Primary Total Knee Arthroplasty: How Does Residual Patellar Thickness Affect Patient-Oriented Outcomes?

Alcerro, Jose C.; Rossi, Mark D.; Lavernia, Carlos J.

doi:10.1016/j.arth.2017.06.046

Cited by 9 publications

(16 citation statements)

References 22 publications

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“…However, due to the mismatch of the patellar implants, the surgeons had to choose between the re-establishment of original thickness and adequate residual bone thickness. By choosing the former, the low residual bone thickness likely causes fracture and instability; by choosing the latter, the increased thickness of the patella causes overstuffing of the patellofemoral joint and leads to anterior knee pain [ 43 , 44 ]. Although several studies have shown that adverse clinical outcomes were unlikely to occur if the overall and residual bone thickness of the patella was maintained in a reasonable range (postoperative thickness within 3 mm of the original thickness of the patella, and residual thickness between 10 and 15 mm), the changes in the patella might affect the patellofemoral contact pressures, thus leading to complications of the patellofemoral joint [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

The patellofemoral morphology and the normal predicted value of tibial tuberosity-trochlear groove distance in the Chinese population

Liu

Tian

et al. 2021

BMC Musculoskelet Disord

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Background Our objective was to obtain normal patellofemoral measurements to analyse sex and individual differences. In addition, the absolute values and indices of tibial tuberosity-trochlear groove (TT-TG) distances are still controversial in clinical application. A better method to enable precise prediction is still needed. Methods Seventy-eight knees of 78 participants without knee pathologies were included in this cross-sectional study. A CT scan was conducted for all participants and three-dimensional knee models were constructed using Mimics and SolidWorks software. We measured and analysed 19 parameters including the TT-TG distance and dimensions and shapes of the patella, femur, tibia, and trochlea. LASSO regression was used to predict the normal TT-TG distances. Results The dimensional parameters, TT-TG distance, and femoral aspect ratio of the men were significantly larger than those of women (all p values < 0.05). However, after controlling for the bias from age, height, and weight, there were no significant differences in TT-TG distances and anterior-posterior dimensions between the sexes (all p values > 0.05). The Pearson correlation coefficients between the anterior femoral offset and other indexes were consistently below 0.3, indicating no relationship or a weak relationship. Similar results were observed for the sulcus angle and the Wiberg index. Using LASSO regression, we obtained four parameters to predict the TT-TG distance (R2 = 0.5612, p < 0.01) to achieve the optimal accuracy and convenience. Conclusions Normative data of patellofemoral morphology were provided for the Chinese population. The anterior-posterior dimensions of the women were thicker than those of men for the same medial-lateral dimensions. More attention should be paid to not only sex differences but also individual differences, especially the anterior condyle and trochlea. In addition, this study provided a new method to predict TT-TG distances accurately.

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Section: Discussionmentioning

confidence: 99%

The patellofemoral morphology and the normal predicted value of tibial tuberosity-trochlear groove distance in the Chinese population

Liu

Tian

et al. 2021

BMC Musculoskelet Disord

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show abstract

“…However, due to the mismatch of the patellar implants, the surgeons had to choose between the reestablishment of original thickness and adequate residual bone thickness. By choosing the former, the low residual bone thickness likely causes fracture and instability; by choosing the latter, the increased thickness of patella causes overstu ng of the patellofemoral joint and leads to anterior knee pain [1,41].…”

Section: Discussionmentioning

confidence: 99%

The Three-Dimensional Morphology of the Patellofemoral Joint and the Normal Predicted Value of Tibial Tuberosity-Trochlear Groove Distance In Chinese Population

Li¹,

Liu²,

Tian³

et al. 2020

Preprint

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Our objective was to obtain normal patellofemoral measurements so as to provide a reference for prosthetic design. Besides, the absolute values and indices of TT-TG distances are still controversial in clinical application. A better method to enable precise clinical applications is still needed.Methods:78 knees of 78 subjects without knee pathologies were included in this cross-sectional study. A CT scan was obtained from all subjects and three-dimensional knee models were constructed using Mimics and SolidWorks software. We measured and analyzed 19 parameters including TT-TG distance and dimensions and shapes of patella, femur, tibia, and trochlea. LASSO regression was used to predict the normal TT-TG distances.Results:The dimensional indexes, TT-TG distance, and femoral aspect ratio of the males were significantly larger than those of females (all P values <0.05). However, after controlling the bias from age, height, and weight, there were no significant differences in TT-TG distances, PAL, and anterior-posterior dimensions between genders (all P values >0.05). The Pearson correlation coefficients between the AFO and other indexes were consistently below 0.3, indicating a none or weak relationship. Similar results were observed for the SA and the Wiberg index. Using LASSO regression, we obtained four parameters to predict TT-TG distance (R2=0.5612, P<0.01) to achieve the optimal accuracy and convenience. Conclusion:The anterior-posterior dimensions of the females were thicker than those of males for the same medial-lateral dimensions. More attention should be paid to not only gender differences but individual differences, especially the anterior condyle and trochlea. Besides, this study provided a new method of predicting TT-TG distance to enable precise clinical diagnoses and guide the medial transfer of the tibial tuberosity.

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“…Additionally, their study also showed that patients who reported more stiffness and lower knee active flexion had greater than native patella thickness after surgery [23]. Studies by Daluga et al and Shoji et al further show that an increase of 12% in anterior-posterior diameter of the knee and increase of 20% in patellar thickness, respectively, leads to marked increase in postoperative stiffness [8,22].…”

Section: Intraoperative Risk Factorsmentioning

confidence: 96%

“…Generally speaking, the amount of patellar bone resected should equal the width of the patellar component while also keeping in mind the thickness of the cartilage that may not be present at the time of TKA. In a study by Alcerro et al, patients in whom the patellar thickness after TKA was restored as close to the native thickness demonstrated the greatest improvements in quality of life, physical measures and Western Ontario and McMaster Universities Arthritis Index stiffness scores [23].…”

Section: Intraoperative Risk Factorsmentioning

confidence: 99%

Stiffness after Primary Total Knee Arthroplasty

Singh¹,

Berdis²,

Goel³

et al. 2020

Knee Surgery - Reconstruction and Replacement

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Total knee arthroplasty remains the definitive treatment for end-stage osteoarthritis of the knee. Despite being a very successful intervention in terms of relieving pain and returning a patient's function, it is not without complications. Post-operative stiffness after total knee arthroplasty is one of those complications that can be puzzling for physicians and debilitating for patients. While the etiology of stiffness is multifactorial, the treatment options are essentially limited to manipulation under anesthesia, removal of adhesions and revision total knee arthroplasty. With patient outcomes directly related to relief of pain and post-operative range of motion, it is paramount that surgeons do all that is necessary to minimize risk of post-operative stiffness.

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Primary Total Knee Arthroplasty: How Does Residual Patellar Thickness Affect Patient-Oriented Outcomes?

Cited by 9 publications

References 22 publications

The patellofemoral morphology and the normal predicted value of tibial tuberosity-trochlear groove distance in the Chinese population

The patellofemoral morphology and the normal predicted value of tibial tuberosity-trochlear groove distance in the Chinese population

The Three-Dimensional Morphology of the Patellofemoral Joint and the Normal Predicted Value of Tibial Tuberosity-Trochlear Groove Distance In Chinese Population

Stiffness after Primary Total Knee Arthroplasty

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