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The effect of trochlea tilting on patellofemoral contact patterns after total knee arthroplasty: an in vitro study

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

Abstract

Introduction

Patellofemoral complications are one major concern after total knee arthroplasty (TKA). Anterior knee pain is one of these complications and to a high percentage responsible for unsatisfied patients after TKA. Malrotation of the femoral component can contribute to retropatellar peak pressure and consequently to anterior knee pain.

Materials and methods

Eight fresh frozen cadavers were tested in a force-controlled knee rig after TKA during isokinetic flexing of the knee from 20° to 120° under constant load. By tilting the trochlea in the material of the created femoral component replicas, a rotation of the femoral component by 3° internal, 0° (neutral), 3° and 6° external rotation to transepicondylar line was simulated without changing flexion or extension gap. Retropatellar pressure distribution was measured during flexion and extension of the knee while quadriceps muscles and hamstring forces were applied.

Results

Maximum peak pressure for internal rotation of the trochlea was 7.32 ± 2.31 MPa, in neutral position the pressure reduced slightly to 7.31 ± 2.12 MPa and during further external rotation of trochlea rotation a decrease from 3° with 7.18 ± 2.14 MPa to 6° with 6.22 ± 1.83 MPa was observed (p < 0.01). There was a tendency of lower quadriceps force with increasing external rotation of the trochlea (p = 0.08).

Conclusions

The implantation of the femoral component by 3° internal trochlea rotation to transepicondylar line resulted in a highly significant increase of the mean maximal retropatellar pressure compared to 6° external rotation of the trochlea of the femoral component (p < 0.01). A higher retropatellar pressure might lead to anterior knee pain after TKA. We recommend an external rotation of the femoral component between 3° and 6° to anatomical transepicondylar line to reduce the maximal retropatellar pressure, but only if adequate soft tissue balancing and stable knee kinematics are provided.

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Acknowledgments

The authors thank the Dr. Auguste Schaedel-Dantscher Foundation for their financial support of this study. The authors also thank the Aesculap Company for providing the prosthesis system, construction of the replicas of the femoral component and set of tools. We also thank Dr. Alexander Crispin (Institute for Biometry and Bioinformatics, LMU München) for his help in generating the statistical tests in this study. Additionally the authors thank Moritz von Holst for his technical help in preparing this paper.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany

    Arnd Steinbrück, Christian Schröder, Matthias Woiczinski, Andreas Fottner, Peter E. Müller & Volkmar Jansson

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  1. Arnd Steinbrück
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  2. Christian Schröder
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  3. Matthias Woiczinski
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  4. Andreas Fottner
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  5. Peter E. Müller
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  6. Volkmar Jansson
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Correspondence to Arnd Steinbrück.

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Steinbrück, A., Schröder, C., Woiczinski, M. et al. The effect of trochlea tilting on patellofemoral contact patterns after total knee arthroplasty: an in vitro study. Arch Orthop Trauma Surg 134, 867–872 (2014). https://doi.org/10.1007/s00402-014-1956-1

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  • DOI: https://doi.org/10.1007/s00402-014-1956-1

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