Contemporary femoral designs in total knee arthroplasty: effects on the patello-femoral congruence

Indelli, Pier Francesco; Marcucci, Massimiliano; Cariello, Donatella; Fusar‐Poli, Paolo; Innocenti, Massimo

doi:10.1007/s00264-011-1454-9

Cited by 23 publications

(25 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Postoperative patellar tracking is affected by patient-related factors including preoperative patellar tilt, Q angle, fixed valgus deformity [18][19][20] and surgery-related factors including the rotation of the femoral and tibial component, the shape of femoral trochlear design, the thickness and position of the patella, and surgical approach [1][2][3][4][21][22][23]. Among these factors, the rotation of the femoral component is thought to be the most important factor affecting patellofemoral tracking [1][2][3][4]7].…”

Section: Discussionmentioning

confidence: 99%

Combining different rotational alignment axes with navigation may reduce the need for lateral retinacular release in total knee arthroplasty

Cinotti

Ripani

Sessa

et al. 2012

International Orthopaedics (SICOT)

View full text Add to dashboard Cite

Purpose The aim of the study was to compare femoropatellar alignment and the incidence of lateral retinacular release (LRR) in total knee arthroplasty (TKA) in which the rotational alignment of the femoral component was determined using a combination of different rotational alignment axes and navigation or a single reference axis in the standard procedure. Methods We assessed 66 patients undergoing TKA in whom the rotation of the femoral component was determined on the posterior condylar axis in standard procedures (group A) and 65 patients in whom it was determined by combining the posterior condylar axis, anteroposterior axis and epicondylar axis in navigated procedures (group B). The mean age was 68 and 69 years in groups A and B, respectively. Patellar tracking was assessed after deflation of the tourniquet and LRR performed in the presence of maltracking. Visual analogue scale (VAS), Knee Society Score (KSS), Lonner patellar score and patellar tilt were recorded. Results LRR was carried out in 18 cases (27 %) in group A and in four (6 %) in group B (p00.003). The KSS and VAS were improved significantly compared to the preoperative status, but with no significant differences between the two groups. The patellar score showed a greater improvement in the navigated compared to the standard group at the four week follow-up. Patella tilt improved significantly in both groups. The complication rate was similar in the two groups. Conclusions Combining different rotational alignment axes with navigation significantly reduces patellar maltracking and the need for LRR compared to the standard procedure in which the posterior condylar axis is used as single anatomical reference.

show abstract

Section: Discussionmentioning

confidence: 99%

Combining different rotational alignment axes with navigation may reduce the need for lateral retinacular release in total knee arthroplasty

Cinotti

Ripani

Sessa

et al. 2012

International Orthopaedics (SICOT)

View full text Add to dashboard Cite

show abstract

“…All 30 patients selected for CT evaluation were available at follow-up and the results are shown in a different study [13]. The rotational alignment of the femoral component has been studied measuring the posterior condyles angle (pCA): the femoral component positioning in relationship to the trans-epicondylar axis at follow-up showed an average of 2.80° of external rotation (±2.10°).…”

Section: Radiological Resultsmentioning

confidence: 99%

“…The right knee was involved in 23 cases and the left in 7. The CT study was performed [13] with the patient assuming a supine position on the radiological table with the knee bent at 20°; CT images were 2 mm in thickness and with 2 mm in reconstructive increments, starting at the distal metaphysis and finishing at the tibial tubercle. particular attention was paid to the following CT measurements, both preoperatively and at the 3-year follow-up: patellar tilt (pTA) according to Fulkerson et al [15], patellar congruence angle (CA) according to Aglietti et al [16], patellar lateralization measuring the lateral patellar displacement (lpD) according to Brossman et al [17] and femoral component external rotation in relation to the trans-epicondylar axis (TeA), measuring the posterior condyles angle (pCA) according to Boisgard et al [18].…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

The effects of femoral component design on the patello-femoral joint in a PS total knee arthroplasty

Indelli

Marcucci

Pipino

et al. 2013

Arch Orthop Trauma Surg

Self Cite

View full text Add to dashboard Cite

without need of reoperation for any reason was 98 % at 3 years minimum follow-up; two reoperations were done for removal of fibromatous intra-articular tissue ("Clunk syndrome"). There were no revisions for septic or aseptic loosening of the components. The mean rOM improved from 104° preoperatively to 115° (97°-132°) postoperatively: postoperative flexion was 120° or more in 58 % of the knees. Severe anterior knee pain was present in 9 % of patients. radiographic evaluation showed 90 knees with a tibio-femoral anatomical axis between 8° and 2° of valgus (±3° from the intraoperative goal). CT evaluation of 30 consecutive knees showed that the femoral component positioning in relationship to the trans-epicondylar axis had only 2.80° of external rotation (±2.10°) with respect to a planned external rotation of 3°. This difference was statistically significant. Conclusions Although the pFC Sigma pS system provides good and predictable results for tricompartmental arthritis of the knee, anterior mechanism complications still represent a reason for dissatisfaction in a substantial group of patients.

show abstract

“…This technique also allows deter mining the correct rotational alignment of the prosthetic components in respect to the extensor mechanism, avoiding many complications related to the patellofemoral joint. 28 Patellofemoral complications after total knee arthroplasty still represent the most cited cause of pain and the most reported reason for revision surgery. 2 Our study has several limitations.…”

Section: Discussionmentioning

confidence: 99%

Rotational Alignment Landmarks in Primary Total Knee Arthroplasty

Baldini

Indelli²,

Manfredini³

et al. 2014

The Duke Orthopaedic Journal

Self Cite

View full text Add to dashboard Cite

Purpose: We hypothesized that the anterior tibial surface curvature is a more reliable landmark for correct tibial component rotational positioning in TKA respect to the 'Akagi' line and the medial third of the tibial tubercle.Methods: Three independent investigators reviewed 124 knee MRI scans, identifying independently the femoral transepicondylar axis (TEA), the femoral posterior condylar axis (PCA), a line connecting the middle of the posterior cruciate ligament and the medial edge of the patellar tendon attachment (Akagi's line), the medial third of the tibial tubercle and the anterior tibial surface curvature. The most appropriate tibial baseplate tracing for the NexGen Total Knee System (Zimmer, Warsaw, USA) was superimposed matching the anterior tibial cortex with its anterior surface. At this point, the rotation of the tibial plate tracing was calculated in respect to the TEA, the medial third of the tibial tubercle line, the Akagi's line and the PCA. Customized software was created and used for analysis of the MRI datasets. Results:The investigators agreed on the localization of the Akagi's line in 64% of the cases within 3° and in 85% of the cases within 5° (minimum -16°, maximum -7°): this landmark might lead to internal rotation of the tibial component. The observers agreed on the localization of the medial third of the tibial tubercle in 29% of the cases within 3° and, in 70% of the cases, within 5° (minimum -4°, maximum +4°): this landmark might lead to external rotation of the tibial component. The investigators agreed on the localization of the anterior tibial surface curvature in 89% of the cases within 3° and in 99% of the cases within 5° (minimum -1°, maximum +4°): component alignment along the anterior cortex guaranteed full matching ±3° to the epicondylar axis in 75% of the knees. Conclusion:Alignment of the tibial component, when based on the anterior tibial surface, was more reliable and easier identifiable than either the Akagi's line or the medial third of the tibial tubercle. Level of evidence:Level 3 (Retrospective cohort study).

show abstract

Contemporary femoral designs in total knee arthroplasty: effects on the patello-femoral congruence

Abstract: This study highlighted that modern femoral designs in TKA allow for a correct reproducibility of a normal patello-femoral conformity. Strict surgical principles are paramount to avoid patello-femoral complications even when modern implants are used.

Cited by 23 publications

References 36 publications

Combining different rotational alignment axes with navigation may reduce the need for lateral retinacular release in total knee arthroplasty

Combining different rotational alignment axes with navigation may reduce the need for lateral retinacular release in total knee arthroplasty

The effects of femoral component design on the patello-femoral joint in a PS total knee arthroplasty

Rotational Alignment Landmarks in Primary Total Knee Arthroplasty

Contact Info

Product

Resources

About