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Yang B, Yuan FZ, Wang HJ, Gong X, Chang YH, Yu JK. Femoral anterior condyle height decreases as the distal anteroposterior size increases in total knee arthroplasty: A comparative study. PLoS One 2024; 19:e0297634. [PMID: 38408088 PMCID: PMC10896507 DOI: 10.1371/journal.pone.0297634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 01/08/2024] [Indexed: 02/28/2024] Open
Abstract
PURPOSE The anterior flange height of the current femoral component increases with an increasing distal femoral anteroposterior dimension. During total knee arthroplasty (TKA), we have observed that a large femur may have a thinner anterior condyle, whereas a small femur may have a thicker anterior condyle. The first purpose of this study was to examine whether the femoral anterior condyle height decreases as the distal femoral anteroposterior size increases and whether gender differences exist in anterior condyle height. METHODS A total of 1218 knees undergoing TKA intraoperative and computed tomography scans from 303 healthy knees were used to measure the anterior lateral condylar height (ALCH), anterior medial condylar height (AMCH), and the lateral anteroposterior (LAP) and medial anteroposterior (MAP) dimensions of distal femurs. The LAP and MAP measurements were used for adjustments to determine whether gender differences exist in anterior condyle heights. Linear regression analysis was performed to determine correlations between ALCH and LAP or between AMCH and MAP. RESULTS There were significant differences between males and females in ALCH in both the CT and TKA groups and AMCH in the CT group (all P<0.01). After adjusting for LAP and MAP, there were significant gender differences in the lateral and medial condylar heights in both groups (P<0.01). There were significant negative correlations between ALCH and LAP values and between AMCH and MAP values in both CT and TKA measurements, with the LAP and MAP values increasing as ALCH and AMCH decreased. CONCLUSIONS The results demonstrate that femoral anterior condylar height decreased with increasing anteroposterior dimension in both the medial and lateral condyle. In addition, this study also showed that anterior condylar heights are highly variable, with gender differences. The data may provide an important reference for designing femoral anterior flange thickness to precisely match the natural anterior condylar anatomy.
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Affiliation(s)
- Bo Yang
- Sports Medicine Department, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
- Department of Orthopaedics, Shaanxi Provincial People's Hospital, The Third Affiliated hospital of Xi'an jiaotong University, Xi'an, China
| | - Fu-Zhen Yuan
- Sports Medicine Department, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
| | - Hai-Jun Wang
- Sports Medicine Department, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
| | - Xi Gong
- Sports Medicine Department, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
| | - Yan-Hai Chang
- Department of Orthopaedics, Shaanxi Provincial People's Hospital, The Third Affiliated hospital of Xi'an jiaotong University, Xi'an, China
| | - Jia-Kuo Yu
- Sports Medicine Department, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
- Orthopaedic Sports Medicine Center, Beijing Tsinghua Changgung Hospital, Affiliated Hospital of Tsinghua University, Changping District, Beijing, China
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Grothues S, Becker AK, Hohlmann B, Radermacher K. Parameter-based patient-specific restoration of physiological knee morphology for optimized implant design and matching. BIOMED ENG-BIOMED TE 2023; 68:537-544. [PMID: 37185164 DOI: 10.1515/bmt-2023-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/03/2023] [Indexed: 05/17/2023]
Abstract
Total knee arthroplasty (TKA) patients may present with genetic deformities, such as trochlear dysplasia, or deformities related to osteoarthritis. This pathologic morphology should be corrected by TKA to compensate for related functional deficiencies. Hence, a reconstruction of an equivalent physiological knee morphology would be favorable for detailed preoperative planning and the patient-specific implant selection or design process. A parametric database of 673 knees, each described by 36 femoral parameter values, was used. Each knee was classified as pathological or physiological based on cut-off values from literature. A clinical and a mathematical classification approach were developed to distinguish between affected and unaffected parameters. Three different prediction methods were used for the restoration of physiological parameter values: regression, nearest neighbor search and artificial neural networks. Several variants of the respective prediction model were considered, such as different network architectures. Regarding all methods, the model variant chosen resulted in a prediction error below the parameters' standard deviation, while the regression yielded the lowest errors. Future analyses should consider other deformities, also of tibia and patella. Furthermore, the functional consequences of the parameter changes should be analyzed.
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Affiliation(s)
- Sonja Grothues
- Chair of Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
| | - Ann-Kristin Becker
- Chair of Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
| | - Benjamin Hohlmann
- Chair of Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
| | - Klaus Radermacher
- Chair of Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
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Yu Z, Cai H, Liu Z. Factors that impact the patellofemoral contact stress in the TKA: a review. ARTHROPLASTY 2023; 5:44. [PMID: 37542328 PMCID: PMC10403927 DOI: 10.1186/s42836-023-00197-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/06/2023] [Indexed: 08/06/2023] Open
Abstract
Abnormal retro patellar stress is believed to contribute to patellofemoral complications after total knee arthroplasty (TKA), but the causal link between TKA and patellofemoral contact stress remains unclear. By reviewing the relevant studies, we found that both TKA implantation and additional patellar resurfacing increase retro patellar pressure. The rotation and size of the femoral component, thickness and position of the patellar component, installation of the tibial component, prosthesis design and soft tissue balance further influence patellofemoral stress. Specific measures can be applied to reduce stress, including the installation of the femoral prosthesis with an appropriate external rotation angle, placing the tibial component at a more posterior position and the patellar button at a more medial position, avoiding over-sized femoral and patellar components, selecting posterior-stabilized design rather than cruciate-retaining design, using gender-specific prosthesis or mobile-bearing TKA system, and releasing the lateral retinaculum or performing partial lateral facetectomy. Despite these measures, the principle of individualization should be followed to optimize the patellofemoral biomechanics.
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Affiliation(s)
- Zhenguo Yu
- Department of Orthopedics II, Beijing Rehabilitation Hospital, Capital Medical University, Xixiazhuang, Shijingshan District, Beijing, 100144, China
| | - Hong Cai
- Department of Orthopedics, Peking University Third Hospital, No.49 North Garden Road, Haidian District, Beijing, 100191, China.
| | - Zhongjun Liu
- Department of Orthopedics, Peking University Third Hospital, No.49 North Garden Road, Haidian District, Beijing, 100191, China
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Lorenz A, Winter A, Mederake M, Freidhager C, Hofmann UK, Leichtle UG. Changes in femoral rollback and rotation with increasing coupling in knee arthroplasty-a biomechanical in-vitro study. BMC Musculoskelet Disord 2023; 24:341. [PMID: 37131176 PMCID: PMC10152755 DOI: 10.1186/s12891-023-06430-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 04/12/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND After total knee arthroplasty, 10-30% of patients still complain about knee pain, even after exact positioning of the components. Altered knee kinematics are crucial in this regard. The aim of our study was to experimentally determine the influence of different degrees of component coupling of knee prostheses on joint kinematics during muscle-loaded knee flexion in-vitro. METHODS Femoral rollback and femoral rotation of a standard cruciate retaining (GCR), a posterior stabilized (GPS), a rotational hinge (RSL) and a total hinge (SSL) design of the same series of knee replacement implants (SL-series) of one single manufacturer (Waldemar Link GmbH, Hamburg, Germany) were analyzed and set in relation to the motion of the corresponding native knee in a paired study design. All different coupling degrees were analyzed in the same human knees. To simulate muscle loaded knee flexion, a knee simulator was used. Kinematics were measured with an ultrasonic motion capture system and integrated in a calculated coordinate system via CT-imaging. RESULTS The largest posterior motion on the lateral side was found for the native knee (8.7 ± 7.0 mm), followed by the GPS (3.2 ± 5.1 mm) and GCR (2.8 ± 7.3 mm) implants, while no motion was found for the RSL (0.1 ± 3.0 mm) and the SSL (-0.6 ± 2.7 mm) implants. In contrast, on the medial side, only the native knee showed a posterior motion (2.1 ± 3.2 mm). Regarding femoral external rotation, the only implant where the observed difference did not reach statistical significance when compared to the native knee was the GCR (p = 0.007). CONCLUSION The GCR and GPS kinematics closely imitate those of the native joint. Medial femoral rollback is reduced, however, with the joint pivoting around a rotational center located in the medial plateau. Without additional rotational forces, the coupled RSL and SSL prostheses closely resemble each other with no femoral rollback or relevant rotational component. The femoral axis, however, shifts ventrally in both models when compared with their primary counterparts. The positioning of the coupling mechanism in the femoral and tibial component thus can already lead to altered joint kinematics even in prostheses with an identical surface geometry.
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Affiliation(s)
- Andrea Lorenz
- Austrian Center for Medical Innovation and Technology (ACMIT Gmbh), Wr. Neustadt, Austria
- Department of Orthopaedic Surgery, University Hospital Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
- Institute for Lightweight Design and Computational Biomechanics, TU Wien, Vienna, Austria
| | - Alexander Winter
- Department of Orthopaedic Surgery, University Hospital Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
| | - Moritz Mederake
- Department of Trauma and Reconstructive Surgery, BG Klinik, University of Tübingen, 72076, Tübingen, Germany.
| | - Clemens Freidhager
- Institute for Lightweight Design and Computational Biomechanics, TU Wien, Vienna, Austria
| | - Ulf Krister Hofmann
- Department of Orthopaedic Surgery, University Hospital Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
- Department of Orthopedic Trauma and Reconstructive Surgery, University of Aachen Medical Center, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Ulf Gunther Leichtle
- Department of Orthopaedic Surgery, University Hospital Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
- Practice for Orthopaedic, Spine and Trauma Surgery, Rottenburg, Germany
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Mizu-Uchi H, Ma Y, Ishibashi S, Colwell CW, Nakashima Y, D'Lima DD. Tibial sagittal and rotational alignment reduce patellofemoral stresses in posterior stabilized total knee arthroplasty. Sci Rep 2022; 12:12319. [PMID: 35854017 PMCID: PMC9296446 DOI: 10.1038/s41598-022-15759-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 06/29/2022] [Indexed: 11/09/2022] Open
Abstract
Patellofemoral joint complications remain an important issue in total knee arthroplasty. We compared the patellofemoral contact status between cruciate-retaining and posterior-stabilized designs with varying degrees of tibial sagittal and rotational alignment using a computer simulation to ensure proper alignments in total knee arthroplasty. Knee kinematics, patellofemoral contact force and quadriceps force were computed using a musculoskeletal modeling program (LifeMOD/KneeSIM 2010; LifeModeler, Inc., San Clemente, California) during a weight-bearing deep knee bend. Two different posterior tibial slope (PTS)s (3° and 7°) and five different tibial tray rotational alignments (neutral, internal 5° and 10°, and external 5° and 10°) were simulated. Patellofemoral contact area and stresses were next computed using finite element analysis. The patellofemoral contact force for the posterior-stabilized design was substantially lower than the cruciate-retaining design after post-cam contact because of increasing femoral roll-back. Neutral rotational alignment of the tibial component resulted in smaller differences in patellofemoral contact stresses between cruciate-retaining and posterior-stabilized designs for PTSs of 3° or 7°. However, the patellar contact stresses in the cruciate-retaining design were greater than those in posterior-stabilized design at 120° of knee flexion with PTS of 3° combined with internal rotation of the tibial component. Our study provides biomechanical evidence implicating lower PTSs combined with internal malrotation of the tibial component and the resultant increase in patellofemoral stresses as a potential source of anterior knee pain in cruciate-retaining design.
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Affiliation(s)
- Hideki Mizu-Uchi
- Department of Orthopaedic Surgery, Saiseikai Fukuoka General Hospital, 1-3-46, Tenjin, Chuo-ku, Fukuoka, 810-0001, Japan.,Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yuan Ma
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Shojiro Ishibashi
- Department of Orthopaedic Surgery, Saiseikai Fukuoka General Hospital, 1-3-46, Tenjin, Chuo-ku, Fukuoka, 810-0001, Japan.,Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Clifford W Colwell
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, 10666 North Torrey Pines Road, MS126, La Jolla, CA, 92037, USA
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Darryl D D'Lima
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, 10666 North Torrey Pines Road, MS126, La Jolla, CA, 92037, USA.
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Asseln M, Grothues SAGA, Radermacher K. Relationship between the form and function of implant design in total knee replacement. J Biomech 2021; 119:110296. [PMID: 33676270 DOI: 10.1016/j.jbiomech.2021.110296] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 01/18/2021] [Accepted: 01/23/2021] [Indexed: 11/29/2022]
Abstract
The implant design in total knee replacement affects postoperative functionality greatly, therefore, its optimization is of major concern. However, little is known about how implant design parameters affect active knee kinematics. Comprehensive in silico and in vitro sensitivity analyses were performed, based on one patient-specific, physical knee implant set and corresponding bone and knee implant surface geometry data. The implant surfaces were parametrized and varied systematically, resulting in 85 different knee implant surface models. In addition, four variations of extensor mechanism parameters, being the muscular attachment points defining the Q-Angle, were investigated. The variations were evaluated in a patient-specific multibody simulation model and an experimental testing rig and contributions of different implant designs and extensor mechanism parameters on kinematics were analysed. The results of the in silico and in vitro analyses showed good qualitative agreement. The highest deviations from the implant's reference kinematics were found for parameter variations of the femoral sagittal radii, the lateral trochlear elevation, the tibial sagittal slopes, the mediolateral position of the patellar ridge and the mediolateral position of the tuberositas tibiae. The implant design parameters identified with the highest functional relevance should be focused on in implant design. As the tuberositas tibiae's position constituted a main impact factor, it should also be considered during implant design and preoperative planning. Due to the competing influence of implant design parameters on active kinematics, respective parameters should be designed which are compatible to each other to avoid adverse constraints and associated functional limitations.
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Affiliation(s)
- Malte Asseln
- Chair of Medical Engineering, RWTH Aachen University, Aachen, Germany
| | | | - Klaus Radermacher
- Chair of Medical Engineering, RWTH Aachen University, Aachen, Germany
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Joseph L, Batailler C, Roger J, Swan J, Servien E, Lustig S. Patellar component size effects patellar tilt in total knee arthroplasty with patellar resurfacing. Knee Surg Sports Traumatol Arthrosc 2021; 29:553-562. [PMID: 32274550 DOI: 10.1007/s00167-020-05984-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 04/06/2020] [Indexed: 01/16/2023]
Abstract
PURPOSE Patellar component positioning and patellofemoral kinematics are of great importance in total knee arthroplasty (TKA). The factors influencing patellar tilt are femoral rotation and lateral patellar release. However, the effect of patellar component size remains unknown. The aim of this study was to evaluate the intra-operative risk factors for patellar tilt, particularly the effect of the patellar component size. The hypothesis was that increasing the patellar component size would reduce the risk of patellar tilt. METHODS 878 primary TKAs with patellar resurfacing were included between January 2015 and October 2018. Analysis was performed at 1-year postoperatively on patients categorized into two groups: patellar tilt (PT) and no patellar tilt (NPT). A multivariate analysis was performed for the effect of patellar component size, femoral rotation, femoral overbuilding, patellar thickness and lateral release on patellar tilt risk. Secondary analysis was performed for any difference in clinical outcomes and revision rates between groups. RESULTS Multivariate analysis showed that increasing the patellar component size decreased the risk of patellar tilt by 37% (p < 0.001). Placing the femoral component at 3° of external rotation decreased the risk of patellar tilt by 67% (p < 0.001). Secondary analysis showed better clinical outcomes in the NPT group, especially regarding global satisfaction, and KSS objective and subjective scores. The revision for any cause was less in the NPT group (p = 0.019). The cause for TKA revision was related to the patellar in 11% of cases in the NPT group and 65% in the PT group (p < 0.001). CONCLUSION Increased patellar component size and positioning the femoral component in external rotation decreases the risk of patellar tilt, improves clinical outcomes and decreases the rate of surgical revision. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Léopold Joseph
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon North University Hospital, Hospices Civils de Lyon, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France
| | - Cécile Batailler
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon North University Hospital, Hospices Civils de Lyon, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France.
| | - Julien Roger
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon North University Hospital, Hospices Civils de Lyon, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France
| | - John Swan
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon North University Hospital, Hospices Civils de Lyon, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France
| | - Elvire Servien
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon North University Hospital, Hospices Civils de Lyon, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France
| | - Sébastien Lustig
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon North University Hospital, Hospices Civils de Lyon, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France
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Ng JWG, Bloch BV, James PJ. Sagittal radius of curvature, trochlea design and ultracongruent insert in total knee arthroplasty. EFORT Open Rev 2019; 4:519-524. [PMID: 31538002 PMCID: PMC6719604 DOI: 10.1302/2058-5241.4.180083] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Multi radius (MR) total knee arthroplasty (TKA) has been associated with mid-flexion instability. Single radius (SR) TKA may provide better anteroposterior stability through single flexion axis and biomechanical advantage for quadriceps function. Medial pivot (MP) TKA and gradually reducing (GR) radius TKA produce better knee kinematics. Clinical outcomes are equivalent for SR, MR and MP TKA. Short-term studies have shown better clinical outcomes and kinematics for GR TKA. Thinner and narrow anterior flange, deeper trochlea groove and more anatomical trochlea design reduces patellofemoral complications in TKA Ultracongruent inserts provide comparable clinical outcomes to posterior-stabilized TKA and cruciate retaining TKA.
Cite this article: EFORT Open Rev 2019;4:519-524. DOI: 10.1302/2058-5241.4.180083
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Roussot MA, Haddad FS. The evolution of patellofemoral prosthetic design in total knee arthroplasty: how far have we come? EFORT Open Rev 2019; 4:503-512. [PMID: 31538000 PMCID: PMC6719608 DOI: 10.1302/2058-5241.4.180094] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Total knee arthroplasty (TKA) has evolved into a successful, cost-effective treatment for end-stage knee arthrosis.The patellofemoral articulation in TKA has largely been ignored during its development despite being an important determinant of outcome.New technologies still need further development to incorporate the patella in TKA surgical planning and operative technique.Alternative approaches to alignment in TKA will have a secondary impact on patellofemoral mechanics and possibly future implant designs.Technologies that assist with precise implant positioning may alter our understanding and overall practice of TKA. Cite this article: EFORT Open Rev 2019;4:503-512. DOI: 10.1302/2058-5241.4.180094.
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Affiliation(s)
- Mark Anthony Roussot
- University College London Hospitals NHS Foundation Trust, London, UK.,Department of Orthopaedic Surgery, University of Cape Town, SA
| | - Fares Sami Haddad
- University College London Hospitals NHS Foundation Trust, London, UK
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TKA design-integrated trochlea groove rotation reduces patellofemoral pressure. Knee Surg Sports Traumatol Arthrosc 2019; 27:1680-1692. [PMID: 30564858 DOI: 10.1007/s00167-018-5324-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 12/07/2018] [Indexed: 01/09/2023]
Abstract
PURPOSE Total knee arthroplasty (TKA) leaves 11-25% of the patients unsatisfied, and patellofemoral joint pain is one cause. This study aimed to compare the differences between kinematics and load transfer in the same knee with axial internal/external rotation of the femoral component (CoRo) versus a separate axial internal/external trochlear groove rotation (TrRo) which is included in the TKA trochlea design. METHODS A validated weight-bearing finite element model with modifications of the TKA axial femoral component rotation (CoRo) and a modified trochlear rotation (TrRo) was calculated and analysed. RESULTS Compared to the neutrally implanted TKA at 105° of flexion, a 6° external rotation of the trochlear groove reduced the retropatellar stress by 7%, whereas a 3° internal trochlear groove rotation increased the retropatellar stress by 7%. With femoral component rotation, the tibia inlay stress of 6.7 MPa at 60° of flexion was two times higher both with a 3° internal component rotation and a 6° external rotation. CONCLUSION These results demonstrate in the tested TKA design that a trochlear groove rotation can reduce retropatellar stress. Additionally, during the TKA operation, the surgeon should be aware of the significant influence of axial femoral component rotation on mechanical inlay stress during flexion and of the fact that even small changes in the patellofemoral joint may influence the tibiofemoral joint. These results support that an external rotation of the femoral component should be preferred in TKA to avoid anterior knee pain. Furthermore, new developed TKA designs should integrate an externally rotated trochlea groove.
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Roessler PP, Moussa R, Jacobs C, Schüttler KF, Stein T, Schildberg FA, Wirtz DC. Predictors for secondary patellar resurfacing after primary total knee arthroplasty using a “patella-friendly” total knee arthroplasty system. INTERNATIONAL ORTHOPAEDICS 2018; 43:611-617. [DOI: 10.1007/s00264-018-4075-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 07/24/2018] [Indexed: 12/14/2022]
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