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Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 24, Issue 11, pp 3668–3677 | Cite as

Isolated patellofemoral arthroplasty reproduces natural patellofemoral joint kinematics when the patella is resurfaced

  • Hilde Vandenneucker
  • Luc Labey
  • Jos Vander Sloten
  • Kaat Desloovere
  • Johan Bellemans
Knee

Abstract

Purpose

The objectives of this in vitro project were to compare the dynamic three-dimensional patellofemoral kinematics, contact forces, contact areas and contact pressures of a contemporary patellofemoral prosthetic implant with those of the native knee and to measure the influence of patellar resurfacing and patellar thickness. The hypothesis was that these designs are capable to reproduce the natural kinematics but result in higher contact pressures.

Methods

Six fresh-frozen specimens were tested on a custom-made mechanical knee rig before and after prosthetic trochlear resurfacing, without and with patellar resurfacing in three different patellar thicknesses. Full three-dimensional kinematics were analysed during three different motor tasks, using infrared motion capture cameras and retroflective markers. Patellar contact characteristics were registered using a pressure measuring device.

Results

The patellofemoral kinematic behaviour of the patellofemoral arthroplasty was similar to that of the normal knee when the patella was resurfaced, showing only significant (p < 0.0001) changes in patellar flexion. Without patellar resurfacing, significant more patellar flexion, lateral tilt and lateral rotation was noticed. Compared to the normal knee, contact pressures were significantly elevated after isolated trochlear resurfacing. However, the values were more than doubled after patellar resurfacing. Changes in patellar thickness only influenced the antero-posterior patellar position. There was no other influence on the kinematics, and only a limited influence on the contact pressures in the low flexion angles.

Conclusion

The investigated design reproduced the normal patellofemoral kinematics acceptable well when the patella was resurfaced. From a kinematic point of view, patellar resurfacing may be advisable. However, the substantially elevated patellar contact pressures remain a point of concern in the decision whether or not to resurface the patella. This study therefore not only adds a new point in the discussion whether or not to resurface the patella, but also supports the claimed advantage that a patellofemoral arthroplasty is capable to reproduce the natural knee kinematics.

Keywords

Patellofemoral arthroplasty Kinematics Contact pressure Patellar resurfacing 

Notes

Acknowledgments

This study was performed in the European Centre for Knee Research of Smith&Nephew. The authors want to thank Ronny Decorte and Bernardo Innocenti for their continuous practical support.

Conflict of interest

Some of the authors have a sporadic consultancy agreement (lectures) with Smith&Nephew.

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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2014

Authors and Affiliations

  • Hilde Vandenneucker
    • 1
  • Luc Labey
    • 2
  • Jos Vander Sloten
    • 3
  • Kaat Desloovere
    • 4
  • Johan Bellemans
    • 1
  1. 1.Department of Development and Regeneration - Orthopaedic SurgeryUniversity Hospitals LeuvenPellenberg-LubbeekBelgium
  2. 2.European Centre for Knee ResearchSmith&NephewLeuvenBelgium
  3. 3.Biomechanics SectionUniversity of LeuvenLeuvenBelgium
  4. 4.Department of Rehabilitation SciencesUniversity Hospital LeuvenPellenberg-LubbeekBelgium

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