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What clinical characteristics and radiographic parameters are associated with patellofemoral instability after kinematically aligned total knee arthroplasty?

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Abstract

Introduction

Thirteen patients presented with patellofemoral instability out of 3212 knees treated with kinematically aligned total knee arthroplasty (KA TKA) during a nine year period. We determined the clinical characteristics and post-operative radiographic parameters associated with patellofemoral instability, and whether re-operation and patient reported outcome measures are different between patients with and without patellofemoral instability.

Methods

Patients with patellofemoral instability were matched 1:3 to a control cohort based on date of surgery (±3 months), age (±10 years), sex, pre-operative knee deformity (varus or valgus), and implant brand. We analyzed clinical characteristics and seven post-operative radiographic parameters.

Results

Patellofemoral instability presented atraumatically (12 of 13) at 5 ± 4.7 months for a 0.4 % incidence at a mean follow-up of 43 ± 36 months. No pre-operative clinical characteristics were associated with instability. Patients with patellofemoral instability had greater flexion of the femoral component (11° versus 5°; p = 0.0012), a trend toward greater external rotation of the tibial component (2° versus 0°; p = 0.2704), more reoperations (9 versus 0; p = 0.0026) and a lower Oxford Knee Score (36 versus 42; p = 0.0045) than controls.

Discussion

Patellofemoral instability after kinematically aligned TKA is infrequent, presents atraumatically, and is associated with greater flexion of the femoral component than the control group.

Conclusion

Minimizing flexion of the femoral component might reduce the risk of patellofemoral instability by promoting early engagement of the patella in the trochlear during knee flexion.

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Acknowledgments

We wish to thank Lukas Haug, MD for measuring the radiographic measurements used to compute the intraclass correlation coefficients.

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Authors and Affiliations

  1. Department of Orthopaedics, University of California, Davis, 4860 Y Street, Suite 3800, Sacramento, CA, 95817, USA

    Alexander J. Nedopil

  2. Biomedical Engineering Graduate Group, University of California, Davis, Davis, CA, 95616, USA

    Stephen M. Howell

  3. Department of Mechanical Engineering, University of California, Davis, CA, 95616, USA

    Maury L. Hull

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  1. Alexander J. Nedopil
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  2. Stephen M. Howell
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  3. Maury L. Hull
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Correspondence to Alexander J. Nedopil.

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This article does not contain any studies with human participants or animals performed by any of the authors (institutional review board (IRB 796385–1)).

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Nedopil, A.J., Howell, S.M. & Hull, M.L. What clinical characteristics and radiographic parameters are associated with patellofemoral instability after kinematically aligned total knee arthroplasty?. International Orthopaedics (SICOT) 41, 283–291 (2017). https://doi.org/10.1007/s00264-016-3287-z

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