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Increased in vivo patellofemoral loading after total knee arthroplasty in resurfaced patellae

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

Abstract

Purpose

The primary purpose of the study was to investigate if and how patellar bone tracer uptake (BTU) distribution in SPECT/CT is influenced by patellar resurfacing and the position of femoral and tibial TKA component position.

Methods

A total of 104 knees of 103 consecutive patients who underwent primary TKA were prospectively investigated. Primary patellar resurfacing was done in 40 knees while 64 had a TKA without patellar resurfacing. All patients underwent clinical assessment using the knee society score (KSS) and standardized radiographs and Tc-99m-HDP-SPECT/CT before and 12 and 24 months after TKA. Measurements of BTU including intensity and anatomical distribution pattern in eight different patellar regions were performed. Tibial and femoral TKA component position was assessed from 3D reconstructed CT data. Patellar height, thickness and tilt were measured and the distance between the tibial tuberosity and the trochlear groove (TT–TG) was measured. Univariate analysis was performed to identify differences between the two groups (p < 0.05).

Results

Significantly higher BTU was found in the anterior, non-articular, areas of the patella in patients who underwent patellar resurfacing (p < 0.05). The BTU pattern was similar between the groups, as the maximal uptake in both groups was seen in the superior posterior parts and the minimal uptake was seen in the inferior anterior parts. The mean postoperative KSS was significantly higher in the unresurfaced group after 12 months (p < 0.05), but with no significant difference after 24 months.

Conclusions

Based on the findings of the present study, patellar resurfacing is related to significantly higher BTU in the anterior parts of the patella and lower clinical outcomes. In light of these results, routine patellar resurfacing as part of a primary TKA might be reevaluated. SPECT/CT enables a precise localization of the BTU and might be considered as the ideal imaging modality for evaluation and investigate of patellofemoral disorders after TKA

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Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Meir General Hospital, Kfar Saba, Israel

    Omer Slevin

  2. Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Switzerland

    Omer Slevin, Florian A. Schmid, Filippo Schiapparelli & Michael T. Hirschmann

  3. Institute of Radiology and Nuclear Medicine, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Switzerland

    Helmut Rasch

  4. University of Basel, Basel, Switzerland

    Florian A. Schmid, Filippo Schiapparelli & Michael T. Hirschmann

Authors
  1. Omer Slevin
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  2. Florian A. Schmid
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  3. Filippo Schiapparelli
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  4. Helmut Rasch
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  5. Michael T. Hirschmann
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Corresponding author

Correspondence to Michael T. Hirschmann.

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Conflict of interest

All authors declare that there is no conflict of interest.

Funding

There was no financial conflict of interest with regards to this study.

Ethical approval

Ethical approval was obtained from the Ethikkommission Nordwest- und Zentralschweiz (EKNZ, Basel). All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Slevin, O., Schmid, F.A., Schiapparelli, F. et al. Increased in vivo patellofemoral loading after total knee arthroplasty in resurfaced patellae. Knee Surg Sports Traumatol Arthrosc 26, 1805–1810 (2018). https://doi.org/10.1007/s00167-017-4803-4

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  • DOI: https://doi.org/10.1007/s00167-017-4803-4

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