Advertisement

No difference in patellar tracking between symmetrical and asymmetrical femoral component designs in TKA

  • J. E. Stoddard
  • D. J. Deehan
  • A. M. J. Bull
  • A. W. McCaskie
  • A. A. AmisEmail author
Knee

Abstract

Purpose

Poor knee extension function after total knee arthroplasty (TKA) is associated with factors including articular geometry and alignment. Femoral trochlear geometry has evolved from symmetrical to become more prominent proximal–laterally, with the groove aligned proximal–lateral to distal–medial. This study in vitro tested the hypothesis that a modern asymmetrical prosthesis would restore patellar tracking and stability to more natural behaviour than an older symmetrical prosthesis.

Methods

Six knees had their patellar tracking measured optically during active knee extension. Medial–lateral force versus displacement stability was measured at fixed angles of knee flexion. The measurements were repeated after inserting each of the symmetrical and asymmetrical TKAs.

Results

Significant differences of patellar lateral displacement stability, compared to normal, were not found at any angle of knee flexion. The patella tracked medial–laterally within 2.5 mm of the natural path with both TKAs. However, for both TKAs near knee extension, the patella was tilted laterally by approximately 6° and was also flexed approximately 8° more than in the natural knee.

Conclusion

The hypothesis was not supported: The more anatomical component design did not provide more anatomical patellar kinematics and stability.

Keywords

Total knee arthroplasty (TKA) Patellofemoral joint Stability Kinematics Trochlear groove 

Notes

Acknowledgments

We thank Stryker (UK) Ltd for donating the prostheses used in this study. J. Stoddard was supported by a grant from the orthopaedic Surgery Department of the University of Newcastle.

References

  1. 1.
    Amis AA, Senavongse W, Bull AM (2006) Patellofemoral kinematics during knee flexion-extension: an in vitro study. J Orthop Res 24:2201–2211PubMedCrossRefGoogle Scholar
  2. 2.
    Anglin C, Brimacombe JM, Wilson DR, Masri BA, Greidanus NV, Tonetti J, Hodgson AJ (2010) Biomechanical consequences of patellar component medialization in total knee arthroplasty. J Arthroplasty 25:793–802PubMedCrossRefGoogle Scholar
  3. 3.
    Back DL, Cannon SR, Hilton A, Banles MJ, Briggs TW (2001) The Kinemax total knee arthroplasty. Nine years’ experience. J Bone Joint Surg Br 83-B:359–363CrossRefGoogle Scholar
  4. 4.
    Baldini A, Anderson JA, Cerulli P et al (2007) Patellofemoral evaluation after total knee arthroplasty. Validation of a new weight-bearing axial radiographic view. J Bone Jt Surg Am 89:1810–1817CrossRefGoogle Scholar
  5. 5.
    Barink M, Meijerink H, Verdonschot N, van Kampen A, De waal Malefijt M (2007) Asymmetrical total knee arthroplasty does not improve patellar tracking: a study without patella resurfacing. Knee Surg Sports Traumatol Arthrosc 15:184–191PubMedCrossRefGoogle Scholar
  6. 6.
    Barink M, Van Der Groes S, Verdonschot N, De waal Malefijt M (2006) The difference in trochlear orientation between the natural knee and current prosthetic knee designs; towards a truly physiological prosthetic groove orientation. J Biomech 39:1708–1715PubMedCrossRefGoogle Scholar
  7. 7.
    Barrack RL, Burak C (2001) Patella in total knee arthroplasty. Clin Orthop Relat Res 389:62–73PubMedCrossRefGoogle Scholar
  8. 8.
    Boyd AD, Ewald FC, Thomas WH, Poss R, Sledge CB (1993) Long-term complications after total knee arthroplasty with or without resurfacing of the patella. J Bone Joint Surg Am 75-A:674–681Google Scholar
  9. 9.
    Bull AMJ, Katchburian MV, Shih YF, Amis AA (2002) Standardisation of the description of patellofemoral motion and comparison between different techniques. Knee Surg Sports Med Arthrosc 10:184–193CrossRefGoogle Scholar
  10. 10.
    Chan KC, Gill GS (1999) Postoperative patellar tilt in total knee arthroplasty. J Arthrop 14:300–304CrossRefGoogle Scholar
  11. 11.
    Chew JT, Stewart NJ, Hanssen AD, Luo ZP, Rand JA, An KN (1997) Differences in patellar tracking and knee kinematics among three different total knee designs. Clin Orthop Relat Res 345:87–89PubMedGoogle Scholar
  12. 12.
    Farahmand F, Senavongse W, Amis AA (1998) Quantitative study of the quadriceps muscles and trochlear groove geometry related to instability of the patellofemoral joint. J Orthop Res 16:132–137Google Scholar
  13. 13.
    Feller JA, Bartlett RJ, Lang DM (1996) Patellar resurfacing versus retention in total knee arthroplasty. J Bone Joint Surg Br 78-B:226–229Google Scholar
  14. 14.
    Fu Y, Wang G, Fu Q (2011) Patellar resurfacing in total knee arthroplasty for osteoarthritis: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 19:1460–1466PubMedCrossRefGoogle Scholar
  15. 15.
    Ghosh KM, Merican A, Iranpour F, Deehan DJ, Amis AA (2009) The effect of overstuffing the patellofemoral joint on the extensor retinaculum. Knee Surg Sports Traumatol Arthrosc 17:1211–1216PubMedCrossRefGoogle Scholar
  16. 16.
    Grood ES, Suntay WJ (1983) A joint coordinate system for the clinical description of three-dimensional motions: application to the knee. J Biomech Eng 105:136–144PubMedCrossRefGoogle Scholar
  17. 17.
    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 19:967–972PubMedCrossRefGoogle Scholar
  18. 18.
    Hsu HP, Garg A, Walker PS, Spector M, Ewald FC (1989) Effect of knee component alignment on tibial load distribution with clinical correlation. Clin Orthop Relat Res 248:135–144PubMedGoogle Scholar
  19. 19.
    Iranpour F, Merican AM, Dandachli W, Amis AA, Cobb JP (2010) The geometry of the trochlear groove. Clin Orthop Relat Res 468:782–788PubMedCrossRefGoogle Scholar
  20. 20.
    Iranpour F, Merican AM, Rodriguez-y-Baena F, Cobb JP, Amis AA (2010) Patellofemoral joint kinematics: the circular path of the patella. J Orthop Res 28:589–594PubMedGoogle Scholar
  21. 21.
    Jenny JY, Boeri C (2004) Low reproducibility of the intra-operative measurement of the transepicondylar axis during total knee replacement. Acta Orthop Scand 75:74–77PubMedCrossRefGoogle Scholar
  22. 22.
    Jenny JY, Lefebvre Y, Vernizeau M, Lavaste F, Skalli W (2002) In vitro analysis of the continuous active patellofemoral kinematics of the normal and prosthetic knee. Rev Chir Orthop Rep 88:797–802Google Scholar
  23. 23.
    Katchburian MV, Bull AM, Shih YF, Heatley FW, Amis AA (2003) Measurement of patellar tracking: assessment and analysis of the literature. Clin Orthop Relat Res 412:241–259PubMedCrossRefGoogle Scholar
  24. 24.
    Lie DTT, Gloria N, Amis AA, Lee BPH, Yeo SJ, Chou SM (2005) The effect of patellar resection on patellar bone strain and fracture risk. Knee Surg Sports Traumatol Arthrosc 13:203–208PubMedCrossRefGoogle Scholar
  25. 25.
    Merican AM, Amis AA (2009) Iliotibial band tension affects patellofemoral and tibiofemoral kinematics. J Biomechs 42:1539–1546CrossRefGoogle Scholar
  26. 26.
    Merican AM, Iranpour Boroujeni F, Amis AA (2009) Iliotibial band tension reduces patellar lateral stability. J Orthop Res 27:335–339PubMedCrossRefGoogle Scholar
  27. 27.
    Merican A, Ghosh KM, Iranpour F, Deehan DJ, Amis AA (2011) The effect of femoral component rotation on the kinematics of the patellofemoral and tibiofemoral joints after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 19:1479–1487PubMedCrossRefGoogle Scholar
  28. 28.
    Patel VV, Hall K, Ries M, Lotz J, Ozhinsky E, Lindsey C, Lu Y, Majumdar S (2004) A three-dimensional MRI analysis of knee kinematics. J Orthop Res 22:283–292PubMedCrossRefGoogle Scholar
  29. 29.
    Petersilge WJ, Oishi CS, Kaufman KR, Irby SE, Colwell CW (1994) The effect of trochlear design on patellofemoral shear and compression forces in total knee arthroplasty. Clin Orthop Relat Res 309:124–130PubMedGoogle Scholar
  30. 30.
    Senavongse W, Amis AA (2005) The effects of articular, retinacular, or muscular deficiencies on patellofemoral joint stability: a biomechanical study in vitro. J Bone Jt Surg Br 87-B:577–582CrossRefGoogle Scholar
  31. 31.
    Senavongse W, Farahmand F, Jones J, Andersen H, Bull AMJ, Amis AA (2003) Quantitative measurement of patellofemoral joint stability: force-displacement behavior of the human patella in vitro. J Orthop Res 21:780–786PubMedCrossRefGoogle Scholar
  32. 32.
    Smith AJ, Wood DJ, Li MG (2008) Total knee replacement with and without patellar resurfacing. J Bone Joint Surg Br 90-B:43–50CrossRefGoogle Scholar
  33. 33.
    Wang H, Simpson K, Ferrara M, Chamnongkich S, Kinsey T, Mahoney O (2006) Biomechanical differences exhibited during sit to stand between total knee arthroplasty designs of varying radii. J Arthrop 21:1193–1198CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • J. E. Stoddard
    • 1
  • D. J. Deehan
    • 2
  • A. M. J. Bull
    • 3
  • A. W. McCaskie
    • 2
    • 4
  • A. A. Amis
    • 1
    • 5
    Email author
  1. 1.Biomechanics Group, Department of Mechanical EngineeringImperial College LondonLondonUK
  2. 2.Department of OrthopaedicsFreeman HospitalNewcastle upon TyneUK
  3. 3.Department of BioengineeringImperial College LondonLondonUK
  4. 4.Institute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK
  5. 5.Musculoskeletal Surgery Group, Department of Surgery and CancerImperial College London, Charing Cross HospitalLondonUK

Personalised recommendations