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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
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

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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Acknowledgments

The authors are pleased to acknowledge the financial support of the Ministry of Science and Technology in Taiwan (MOST 100-2221-E-195-001-MY2 and MOST 102-2221-E-195-001). We particularly thank Colin J. McClean for his kind assistance in language editing and proofreading of this manuscript.

Author information

Authors and Affiliations

  1. Biomechanics Research Laboratory, Mackay Memorial Hospital, No. 45, Mingsheng Rd, Tamshui District, New Taipei City, 25160, Taiwan

    Chang-Hung Huang, Lin-I Hsu, Ting-Kuo Chang, Yung-Chang Lu & Chun-Hsiung Huang

  2. Department of Physical Therapy and Assistive Technology, National Yang-Ming University, No. 155, Sec. 2, Li-Nung St., Taipei, 112, Taiwan

    Chang-Hung Huang, Shih-Liang Shih & Chen-Sheng Chen

  3. Institute of Biomedical Engineering, National Yang-Ming University, Taipei, Taiwan

    Chang-Hung Huang & Chun-Hsiung Huang

  4. Department of Orthopaedic Surgery, Mackay Memorial Hospital, Taipei, Taiwan

    Ting-Kuo Chang, Yung-Chang Lu & Chun-Hsiung Huang

  5. Department of Orthopedic Surgery, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan

    Tai-Yuan Chuang

  6. Department of Orthopaedic Surgery, Zhong-Xing Branch of Taipei-City Hospital, Taipei, Taiwan

    Shih-Liang Shih

  7. Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan

    Yung-Chang Lu

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  1. Chang-Hung Huang
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Correspondence to Yung-Chang Lu or Chen-Sheng Chen.

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Chang-Hung Huang and Lin-I Hsu have contributed equally to this article.

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Huang, CH., Hsu, LI., Chang, TK. et al. 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 25, 263–271 (2017). https://doi.org/10.1007/s00167-014-3485-4

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  • DOI: https://doi.org/10.1007/s00167-014-3485-4

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