Medial stabilized and posterior stabilized TKA affect patellofemoral kinematics and retropatellar pressure distribution differently

Glogaza, Alexander; Schröder, Christian; Woiczinski, Matthias; Müller, Peter E.; Jansson, Volkmar; Steinbrück, Arnd

doi:10.1007/s00167-017-4772-7

Cited by 12 publications

(13 citation statements)

References 32 publications

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“…Although some previous studies showed no significant differences between AFO restoration and clinical outcomes, there was a trend towards improved outcomes [ 3 , 45 ]. Other studies showed that if the AFO increased after TKA and there was a risk of overstuffing due to the mismatch of the prosthesis, the pressure of the patellofemoral joint would increase, and then, there would be complications such as anterior knee pain and decreased knee motion [ 46 ]. Taking these issues into account, an increasing number of studies have analysed the shape and variance of the distal femur.…”

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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“…This could affect the external validity of the study, but only in countries where resurfacing is done more or less by default for reasons stated earlier [ 14 , 18 , 33 ]. One study recently implied that postoperative retropatellar pressure is low in medial pivot implants [ 17 ], yet our study showed there is an increased risk for revision due to patellar erosion.…”

Section: Discussionmentioning

confidence: 52%

“…However, we documented a near fivefold risk of revision for malalignment, and a doubled risk of revision for instability in Australia for medial pivot designs compared with cruciate-retaining implants. Some reports indicate that medial pivot design improve patellofemoral biomechanics [ 1 , 17 , 42 ], possibly due to the lack of medial translation and the lateral femoral rollback [ 39 ]. However, other studies fail to report this [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Decreased Survival of Medial Pivot Designs Compared with Cruciate-retaining Designs in TKA Without Patellar Resurfacing

Øhrn

Gøthesen

Lygre

et al. 2020

Clin Orthop Relat Res

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Background The medial pivot TKA design was introduced in the 1990s. These are fixed-bearing, medial-conforming implants with virtually no translation in the medial part of the knee, in contrast to the flat lateral part of the insert allowing for translation similar to the native knee during flexion and extension. Most primary TKAs performed in Norway and Australia are cruciate-retaining. All of the medial pivot implants in our study are cruciate-sacrificing but without a post-cam mechanism. The medial pivot implant design was developed to more closely mimic native knee motion, in the hope of improving function, and not primarily as a more constrained knee for difficult cases. In the past 10 to 12 years, a second-generation medial-pivot design has emerged, but there are no larger registry studies on the survival of these implants. Both cruciate-retaining and medial pivot designs are reported in the Australian and Norwegian registries, allowing for large-scale, comparative survivorship studies. Questions/purposes (1) Is there any difference in survival between the medial pivot design and the three most commonly used cruciate-retaining TKA designs? (2) Is there any difference in survival among the different medial pivot implant designs? (3) What are the main indications for revision of medial pivot TKAs? Methods Registry data from the Australian Orthopaedic Association National Joint Replacement Registry and Norwegian Arthroplasty Register from 2005 until the end of 2017 were used to compare the five different brands of medial pivot TKA designs (total primary TKAs assessed: 6310). In Australia, the study group of medial pivot implants represented 9% (6012 of 72,477) of the total number of cemented/hybrid TKAs without patellar resurfacing; 345 had cementless femoral components. In Norway, the study group represented 1% (298 of 47,820) of the total number of TKAs with cemented tibias without patellar resurfacing; all had cemented femoral components. The control group consisted of the three most commonly used cruciate-retaining TKA designs (n = 70,870; Australia n = 54,554; Norway n = 16,316). All TKAs used a fixed-bearing, cemented tibial component and did not involve patella resurfacing. Kaplan-Meier survival analysis was assessed to estimate survivorship. We compared the groups by calculating the hazard ratios (HR) using Cox regression adjusted for age, gender and preoperative diagnosis with 95% CI. To answer our third question, we calculated the percentage of each revision indication from the total number of revisions in each group, and used a Cox regression analysis to compare revision causes and HRs. Analyses were performed separately by each registry. Accounting for competing risks (Fine and Gray) did not alter our findings [ 12 ]. Results After controlling for potential confounding variables such as gender, age and preoperative diagnosis, we found an increased r...

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“…Although some previous studies showed no signi cant differences between restoration of AFO and clinical outcomes, there was a trend toward improved outcomes [34,42]. Other studies showed that if the AFO increased after TKA and the there was a risk of overstu ng due to the mismatch of the prosthesis, the pressure of the patellofemoral joint would increase, and then there would be complications such as anterior knee pain and decreased knee motion [20]. If there was a risk of notching of the patellofemoral joint, it leaded to cause instability in knee exion [6].…”

Section: Discussionmentioning

confidence: 95%

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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Medial stabilized and posterior stabilized TKA affect patellofemoral kinematics and retropatellar pressure distribution differently

Abstract: Patellofemoral kinematics and retropatellar pressure change after TKA in different manner depending on the type of TKA used. Surgeons should be aware of influencing the risks of patellofermoral complications by the choice of the prosthesis design.

Cited by 12 publications

References 32 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

Decreased Survival of Medial Pivot Designs Compared with Cruciate-retaining Designs in TKA Without Patellar Resurfacing

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

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