiomech.2006.01.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2005] [Revised: 12/07/2005] [Accepted: 01/10/2006] [Indexed: 02/07/2023]
Abstract
BACKGROUND Currently there is a limited understanding of the factors influencing range of motion by comparing patellar resurfacing vs non-resurfacing in total knee arthroplasty during activities of daily living. A recent meta-analysis of patellar replacement confirms better outcome with patella resurfacing; however, the result can be influenced by many other factors, such as: component design, surgeon experience, and technical aspects of the surgery. This study compares the biomechanics of the knee in patients after total knee arthroplasty with and without patellar resurfacing during stair climbing. METHODS Forty-seven patients with total knee arthroplasty were assessed at the mean follow-up of 24 months. In all of them a posterior stabilised fixed bearing prosthesis (Optetrak PS, Exactech) was implanted. Twenty-six patients were treated without patellar resurfacing and 21 with patellar resurfacing. Clinical evaluations were performed using the International Knee Society and the Hospital for Special Surgery scores. Ten patients with patellar resurfacing and 10 patients without patellar resurfacing were also studied with motion analysis during stair climbing; 10 healthy subjects were studied for statistical comparison. FINDINGS Clinical passive knee flexion, International Knee Society Function and Hospital for Special Surgery scores were significantly higher in the patellar resurfacing group. During stair climbing, active knee joint range of motion during the stance phase was greater in patients with patellar resurfacing. The maximum adduction moment was significantly higher in the group without patellar resurfacing. INTERPRETATION Patients with patellar resurfacing demonstrated better clinical scores, and kinematic and kinetic data while ascending stairs.
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Affiliation(s)
- Lisa Berti
- Movement Analysis Laboratory, Department of Orthopaedic Surgery, Istituti Ortopedici Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy.
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Han I, Chang CB, Kang YG, Yoon SW, Seong SC, Kim TK. Intraobserver and interobserver reliability of the assessment of the patellar articular cartilage in osteoarthritic patients undergoing total knee arthroplasty. J Arthroplasty 2006; 21:567-71. [PMID: 16781411 DOI: 10.1016/j.arth.2005.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2004] [Accepted: 06/23/2005] [Indexed: 02/01/2023] Open
Abstract
This study was performed to investigate intraobserver and interobserver reliability of the intraoperative assessment of patellar cartilage status and the decision on patellar resurfacing based on the cartilage assessment in osteoarthritic patients undergoing total knee arthroplasty. Photographs of patellar cartilage were taken in 80 knees of 53 patients undergoing total knee arthroplasty. Three investigators assessed the depth and size of the cartilage lesion and made a decision on patellar resurfacing, using the photographs twice. Intraobserver and interobserver reliabilities were calculated with the kappa coefficient. Cartilage assessment had substantial intraobserver (kappa = 0.77 for depth and 0.71 for size) and moderate interobserver (kappa = 0.54 for depth and 0.45 for size) reliabilities. Decision on patellar resurfacing had almost perfect intraobserver and substantial interobserver reliabilities (kappa = 0.88 and 0.68, respectively). We found that intraoperative assessment of the patellar articular cartilage and the decision for patellar resurfacing are reliable.
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Affiliation(s)
- Ilkyu Han
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, South Korea
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