Finite Element Analysis of Resurfacing Depth and Obliquity on Patella Stress and Stability in TKA

Amirouche, Farid; Choi, Kwang Won; Goldstein, Wayne M.; Gonzalez, Mark H.; Broviak, Stefanie

doi:10.1016/j.arth.2013.02.002

Cited by 14 publications

(13 citation statements)

References 17 publications

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“…Amirouche et al 28 confirmed these results using a 3-dimensional model of a patella constructed on a digital program. The authors concluded that stress will increase on the patella, both native and prosthetic, as it becomes more thin.…”

Section: Periprosthetic Patellar Fracturesmentioning

confidence: 76%

“…Previous reports have proposed that if the newly resurfaced patella is too thin, there may be an increased risk of fracture due to an increase in the stresses on the remaining native bone. 20,27,28 Using a cadaver biomechanical model, Oishi et al 27 assessed the role of patellar thickness in compression and shear forces (10 knees) within the patellofemoral joint. After placing a load onto each knee, the authors noted greater forces on the thinner patella (P<.05).…”

Section: Periprosthetic Patellar Fracturesmentioning

confidence: 99%

“…However, basic science and clinical studies on the most recent generational constructs support the hypothesis that a decreased post-resection thickness may be associated with an increased periprosthetic fracture risk. 20,[27][28][29][30] reoPerations Although there are few studies regarding the risk of requiring a reoperation and the effect of the patellar thickness, there are no studies currently displaying a relationship between these 2 variables. In the previously mentioned study performed by Meding et al, 35 the authors found a significant association between decreasing patellar-prosthesis thickness and risk of patellar fracture (P=.03), but no association between increasing patellaprosthesis complex thickness and the need for component revision (P=.63).…”

Section: Periprosthetic Patellar Fracturesmentioning

confidence: 99%

See 2 more Smart Citations

Is There an Ideal Patellar Thickness Following Total Knee Arthroplasty?

Pierce¹,

Jauregui²,

Cherian³

et al. 2016

Orthopedics

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Orthopedic surgeons resurface the patella during total knee arthroplasty to avoid complications such as pain, patello-femoral arthritis, and patellar maltracking and to reduce the risk for reoperation. However, many complications, such as decreased range of motion, increased fractures, and polyethylene wear, have been described with this procedure. One determinant when resurfacing a patella is the thickness of its cuts. This review aims to investigate the relationship between patellar thickness and outcome parameters such as range of motion, patient-reported outcomes, periprosthetic fractures, and reoperations.

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Section: Periprosthetic Patellar Fracturesmentioning

confidence: 76%

Section: Periprosthetic Patellar Fracturesmentioning

confidence: 99%

Section: Periprosthetic Patellar Fracturesmentioning

confidence: 99%

See 1 more Smart Citation

Is There an Ideal Patellar Thickness Following Total Knee Arthroplasty?

Pierce¹,

Jauregui²,

Cherian³

et al. 2016

Orthopedics

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“…In vivo (Carpenter et al, 2009;Sharma et al, 2012), in vitro (Lie et al, 2005;Matsuda et al, 1997;Merican et al, 2014) and in silico (Amirouche et al, 2013;Fitzpatrick et al, 2011;Takahashi et al, 2012) studies have shown that TKA leads to significant changes in patellar kinematics, forces acting on the patella, and resulting bone strain in comparison with the intact knee. One of the possible causes of these changes can be related to a surgical technique influencing the positioning of the prosthetic components, their rotation around the joint axes, and the amount of bone cut.…”

Section: Introductionmentioning

confidence: 99%

“…Several numerical and in vitro studies showed that reduction of patellar thickness can lead to increase of patellar bone strain (Amirouche et al, 2013;Fitzpatrick et al, 2013;Lie et al, 2005), thus increasing risk of the patellar fracture and possibly contributing to AKP symptoms (Draper et al, 2012;Ho et al, 2014). However, these studies were conducted on cadaveric knees.…”

Section: Introductionmentioning

confidence: 99%

A patient-specific model of total knee arthroplasty to estimate patellar strain: A case study

Latypova

Arami

Becce³

et al. 2016

Clinical Biomechanics

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Background: Inappropriate patellar cut during total knee arthroplasty can lead to patellar complications due to increased bone strain. In this study, we evaluated patellar bone strain of a patient who had a deeper patellar cut than the recommended. Methods: A patient-specific model based on patient preoperative data was created. The model was decoupled into two levels: knee and patella. The knee model predicted kinematics and forces on the patella during squat movement. The patella model used these values to predict bone strain after total knee arthroplasty. Mechanical properties of the patellar bone were identified with micro-finite element modeling testing of cadaveric samples. The model was validated with a robotic knee simulator and postoperative X-rays. For this patient, we compared the deeper patellar cut depth to the recommended one, and evaluated patellar bone volume with octahedral shear strain above 1%. Findings: Model predictions were consistent with experimental measurements of the robotic knee simulator and postoperative X-rays. Compared to the recommended cut, the deeper cut increased the critical strain bone volume, but by less than 3% of total patellar volume. Interpretation: We thus conclude that the predicted increase in patellar strain should be within an acceptable range, since this patient had no complaints 8 months after surgery. This validated patient-specific model will later be used to address other questions on groups of patients, to eventually improve surgical planning and outcome of total knee arthroplasty.

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