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The effects of femoral component design on the patello-femoral joint in a PS total knee arthroplasty

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Anterior knee pain following TKA performed utilizing the PFC Sigma system still represents a cause of failure. The purpose of this study was to evaluate whether or not a recent change in the femoral design (PFC Sigma PS) had a positive impact on the patello-femoral complication rate.

Materials and methods

A consecutive series of 100 TKA using the PFC Sigma PS system was followed prospectively for a minimum of 3 years. All patellae were replaced and a standard lateral release was never performed. Radiographic analysis following the Knee Society Score (KSS) included antero-posterior weight-bearing, lateral and bilateral axial radiographs. TKA rotational alignment was recorded at the final follow-up in 30 consecutive knees by performing a CT evaluation.

Results

Good to excellent clinical results according to the KSS were achieved in 94 % of the knees. Survival without need of reoperation for any reason was 98 % at 3 years minimum follow-up; two reoperations were done for removal of fibromatous intra-articular tissue (“Clunk syndrome”). There were no revisions for septic or aseptic loosening of the components. The mean ROM improved from 104° preoperatively to 115° (97°–132°) postoperatively: postoperative flexion was 120° or more in 58 % of the knees. Severe anterior knee pain was present in 9 % of patients. Radiographic evaluation showed 90 knees with a tibio-femoral anatomical axis between 8° and 2° of valgus (±3° from the intraoperative goal). CT evaluation of 30 consecutive knees showed that the femoral component positioning in relationship to the trans-epicondylar axis had only 2.80° of external rotation (±2.10°) with respect to a planned external rotation of 3°. This difference was statistically significant.

Conclusions

Although the PFC Sigma PS system provides good and predictable results for tricompartmental arthritis of the knee, anterior mechanism complications still represent a reason for dissatisfaction in a substantial group of patients.

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References

  1. Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD (2010) Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res 468(1):57–63

    Article  PubMed  Google Scholar 

  2. Hofmann S, Seitlinger G, Djahani O, Pietsch M (2011) The painful knee after TKA: a diagnostic algorithm for failure analysis. Knee Surg Sp Traumatol Arthrosc 19(9):1442–1452

    Article  CAS  Google Scholar 

  3. Patel J, Ries MD, Bozic KJ (2008) Extensor mechanism complications after total knee arthroplasty. Instr Course Lect 2008(57):283–294

    Google Scholar 

  4. Aglietti P, Baldini A, Buzzi R, Indelli PF (2001) Patella resurfacing in TKA: functional evaluation and complications. Knee Surg Sp Traumatol Arthrosc 9(Suppl 1):27–33

    Article  Google Scholar 

  5. Kim YH, Choi Y, Kim JS (2010) Comparison of a standard and a gender-specific posterior cruciate-substituting high-flexion knee prosthesis: a prospective, randomized, short-term outcome study. J Bone Joint Surg Am 92(10):1911–1920

    Article  PubMed  Google Scholar 

  6. Zihlmann MS, Stacoff A, Romero J, Quervain IK, Stüssi E (2005) Biomechanical background and clinical observations of rotational malalignment in TKA: literature review and consequences. Clin Biomech 20(7):661–668

    Article  Google Scholar 

  7. Benjamin J (2006) Component alignment in total knee arthroplasty. Instr Course Lect 2006(55):405–412

    Google Scholar 

  8. Dalury DF, Gonzales RA, Adams MJ, Gruen TA, Trier K (2008) Midterm results with the PFC Sigma total knee arthroplasty system. J Arthroplast 23(2):175–181

    Article  Google Scholar 

  9. Zaki SH, Rafiq I, Kapoor A, Raut V, Gambhir AK, Porter ML (2007) Medium term results with the Press Fit Condylar (PFC) Sigma knee prosthesis the Wrightington experience. Acta Orthop Belg 73:55–59

    PubMed  Google Scholar 

  10. Hanusch B, Lou TN, Warriner G, Hui A, Gregg P (2010) Functional outcome of PFC Sigma fixed and rotating-platform total knee arthroplasty. A prospective randomized controlled trial. Int Orthop 34:349–354

    Article  PubMed Central  PubMed  Google Scholar 

  11. Ranawat AS, Ranawat CS, Slamin JE, Dennis DA (2006) Patellar crepitation in the P.F.C. sigma total knee system. Orthopedics 29(9 Suppl):68–70

    Google Scholar 

  12. Meftah M, Ranawat AS, Ranawat CS (2011) Safety and efficacy of a rotating-platform, high-flexion knee design three- to five-year follow-up. J Arthroplasty 27(2):201–206

    Article  PubMed  Google Scholar 

  13. Indelli PF, Marcucci M, Cariello D, Poli P, Innocenti M (2012) Contemporary femoral designs in total knee arthroplasty: effects on the patello-femoral congruence. Int Orthop 36(6):1167–1173

    Article  PubMed Central  PubMed  Google Scholar 

  14. Kharwadkar N, Kent RE, Sharara KH, Naique S (2006) 5° to 6° of distal femoral cut for uncomplicated primary total knee arthroplasty: is it safe? Knee 13(1):57–60

    Article  CAS  PubMed  Google Scholar 

  15. Fulkerson JP, Schutzer SF, Ramsby GR, Bernstein RA (1987) Computerized tomography of the patellofemoral joint before and after lateral release or realignment. Arthroscopy 3(1):19–24

    Article  CAS  PubMed  Google Scholar 

  16. Aglietti P, Insall JN, Cerulli G (1983) Patellar pain and incongruence: I. Measurements of incongruence. Clin Orthop Relat Res 176:217–224

    PubMed  Google Scholar 

  17. Brossmann J, Muhle C, Schröder C, Melchert UH et al (1993) Patellar tracking patterns during active and passive knee extension: evolution with motion-triggered. Cine MR Imaging Radiol 187(1):205–212

    CAS  Google Scholar 

  18. Boisgard S, Moreau PE, Descamps S, Courtalhiac C, Silbert H, Moreel P, Michel JL, Levai JP (2003) Computed tomographic study of the posterior condylar angle in arthritic knees: its use in the rotational positioning of the femoral implant of total knee prostheses. Surg Radiol Anat 25:330–334

    Article  CAS  PubMed  Google Scholar 

  19. Ranawat CS, Rose HA, Rich DS (1984) Total condylar knee arthroplasty for valgus and combined valgus-flexion deformity of the knee. Instr Course Lect 198433:412–416

    Google Scholar 

  20. Rodricks DJ, Patil S, Pulido P, Colwell CW Jr (2007) Press-fit condylar design total knee arthroplasty fourteen to seventeen-year follow-up. J Bone Joint Surg Am 89(1):89–95

    Article  PubMed  Google Scholar 

  21. Dalury DF, Barrett WP, Mason JB, Goldstein WM et al (2008) Midterm survival of a contemporary modular knee replacement. A multicentre study of 1970 knees. JBJS (Br) 90-B:1594–1596

    Article  Google Scholar 

  22. Dalury DF, Mason JB, Murphy JA, Adams MJ (2009) Analysis of the outcome in male and female patients using a unisex total knee replacement system. JBJS (Br) 91-B:357–360

    Article  Google Scholar 

  23. Pagnano MV, Trousdale RT (2004) Rotating platform knees did not improve patellar tracking: a prospective, randomized study of 240 primary TKA. Clin Orthop Relat Res 428:221–227

    Article  PubMed  Google Scholar 

  24. Meftah M, Ranawat AS, Ranawat CS (2011) The natural history of anterior knee pain in 2 posterior-stabilized, modular total knee arthroplasty designs. J Arthroplasty 26(8):1145–1148

    Article  PubMed  Google Scholar 

  25. Meijerink HJ, Barink M, Van Loon CJ et al (2007) The trochlea is medialized by total knee arthroplasty: an intraoperative assessment in 61 patients. Acta Ortop 78(1):123–127

    Article  Google Scholar 

  26. Barink M, Van de Groes S, Verdonschot N et al (2006) The difference in trochlear orientation between the natural knee and current prosthetic knee designs: towards a truly physiological prosthetic groove orientation. J Biomech 39:1708–1715

    Article  CAS  PubMed  Google Scholar 

  27. Kulkarni SK, Freeman MAR, Poal-Manresa JC, Asencio JI, Rodriquez JJ (2000) The patellofemoral joint in total knee arthroplasty. Is the design the critical factor? J Arthroplasty 15(4):424–429

    Article  CAS  PubMed  Google Scholar 

  28. D’Lima DD, Steklov N, Patil S, Colwell CW (2008) The Mark Coventry Award: in vivo knee forces during recreation and exercise after knee arthroplasty. Clin Orthop Relat Res 466(11):2605–2611

    Article  PubMed  Google Scholar 

  29. Ostermeier S, Hurschler C, Stukenborg-Colsman C (2004) Quadriceps function after TKA—an in vitro study in a knee kinematic simulator. Clin Biomech 19(3):270–276

    Article  CAS  Google Scholar 

  30. Winemaker MJ (2002) Perfect balance in total knee arthroplasty: the elusive compromise. J Arthroplasty 17(1):2–10

    Article  CAS  PubMed  Google Scholar 

  31. Parratte S, Pagnano MW, Trousdale RT, Berry DJ (2010) Effect of postoperative mechanical axis alignment on the fifteen-year survival of modern, cemented total knee replacements. J Bone Joint Surg Am 92(12):2143–2149

    Article  PubMed  Google Scholar 

  32. Lachiewicz PF (2004) Implant design and techniques for patellar resurfacing in total knee arthroplasty. Instr Course Lect 2004(53):187–191

    Google Scholar 

  33. Chonko DJ, Lombardi AV Jr, Berend KR (2004) Patella baja and total knee arthroplasty (TKA): etiology, diagnosis, and management. Surg Technol Int 12:231–238

    PubMed  Google Scholar 

  34. Schindler OS (2012) The controversy of patellar resurfacing in TKA: ibisne in medio tutissimus? Knee Surg Sp Traumatol Arthrosc 20:1227–1244

    Article  Google Scholar 

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Authors and Affiliations

  1. Centro Eccellenza Sostituzioni Articolari Toscana (CESAT), Clinica Ortopedica Universita’ di Firenze, Florence, Italy

    Pier Francesco Indelli & Massimiliano Marcucci

  2. Fondazione Onlus, “…In Cammino…”, Fucecchio, Italy

    Pier Francesco Indelli & Massimiliano Marcucci

  3. Breyer Center for Overseas Study, Stanford University in Florence, Florence, Italy

    Pier Francesco Indelli & Sophie Charlton

  4. Ospedale Villa Regina, Bologna, Italy

    Gennaro Pipino

  5. Clinica Ortopedica Universita’ di Firenze, Florence, Italy

    Pier Francesco Indelli, Massimiliano Marcucci, Christian Carulli & Massimo Innocenti

  6. CESAT, Piazza Lavagnini 1, 50054, Fucecchio, Firenze, Italy

    Pier Francesco Indelli & Massimiliano Marcucci

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  1. Pier Francesco Indelli
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  2. Massimiliano Marcucci
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  3. Gennaro Pipino
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  4. Sophie Charlton
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  5. Christian Carulli
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  6. Massimo Innocenti
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Correspondence to Pier Francesco Indelli.

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Indelli, P.F., Marcucci, M., Pipino, G. et al. The effects of femoral component design on the patello-femoral joint in a PS total knee arthroplasty. Arch Orthop Trauma Surg 134, 59–64 (2014). https://doi.org/10.1007/s00402-013-1877-4

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  • DOI: https://doi.org/10.1007/s00402-013-1877-4

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