Biomechanical Study of Patellar Component Fixation with Varying Degrees of Bone Loss

Beck, Cameron; Nwannunu, B.I.; Teigen, Kari; Wagner, Russell

doi:10.1016/j.arth.2020.08.044

Cited by 4 publications

(5 citation statements)

References 15 publications

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“…The construct was first preloaded to 100 N and held under that load for 90 seconds to achieve a steady viscoelastic state, define zero-strain at a set preload, and ensure uniform contact with the compression plate [ 28 ]. The compression plate attached to the actuator descended at a rate of 5 mm/s in axial compression until ultimate load to failure representing a patella fracture occurred [ 29 ]. Fractures of the patella were identified by 2 methods: a decrease in strength in the stress-strain curve noted on the MTS followed by visual inspection to confirm fracture ( Fig.…”

Section: Methodsmentioning

confidence: 99%

Fracture Risk With Patella Resurfacing During Total Knee Arthroplasty After Anterior Cruciate Ligament Reconstruction Using Bone-Patella-Bone Autograft: A Biomechanical Analysis

Wilder¹,

Patel²,

Ross³

et al. 2022

Arthroplasty Today

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Background Anterior cruciate ligament (ACL) tears are common injuries. Ipsilateral bone patellar tendon bone (BPTB) autograft has been frequently used for ACL reconstructions. A large percentage of patients who sustain ACL ruptures develop early osteoarthritis and require total knee arthroplasty (TKA). When patients with previous BPTB autograft for an ACL tear undergo TKA, there may be an increased risk of fracture after patellar resurfacing. Methods There were 20 artificial Sawbones and 10 cadaveric patellae resurfaced. To simulate the presence of a previous BPTB autograft, a bone plug was removed from the anterior surface of the patellae and was resurfaced with a cemented patellar button. Biomechanical testing was performed to determine the compressive load to fracture of patellae with and without previous BPTB autograft. Results The average maximum load to failure for the artificial Sawbones patellae without a previous BPTB autograft was 4551.40 N ± 753.12 compared with 2855.39 N ± 531.46 with a previous BPTB autograft ( P < .001). The average maximum load to failure for the cadaveric patellae without a previous BPTB autograft was 7256.37 N ± 1473.97 compared with 5232.22 N ± 475.04 with a previous BPTB autograft ( P = .021). Conclusions The results demonstrate a significantly lower maximum load to failure of a resurfaced patella in the presence of a previous BPTB autograft. This can be used to aid in the decision of whether to resurface the patellae in these patients and to educate patients that the presence of a previous BPTB autograft may be an increased risk factor for patella fracture after TKA.

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Section: Methodsmentioning

confidence: 99%

Fracture Risk With Patella Resurfacing During Total Knee Arthroplasty After Anterior Cruciate Ligament Reconstruction Using Bone-Patella-Bone Autograft: A Biomechanical Analysis

Wilder¹,

Patel²,

Ross³

et al. 2022

Arthroplasty Today

View full text Add to dashboard Cite

show abstract

“…Initially, the construct was preloaded to 100N for 90 seconds to achieve a steady viscoelastic state, define zero strain at a set preload, and ensure uniform contact with the compression plate [ 28 ]. Then, the compression plate attached to the actuator descended at a rate of 5 mm/s in axial compression to apply a loading force perpendicular to the axis of the patella button until ultimate load to failure resulted in a patella fracture [ 29 ] ( Fig. 4 ).…”

Section: Methodsmentioning

confidence: 99%

Patella Strength Characteristics in Cemented vs Press-fit Implants: A Biomechanical Analysis of Initial Stability

et al. 2022

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“…Previous studies have reported that a minimum 10 to 12 mm of bone stock must be present to resurface the patella. This bone stock would allow extensor mechanism to function and not drill through the anterior cortex of the patella [19,68,170,175].…”

Section: Question 3 What Are the Surgical Options For Reconstruction ...mentioning

confidence: 99%

“…The remaining cancellous bone can be sclerotic or filled with fibrous tissue, while sometimes the remaining patella is just a cortical eggshell [68,81]. Furthermore, the inherent stability of the component is affected by the size of the cancellous defects, the number of holes with a defect, and the capacity of cement to interdigitate with the cancellous bone [19]. Finally, polymethyl methacrylate (PMMA) is weak in tension and shear forces.…”

Section: Panel 3: Managing Patellar Bone Loss and The Extensor Mechan...mentioning

confidence: 99%

“…During TKA revision, the surgeon first must decide if there is a need for the patellar component to be revised and then whether or not a new patellar component should be placed. While the patellar revision can optimize the patellofemoral congruency, it may compromise the bone stock and subsequently increase the possibility of further complications [19,133]. The most common reasons for revising a patellar component include loose component or significant wear, malpositioning, maltracking, instability, or even anterior knee pain [133].…”

Section: Panel 3: Managing Patellar Bone Loss and The Extensor Mechan...mentioning

confidence: 99%

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Management of Bone Loss in Revision Total Knee Arthroplasty: An International Consensus Symposium

Sculco,

Flevas,

Jerabek

et al. 2024

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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The evaluation, classification, and treatment of significant bone loss after total knee arthroplasty (TKA) continue to be a complex and debated topic in revision TKA (rTKA). Despite the introduction of new evidence and innovative technologies aimed at addressing the approach and care of severe bone loss in rTKA, there is no single document that systematically incorporates these newer surgical approaches. Therefore, a comprehensive review of the treatment of severe bone loss in rTKA is necessary. The Stavros Niarchos Foundation Complex Joint Reconstruction Center Hospital for Special Surgery, dedicated to clinical care and research primarily in revision hip and knee replacement, convened a Management of Bone Loss in Revision TKA symposium on June 24, 2022. At this meeting, the 42 international invited experts were divided into groups; each group was assigned to discuss questions related to 1 of the 4 topics: (1) assessing preoperative workup and imaging, anticipated bone loss, classification system, and implant surveillance; (2) achieving durable fixation in the setting of significant bone loss in revision TKA; (3) managing patellar bone loss and the extensor mechanism in cases of severe bone loss; and (4) considering the use of complex modular replacement systems: hinges, distal femoral, and proximal tibial replacements. Each group came to consensus, when possible, based on an extensive literature review and interactive discussion on their group topic. This document reviews each these 4 areas, the consensus of each group, and directions for future research.

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Biomechanical Study of Patellar Component Fixation with Varying Degrees of Bone Loss

Cited by 4 publications

References 15 publications

Fracture Risk With Patella Resurfacing During Total Knee Arthroplasty After Anterior Cruciate Ligament Reconstruction Using Bone-Patella-Bone Autograft: A Biomechanical Analysis

Fracture Risk With Patella Resurfacing During Total Knee Arthroplasty After Anterior Cruciate Ligament Reconstruction Using Bone-Patella-Bone Autograft: A Biomechanical Analysis

Patella Strength Characteristics in Cemented vs Press-fit Implants: A Biomechanical Analysis of Initial Stability

Management of Bone Loss in Revision Total Knee Arthroplasty: An International Consensus Symposium

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