Incidence of Patellar Clunk Syndrome in Fixed Versus High-Flex Mobile Bearing Posterior-Stabilized Total Knee Arthroplasty

Snir, Nimrod; Schwarzkopf, Ran; Diskin, Brian; Takemoto, Richelle; Hamula, Mathew; Meere, Patrick

doi:10.1016/j.arth.2014.05.011

Cited by 24 publications

(27 citation statements)

References 29 publications

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“…Certain traditional knee implants have been designed with a constrained patellar articulation and tend to function best when the patella is resurfaced. Snir et al [27] reported a significantly higher (p < 0.001) incidence of patellar clunk syndrome in patients that received a mobile-bearing, high-flex, PFC Sigma implant (DePuy) as compared with a fixed-bearing, single-radius, Scorpio implant (Stryker) with 22 knees (11.7%) and 4 knees (1.8%) reporting patellar clunk, respectively.…”

Section: Discussionmentioning

confidence: 99%

Early Experience with a Modern Generation Knee System: Average 2 Years’ Follow-up

Paszicsnyek¹

2015

ReconRev

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Arthritis in the knee is a leading cause of pain and disability with total knee arthroplasty (TKA) often the treatment of choice after failure of more conservative treatments. TKA has been demonstrated to be one of the most successful procedures performed. However, despite the good long-term survivorship rates, patient satisfaction is still an issue post TKA with over 20% of patients exhibiting patient dissatisfaction most commonly due to anterior knee pain (over 18-28% patients) and mediolateral or varus-valgus instability. Recent studies have demonstrated that collateral ligament strains are altered post TKA which may lead to laxity and/or tightness of the ligaments resulting in patient discomfort, pain, stiffness and/or instability post TKA. As a result, it may be beneficial to ensure ligamentous strains after TKA are similar or close to the native situation. The purpose of this study was to evaluate the clinical and radiographic results of the Unity Knee™ Total Knee System (Corin Ltd, Cirencester, UK), a modern generation, single-radius total knee replacement (TKR) and its accompanying instrumentation which is designed to help maintain proper ligament balance and restore the medial jointline. A total of 89 knees (89 patients) were implanted with the device in a single surgeon series. All patients were assessed using the American Knee Society Score (AKSS), the Oxford Knee Score (OKS), and radiographs. There was 1 revision due to infection and Kaplan-Meier survivorship was 98.9% at 2 years. The mean AKSS knee score for the total cohort was 87.1 ± 7.98 and the mean Oxford Knee score was 45.89 + 3.69. Radiographic review found no signs of radiographic failure in any of the knees. This study demonstrates good survivorship, clinical, and radiographic results at 2 years for this TKR.

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Section: Discussionmentioning

confidence: 99%

Early Experience with a Modern Generation Knee System: Average 2 Years’ Follow-up

Paszicsnyek¹

2015

ReconRev

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“…Nevertheless this non randomized study is affected by some relevant patient related bias, as preoperative data reported in the FB group showed statistically significant higher age, higher proportions of female gender, higher degrees of extension lag and lower muscular strength. Furthermore, the study compared a FB posterior stabilized (PS) design with a meniscal bearing posterior cruciate retaining (PCR) design, being PS implants related to patello-femoral complications in several previous studies (16).…”

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confidence: 99%

Mobile bearing and fixed bearing total knee arthroplasty

Capella¹,

Dolfin²,

Saccia³

2016

Ann. Transl. Med.

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The mobile bearing (MB) concept in total knee arthroplasty (TKA) was developed as an alternative to fixed bearing (FB) implants in order to reduce wear and improve range of motion (ROM), especially focused on younger patients. Unfortunately, its theoretical advantages are still controversial. In this paper we exhibit a review of the more recent literature available comparing FB and MB designs in biomechanical and clinical aspects, including observational studies, clinical trials, national and international registries analyses, randomized controlled trials, meta-analyses and Cochrane reviews. Except for some minor aspects, none of the studies published so far has reported a significant improvement related to MBs regarding patient satisfaction, clinical, functional and radiological outcome or medium and long-term survivorship. Thus the presumed superiority of MBs over FBs appears largely inconsistent. The routine use of MB is not currently supported by adequate evidences; implant choice should be therefore made on the basis of other factors, including cost and surgeon experience.

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“…Lengthening the trochlea groove distally make it more difficult for a nodule to develop and become entrapped [28]. Besides, patella baja or alta, abnormal patellar tracking, anterior placement of the tibial tray, and an increased degree of postoperative knee flexion have also been associated with the development of patellar clunk syndrome [30,31].…”

Section: Discussionmentioning

confidence: 99%

Differences between native and prosthetic knees in trochlear groove tracking based on a morphometric measurement of three-dimensional reconstruction models in Chinese people

Chen¹,

Xu²,

Gong³

2020

Preprint

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Background Prosthetic trochlear design is important to ideal postoperative patellofemoral kinematics and knee function. But there has been little research on the differences of trochlear groove trackings between the native and prosthetic knees. We aimed to investigate the differences between native and prosthetic knees through the entire trochlear length by three-dimensional computerized quantification.Methods Virtual total knee arthroplasty was performed, using three-dimensional models of 42 healthy knees that were matched to the femoral components of five different prosthesis systems. Coaxial planes were created along the trochlear groove in 3° increments, and the deepest points of the trochlear groove were marked in each plane. Taking the lower extremity mechanical axis as reference line, the differences in the mediolateral location of the groove tracking were analyzed between the native and prosthetic knees.Results From the proximal to the distal end, the native tracking started from 0° cross section and extended laterally and then medially with its turning point located in 69° cross section, while the prosthetic knees showed medial orientation throughout the trochlear length. Compared with the proximal portion of the native tracking, the prosthetic trackings extended along a paradoxical orientation and started from a more proximal and lateral position, with maximal discrepancy to, 3.2 mm in the 0° cross section. Distally, the prosthetic trackings were located significantly medial, with maximal discrepancy, to 2.4 mm in the 69° cross section.Conclusion The prosthetic trochlear design varies among different types, and does not conform to that of the native knee in terms of shape, orientation, and location, which may cause soft tissue tension imbalance and abnormal patellofemoral biomechanics during knee flexion. This study may be helpful for prosthetic trochlear design that accords with native anatomy so as to optimize patellofemoral biomechanics and decrease the risk of patellofemoral complications.

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Incidence of Patellar Clunk Syndrome in Fixed Versus High-Flex Mobile Bearing Posterior-Stabilized Total Knee Arthroplasty

Cited by 24 publications

References 29 publications

Early Experience with a Modern Generation Knee System: Average 2 Years’ Follow-up

Early Experience with a Modern Generation Knee System: Average 2 Years’ Follow-up

Mobile bearing and fixed bearing total knee arthroplasty

Differences between native and prosthetic knees in trochlear groove tracking based on a morphometric measurement of three-dimensional reconstruction models in Chinese people

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