Abstract
Purpose
This study aimed to compare the position of the patella at 90° of flexion before and after implantation of two TKA models with identical tibiofemoral geometry but different trochlear and patellar designs. The hypothesis was that the design with the deeper ‘anatomic’ trochlea could produce more natural patellar positions.
Methods
Intra-operative navigation data were collected from 22 consecutive cases that received two TKA designs (9 HLS Noetos® and 13 HLS KneeTec®). Both implants were cemented postero-stabilised TKAs with mobile tibial inserts and patellar resurfacing. Operations were guided by a non-image-based system that recorded relative femoral, tibial and patellar positions pre- and post-operatively.
Results
The two groups exhibited little difference in femoral internal–external rotation and anterior–posterior translation during knee flexion. The two groups exhibited significant differences in patellar position at 90° of flexion. Post-operatively, the patella was similarly shifted medially relative to the femur (Noetos 6.9 mm, KneeTec 6.0 mm, n.s.). Patellar flexion was equivalent in native knees (Noetos 18.3°, KneeTec 20.5°, n.s.), but in implanted knees, it was considerably different (Noetos 6.3°, KneeTec 23.5°, p = 0.031).
Conclusions
The present study compared intra-operative navigation data from two patient series that received TKA implants with identical tibiofemoral articular geometry but different patellofemoral designs. The results confirm that tibiofemoral kinematics are unchanged, but that patellar positions at 90° of flexion offer greater mechanical advantage to the quadriceps using the KneeTec than using the Noetos. The findings raise awareness of influence of patellofemoral geometry on mid-flexion kinematics and help surgeons select the most suitable implant for patients with weak quadriceps muscles or with history of patellar instability.
Level of evidence
Comparative study, Level III.
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References
Aglietti P, Buzzi R, Gaudenzi A (1988) Patellofemoral functional results and complications with the posterior stabilized total condylar knee prosthesis. J Arthroplasty 3(1):17–25
Aglietti P, Insall JN, Walker PS, Trent P (1975) A new patella prosthesis: design and application. Clin Orthop Relat Res 107:175–187
Akkawi I, Colle F, Bruni D, Raspugli GF, Bignozzi S, Zaffagnini S, Iacono F, Marcacci M (2014) Deep-dished highly congruent tibial insert in CR-TKA does not prevent patellar tendon angle increase and patellar anterior translation. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-014-2889-5
Amis AA (2007) Current concepts on anatomy and biomechanics of patellar stability. Sports Med Arthrosc 15(2):48–56
Amis AA, Senavongse W, Bull AM (2006) Patellofemoral kinematics during knee flexion–extension: an in vitro study. J Orthop Res 24(12):2201–2211
Anagnostakos K, Lorbach O, Reiter S, Kohn D (2011) Comparison of five patellar height measurement methods in 90 degrees knee flexion. Int Orthop 35(12):1791–1797
Baier C, Springorum H-R, Götz J, Schaumburger J, Lüring C, Grifka J, Beckmann J (2013) Comparing navigation-based in vivo knee kinematics pre- and postoperatively between a cruciate-retaining and a cruciate-substituting implant. Int Orthop 37:407–414
Barink M, Meijerink H, Verdonschot N, Kampen A, Waal Malefijt M (2007) Asymmetrical total knee arthroplasty does not improve patella tracking: a study without patella resurfacing. Knee Surg Sports Traumatol Arthrosc 15:184–191
Becker R, Karlsson J (2014) The importance of the third knee compartment on outcome following total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 22(3):475–477
Belvedere C, Ensini A, Leardini A, Dedda V, Feliciangeli A, Cenni F, Timoncini A, Barbadoro P, Giannini S (2014) Tibio-femoral and patello-femoral joint kinematics during navigated total knee arthroplasty with patellar resurfacing. Knee Surg Sports Traumatol Arthrosc 22(8):1719–1727
Bicos J, Fulkerson JP, Amis A (2007) Current concepts review: the medial patellofemoral ligament. Am J Sports Med 35(3):484–492
Bignozzi S, Lopomo N, Zaffagnini S, Martelli S, Bruni D, Marcacci M (2008) Accuracy, reliability, and repeatability of navigation systems in clinical practice. Oper Tech Orthop 18:154–157
Buff HU, Jones LC, Hungerford DS (1988) Experimental determination of forces transmitted through the patello-femoral joint. J Biomech 21(1):17–23
Bull AM, Katchburian MV, Shih YF, Amis AA (2002) Standardisation of the description of patellofemoral motion and comparison between different techniques. Knee Surg Sports Traumatol Arthrosc 10(3):184–193
Calliess T, Schado S, Richter BI, Becher C, Ezechieli M, Ostermeier S (2014) Quadriceps force during knee extension in different replacement scenarios with a modular partial prosthesis. Clin Biomech (Bristol, Avon) 29(2):218–222
Casino D, Zaffagnini S, Martelli S, Lopomo N, Bignozzi S, Iacono F, Russo A, Marcacci M (2009) Intraoperative evaluation of total knee replacement: kinematic assessment with a navigation system. Knee Surg Sports Traumatol Arthrosc 17:369–373
Clarke HD, Fuchs R, Scuderi GR, Mills EL, Scott WN, Insall JN (2006) The influence of femoral component design in the elimination of patellar clunk in posterior-stabilized total knee arthroplasty. J Arthroplasty 21(2):167–171
Cole GK, Nigg BM, Ronsky JL, Yeadon MR (1993) Application of the joint coordinate system to three-dimensional joint attitude and movement representation: a standardization proposal. J Biomech Eng 115(4A):344–349
D’Lima DD, Chen PC, Kester MA, Colwell CW Jr (2003) Impact of patellofemoral design on patellofemoral forces and polyethylene stresses. J Bone Joint Surg Am 85-A(Suppl 4):85–93
D’Lima DD, Poole C, Chadha H, Hermida JC, Mahar A, Colwell CW Jr (2001) Quadriceps moment arm and quadriceps forces after total knee arthroplasty. Clin Orthop Relat Res 392:213–220
Dejour D, Ntagiopoulos PG, Saffarini M (2014) Evidence of trochlear dysplasia in femoral component designs. Knee Surg Sports Traumatol Arthrosc 22(11):2599–2607
Frye BM, Floyd MW, Pham DC, Feldman JJ, Hamlin BR (2012) Effect of femoral component design on patellofemoral crepitance and patella clunk syndrome after posterior-stabilized total knee arthroplasty. J Arthroplasty 27(6):1166–1170
Goodfellow J, Hungerford DS, Zindel M (1976) Patello-femoral joint mechanics and pathology. 1. Functional anatomy of the patello-femoral joint. J Bone Joint Surg Br 58(3):287–290
Grelsamer RP (2001) The sulcus angle and malalignment of the extensor mechanism of the knee. J Bone Joint Surg Br 83(5):772–773
Healy WL, Wasilewski SA, Takei R, Oberlander M (1995) Patellofemoral complications following total knee arthroplasty. Correlation with implant design and patient risk factors. J Arthroplasty 10(2):197–201
Hehne HJ (1990) Biomechanics of the patellofemoral joint and its clinical relevance. Clin Orthop Relat Res 258:73–85
Heinert G, Kendoff D, Preiss S, Gehrke T, Sussmann P (2011) Patellofemoral kinematics in mobile-bearing and fixed-bearing posterior stabilised total knee replacements: a cadaveric study. Knee Surg Sports Traumatol Arthrosc 19(6):967–972
Hozack WJ, Rothman RH, Booth RE Jr, Balderston RA (1989) The patellar clunk syndrome: a complication of posterior stabilized total knee arthroplasty. Clin Orthop Relat Res 241:203–208
Hungerford DS, Barry M (1979) Biomechanics of the patellofemoral joint. Clin Orthop Relat Res 144:9–15
Indelli PF, Marcucci M, Cariello D, Poli P, Innocenti M (2012) Contemporary femoral designs in total knee arthroplasty: effects on the patello-femoral congruence. Int Orthop 36(6):1167–1173
Iwaki H, Pinskerova V, Freeman MA (2000) Tibiofemoral movement 1: the shapes and relative movements of the femur and tibia in the unloaded cadaver knee. J Bone Joint Surg Br 82:1189–1195
Kaufer H (1979) Patellar biomechanics. Clin Orthop Relat Res 144:51–54
Kessler O, Patil S, Colwell CW Jr, D’Lima DD (2008) The effect of femoral component malrotation on patellar biomechanics. J Biomech 41(16):3332–3339
Laurin CA, Levesque HP, Dussault R, Labelle H, Peides JP (1978) The abnormal lateral patellofemoral angle: a diagnostic roentgenographic sign of recurrent patellar subluxation. J Bone Joint Surg Am 60(1):55–60
Long R, Gheduzzi S, Bucher TA, Toms AD, Miles AW (2013) A biomechanical evaluation of hinged total knee replacement prostheses. Proc Inst Mech Eng H 227(8):875–883
Maloney WJ (2003) Orthopaedic crossfire—larger femoral heads: a triumph of hope over reason! In opposition. J Arthroplasty 18(3 Suppl 1):85–87
Martelli S, Zaffagnini S, Bignozzi S, Bontempi M, Marcacci M (2006) Validation of a new protocol for computer-assisted evaluation of kinematics of double-bundle ACL reconstruction. Clin Biomech 21:279–287
Mason JJ, Leszko F, Johnson T, Komistek RD (2008) Patellofemoral joint forces. J Biomech 41(11):2337–2348
Meijerink HJ, Barink M, van Loon CJ, Schwering PJ, Donk RD, Verdonschot N, de Waal Malefijt MC (2007) The trochlea is medialized by total knee arthroplasty: an intraoperative assessment in 61 patients. Acta Orthop 78(1):123–127
Merchant AC (1988) Classification of patellofemoral disorders. Arthroscopy 4(4):235–240
Merican AM, Ghosh KM, Baena FR, Deehan DJ, Amis AA (2014) Patellar thickness and lateral retinacular release affects patellofemoral kinematics in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 22(3):526–533
Merican AM, Ghosh KM, Iranpour F, Deehan DJ, Amis AA (2011) The effect of femoral component rotation on the kinematics of the tibiofemoral and patellofemoral joints after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 19(9):1479–1487
Ostermeier S, Buhrmester O, Hurschler C, Stukenborg-Colsman C (2005) Dynamic in vitro measurement of patellar movement after total knee arthroplasty: an in vitro study. BMC Musculoskelet Disord 6:30
Ostermeier S, Stukenborg-Colsman C (2011) Quadriceps force after TKA with femoral single radius. Acta Orthop 82(3):339–343
Pandit H, Ward T, Hollinghurst D, Beard DJ, Gill HS, Thomas NP, Murray DW (2005) Influence of surface geometry and the cam-post mechanism on the kinematics of total knee replacement. J Bone Joint Surg Br 87:940–945
Patel J, Ries MD, Bozic KJ (2008) Extensor mechanism complications after total knee arthroplasty. Instr Course Lect 57:283–294
Pinaroli A, Piedade SR, Servien E, Neyret P (2009) Intraoperative fractures and ligament tears during total knee arthroplasty: a 1795 posterostabilized TKA continuous series. Orthop Traumatol Surg Res 95(3):183–189
Stagni R, Fantozzi S, Catani F, Leardini A (2010) Can Patellar Tendon Angle reveal sagittal kinematics in total knee arthroplasty? Knee Surg Sports Traumatol Arthrosc 18:949–954
Star MJ, Kaufman KR, Irby SE, Colwell CW Jr (1996) The effects of patellar thickness on patellofemoral forces after resurfacing. Clin Orthop Relat Res 322:279–284
Tanzer M, McLean CA, Laxer E, Casey J, Ahmed AM (2001) Effect of femoral component designs on the contact and tracking characteristics of the unresurfaced patella in total knee arthroplasty. Can J Surg 44(2):127–133
Tecklenburg K, Dejour D, Hoser C, Fink C (2006) Bony and cartilaginous anatomy of the patellofemoral joint. Knee Surg Sports Traumatol Arthrosc 14(3):235–240
van Eijden TM, Kouwenhoven E, Verburg J, Weijs WA (1986) A mathematical model of the patellofemoral joint. J Biomech 19(3):219–229
Vandenneucker H, Labey L, Victor J, Vander Sloten J, Desloovere K, Bellemans J (2014) Patellofemoral arthroplasty influences tibiofemoral kinematics: the effect of patellar thickness. Knee Surg Sports Traumatol Arthrosc 22(10):2560–2568
Varadarajan KM, Rubash HE, Li G (2011) Are current total knee arthroplasty implants designed to restore normal trochlear groove anatomy? J Arthroplasty 26(2):274–281
Ward SR, Terk MR, Powers CM (2005) Influence of patella alta on knee extensor mechanics. J Biomech 38(12):2415–2422
Zaffagnini S, Bignozzi S, Saffarini M, Colle F, Sharma B, Kinov PS, Marcacci M, Dejour D (2014) Comparison of stability and kinematics of the natural knee versus a PS TKA with a ‘third condyle’. Knee Surg Sports Traumatol Arthrosc 22(8):1778–1785
Conflict of interest
D.D. and M.S. receive royalties or fees from Tornier SA. S.B is an employee of Orthokey Italia srl. S.Z. and F.C. and MM have not included a conflict of interest disclosure statement.
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Saffarini, M., Zaffagnini, S., Bignozzi, S. et al. Does patellofemoral geometry in TKA affect patellar position in mid-flexion?. Knee Surg Sports Traumatol Arthrosc 23, 1799–1807 (2015). https://doi.org/10.1007/s00167-015-3565-0
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DOI: https://doi.org/10.1007/s00167-015-3565-0