Although the results of total knee arthroplasty continue to improve, problems related to the patellofemoral joint remain significant. This study examined the factors affecting patellar alignment after total knee arthroplasty and subsequent changes in 56 knees during a postoperative period of 5.3 years. None of the knees examined displayed any clinical complications of the patellofemoral joint; no revision surgeries were necessary, with acceptable patellar alignment on average. The patellar resection angle had a strong influence on patellar alignment. Thinning of the patellar remnant on the medial side can increase postoperative lateral tilt, which leads to a need for lateral retinacular release. Although the changes in patellar alignment were minimal, the tendency that postoperative varus alignment resulted in patellar lateral tilt was observed. As postoperative femorotibial misalignment can lead to patellofemoral problems after total knee arthroplasty, surgeons need to pay scrupulous attention to femorotibial alignment and proper patellar preparation to decrease patellofemoral complications.
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Anglin C, Brimacombe JM, Hodgson AJ, Masri BA, Greidanus NV, Tonetti J, Wilson DR (2008) Determinants of patellar tracking in total knee arthroplasty. Clin Biomech (Bristol, Avon) 23:900–910
Anouchi YS, Whiteside LA, Kaiser AD, Milliano MT (1993) The effects of axial rotational alignment of the femoral component on knee stability and patellar tracking in total knee arthroplasty demonstrated on autopsy specimens. Clin Orthop Relat Res 287:170–177
Baldini A, Anderson JA, Cerulli-Mariani P, Kalyvas J, Pavlov H, Sculco TP (2007) Patellofemoral evaluation after total knee arthroplasty. Validation of a new weight-bearing axial radiographic view. J Bone Jt Surg Am 89:1810–1817
Berger RA, Crossett LS, Jacobs JJ, Rubash HE (1998) Malrotation causing patellofemoral complications after total knee arthroplasty. Clin Orthop Relat Res 356:144–153
Cahue S, Dunlop D, Hayes K, Song J, Torres L, Sharma L (2004) Varus-valgus alignment in the progression of patellofemoral osteoarthritis. Arthritis Rheum 50:2184–2190
Chan KC, Gill GS (1999) Postoperative patellar tilt in total knee arthroplasty. J Arthroplast 14:300–304
Elahi S, Cahue S, Felson DT, Engelman L, Sharma L (2000) The association between varus-valgus alignment and patellofemoral osteoarthritis. Arthritis Rheum 43:1874–1880
Goldberg VM, Figgie HE 3rd, Inglis AE, Figgie MP, Sobel M, Kelly M, Kraay M (1988) Patellar fracture type and prognosis in condylar total knee arthroplasty. Clin Orthop Relat Res 236:115–122
Grace JN, Rand JA (1988) Patellar instability after total knee arthroplasty. Clin Orthop Relat Res 237:184–189
Huberti HH, Hayes WC (1984) Patellofemoral contact pressures: the influence of Q-angle and tendofemoral contact. J Bone Jt Surg Am 66:715–724
Hungerford DS, Barry M (1979) Biomechanics of the patellofemoral joint. Clin Orthop Relat Res 144:9–15
Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the knee society clinical rating system. Clin Orthop Relat Res 248:13–14
Kawano T, Miura H, Nagamine R, Urabe K, Matsuda S, Mawatari T, Moro-oka T, Iwamoto Y (2002) Factors affecting patellar tracking after total knee arthroplasty. J Arthroplast 17:942–947
Laughlin RT, Werries BA, Verhulst SJ, Hayes JM (1996) Patellar tilt in total knee arthroplasty. Am J Orthop 25:300–304
Laurin CA, Lévesque HP, Dussault R, Labelle H, Peides JP (1978) The abnormal lateral patellofemoral angle: a diagnostic roentgenographic sign of recurrent patellar subluxation. J Bone Jt Surg Am 60:55–60
Lewonowski K, Dorr LD, McPherson EJ, Huber G, Wan Z (1997) Medialization of the patella in total knee arthroplasty. J Arthroplast 12:161–167
Lie DT, Gloria N, Amis AA, Lee BP, Yeo SJ, Chou SM (2005) Patellar resection during total knee arthroplasty: effect on bone strain and fracture risk. Knee Surg Sports Traumatol Arthrosc 13:203–208
Lombardi AV Jr, Engh GA, Volz RG, Albrigo JL, Brainard BJ (1988) Fracture/dissociation of the polyethylene in metal-backed patellar components in total knee arthroplasty. J Bone Jt Surg Am 70:675–679
Luring C, Perlick L, Bäthis H, Tingart M, Grifka J (2007) The effect of femoral component rotation on patellar tracking in total knee arthroplasty. Orthopedics 30:965–967
Matsuda S, Miura H, Nagamine R, Urabe K, Hirata G, Iwamoto Y (2001) Effect of femoral and tibial component position on patellar tracking following total knee arthroplasty: 10-year follow-up of Miller-Galante I knees. Am J Knee Surg 14:152–156
Miyagi T, Matsuda S, Miura H, Nagamine R, Urabe K, Inoue S, Iwamoto Y (2002) Changes in patellar tracking after total knee arthroplasty: 10-year follow-up of Miller-Galante I knees. Orthopedics 25:811–813
Ozkoc G, Hersekli MA, Akpinar S, Ozalay M, Uysal M, Cesur N, Tandogan RN (2005) Time dependent changes in patellar tracking with medial parapatellar and midvastus approaches. Knee Surg Sports Traumatol Arthrosc 13:654–657
Ritter MA, Herbst SA, Keating EM, Faris PM, Meding JB (1996) Patellofemoral complications following total knee arthroplasty. Effect of a lateralrelease and sacrifice of the superior lateral geniculate artery. J Arthroplast 11:368–372
Scuderi G, Scharf SC, Meltzer LP, Scott WN (1987) The relationship of lateral releases to patella viability in total knee arthroplasty. J Arthroplast 2:209–214
Wetzner SM, Bezreh JS, Scott RD, Bierbaum BE, Newberg AH (1985) Bone scanning in the assessment of patellar viability following knee replacement. Clin Orthop Relat Res 199:215–219
Windsor RE, Scuderi GR, Insall JN (1989) Patellar fractures in total knee arthroplasty. J Arthroplast 4(Suppl):S63–S67
Youm YS, Cho WS, Woo JH, Kim BK (2010) The effect of patellar thickness changes on patellar tilt in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc [Epub ahead of print]
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Fukagawa, S., Matsuda, S., Mizu-uchi, H. et al. Changes in patellar alignment after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 19, 99–104 (2011). https://doi.org/10.1007/s00167-010-1164-7
- Total knee arthroplasty
- Patellar alignment
- Postoperative change