Anteroposterior positioning of the tibial component and its effect on the mechanics of patellofemoral contact

Didden, K.; Luyckx, Thomas; Bellemans, Johan; Labey, Luc; Innocenti, Bernardo; Vandenneucker, Hilde

doi:10.1302/0301-620x.92b10.24221

Cited by 25 publications

(12 citation statements)

References 16 publications

(17 reference statements)

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“…Another advantage of our study is the use of a detailed MMBS model incorporating relevant muscles of the lower extremity as active force elements compared to previous studies that assumed the muscles to apply only constant forces [15,16,30,51,85], considered only few muscles [28,33], or analyzed passive load cases without active muscle forces [34]. Our study showed the potential of MMBS in very comprehensively investigating the effects of surgical parameters on knee joint dynamics.…”

Section: Discussionmentioning

confidence: 99%

“…However, most experimental studies have only investigated passive knee flexion without active muscle forces, simulated rather uncommon motion patterns, commonly the knee rig configuration [28,33,42,51], or assumed a static quadriceps force, usually some predefined maximum value [28]. Furthermore, only a few studies addressing the biomechanical impact of different patellar component positions and designs on PF dynamics could be identified [15,18,28,33].…”

Section: Introductionmentioning

confidence: 99%

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Musculoskeletal Multibody Simulation Analysis on the Impact of Patellar Component Design and Positioning on Joint Dynamics after Unconstrained Total Knee Arthroplasty

Kebbach

Darowski

Krueger³

et al. 2020

Materials

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Patellofemoral (PF) disorders are considered a major clinical complication after total knee replacement (TKR). Malpositioning and design of the patellar component impacts knee joint dynamics, implant fixation and wear propagation. However, only a limited number of studies have addressed the biomechanical impact of the patellar component on PF dynamics and their results have been discussed controversially. To address these issues, we implemented a musculoskeletal multibody simulation (MMBS) study for the systematical analysis of the patellar component’s thickness and positioning on PF contact forces and kinematics during dynamic squat motion with virtually implanted unconstrained cruciate-retaining (CR)-TKR. The patellar button thickness clearly increased the contact forces in the PF joint (up to 27%). Similarly, the PF contact forces were affected by superior–inferior positioning (up to 16%) and mediolateral positioning (up to 8%) of the patellar button. PF kinematics was mostly affected by the mediolateral positioning and the thickness of the patellar component. A medialization of 3 mm caused a lateral patellar shift by up to 2.7 mm and lateral patellar tilt by up to 1.6°. However, deviations in the rotational positioning of the patellar button had minor effects on PF dynamics. Aiming at an optimal intraoperative patellar component alignment, the orthopedic surgeon should pay close attention to the patellar component thickness in combination with its mediolateral and superior–inferior positioning on the retropatellar surface. Our generated MMBS model provides systematic and reproducible insight into the effects of patellar component positioning and design on PF dynamics and has the potential to serve as a preoperative analysis tool.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Musculoskeletal Multibody Simulation Analysis on the Impact of Patellar Component Design and Positioning on Joint Dynamics after Unconstrained Total Knee Arthroplasty

Kebbach

Darowski

Krueger³

et al. 2020

Materials

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“…The changes in shape, dimensions and positioning may have affected AP alignment of the tibial tray. A more anterior position leads to increased stress on the patellofemoral joint and less efficient use of the extensor mechanism [19]. …”

Section: Discussionmentioning

confidence: 99%

Do refinements to original designs improve outcome of total knee replacement? A retrospective cohort study

et al. 2014

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BackgroundLong-term results of the 'classic’ low contact stress (LCS) total knee replacement (TKR) have been satisfactory; nonetheless, design changes have been made which resulted in the 'complete’ LCS TKR. The aim of this study is to compare the 5-year incidence of revision and midterm clinical performance before and after introduction of the 'complete’.MethodsA retrospective cohort analysis was conducted on 100 primary uncemented TKRs of both designs. At 5-year follow-up, revision and reoperation rates were determined for these 200 TKRs. Knee Society score (KSS), the Oxford Knee score (OKS) and range of motion were determined for 143 TKRs.ResultsIn the 'classic’ cohort, 3% of the TKRs were revised compared with 5% in the 'complete’ cohort (p = 0.72).The mean KSS was 134.1 (SD 38.3) in the 'classic’ cohort compared to 135.0 (SD 42.8) in the 'complete’ cohort (p = 0.89). Of the 'complete’ TKRs, 35.2% scored within the lowest quartile of the KSS knee compared to 16.7% of the 'classic’ TKRs (p = 0.01). The OKS was 23.3 (SD 9.3) in the 'classic’ cohort compared to 22.5 (SD 10.1) in the 'complete’ cohort (p = 0.45). More than 5° flexion contracture was only found in four patients in the 'complete’ cohort (p = 0.04).ConclusionsNo statistical difference in revision rate and average scores for midterm clinical performance was observed between the 'classic’ and the 'complete’. However, the 'complete’ cohort had a higher percentage of KSS Knee in the lowest quartile, which suggests a clinical relevant difference compared with the 'classic’. Further investigation in future studies with new designs is needed.

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“…The pressure within the PFJ following TKA is a strong indicator of the risk of wear of the implanted patella button and pain within the joint. 9,57,58 Previous studies have used the Pliance system 14,18 or the K-Scan and I-Scan systems (Tekscan, Boston, MA, USA) 17,19,59 to measure contact area and pressure dynamically within the PFJ. However, these were not suitable for use in this study due to the low sensor density and relatively large thickness (2 mm) of the Pliance sensor, and the limited pliability and high expense of the Tekscan systems.…”

Section: Discussionmentioning

confidence: 99%

In vitro method for assessing the biomechanics of the patellofemoral joint following total knee arthroplasty

Coles

Gheduzzi

Miles

2014

Proc Inst Mech Eng H

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The patellofemoral joint is a common site of pain and failure following total knee arthroplasty. A contributory factor may be adverse patellofemoral biomechanics. Cadaveric investigations are commonly used to assess the biomechanics of the joint, but are associated with high inter-specimen variability and often cannot be carried out at physiological levels of loading. This study aimed to evaluate the suitability of a novel knee simulator for investigating patellofemoral joint biomechanics. This simulator specifically facilitated the extended assessment of patellofemoral joint biomechanics under physiological levels of loading. The simulator allowed the knee to move in 6 degrees of freedom under quadriceps actuation and included a simulation of the action of the hamstrings. Prostheses were implanted on synthetic bones and key soft tissues were modelled with a synthetic analogue. In order to evaluate the physiological relevance and repeatability of the simulator, measurements were made of the quadriceps force and the force, contact area and pressure within the patellofemoral joint using load cells, pressure-sensitive film, and a flexible pressure sensor. The results were in agreement with those previously reported in the literature, confirming that the simulator is able to provide a realistic physiological loading situation. Under physiological loading, average standard deviations of force and area measurements were substantially lower and comparable to those reported in previous cadaveric studies, respectively. The simulator replicates the physiological environment and has been demonstrated to allow the initial investigation of factors affecting patellofemoral biomechanics following total knee arthroplasty.

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Anteroposterior positioning of the tibial component and its effect on the mechanics of patellofemoral contact

Cited by 25 publications

References 16 publications

Musculoskeletal Multibody Simulation Analysis on the Impact of Patellar Component Design and Positioning on Joint Dynamics after Unconstrained Total Knee Arthroplasty

Musculoskeletal Multibody Simulation Analysis on the Impact of Patellar Component Design and Positioning on Joint Dynamics after Unconstrained Total Knee Arthroplasty

Do refinements to original designs improve outcome of total knee replacement? A retrospective cohort study

In vitro method for assessing the biomechanics of the patellofemoral joint following total knee arthroplasty

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