Patella-height analysis and correlation with clinical outcome after primary total knee arthroplasty

Konrads, Christian; Rejaibia, Jesin; Grosse, Lucia; Springer, Fabian; Schreiner, Anna J.; Schmidutz, Florian; Erne, Felix

doi:10.1016/j.jor.2021.01.001

Cited by 10 publications

(11 citation statements)

References 15 publications

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“…The primary predictor of postoperative ROM was preoperative ROM. In a recent study, Konrads et al 32 demonstrated that preoperative ROM is a good predictor of postoperative ROM after TKA. The results of these studies were similar to those of our study, in which preoperative ROM was a contributing factor affecting the postoperative squatting ability.…”

Section: Discussionmentioning

confidence: 99%

Factors Affecting Squatting Ability in Total Knee Arthroplasty Using High Flexion Prosthesis

Li¹,

Sun²,

Du³

et al. 2021

TCRM

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Purpose: Total knee arthroplasty (TKA) is widely used as a treatment for knee osteoarthritis. Few studies have analysed the factors affecting the squatting ability of patients after TKA. The purpose of this study was to comprehensively analyse the factors affecting squatting ability after TKA and to determine which ones are important. Patients and Methods: Three hundred primary TKA cases with a minimum 3-year followup were retrospectively analysed. All patients received a conventional posterior-stabilized TKA implant and underwent a standard perioperative care pathway. The patients were divided into two groups according to the squatting position and knee flexion angle while weight-bearing (Group I -inability to squat group, Group II -ability to squat group). Demographic, operative, and clinical data were collected. Radiographic assessment included joint line elevation, patellar position, posterior condylar offset (PCO), etc. Statistical analysis of the effect of all the above factors on squatting ability was performed. Results: The preoperative range of motion and joint line of Group I were 82.9±12.6 and 3.24±1.07, respectively, and those of Group II were 107±9.6 and 1.83±0.89 respectively. The univariate analysis showed that age, prosthesis size, preoperative ROM and joint line position were correlated with squatting ability. But in the final multivariate analysis, joint line position and preoperative ROM were independent influencing factors that affected squatting ability after TKA (p value < 0.01). Conclusion:Preoperative ROM and joint line position were independent influencing factors affecting squatting ability after TKA. Patients should be counseled accordingly and be made to understand these factors. To ensure that patients can squat postoperatively, we should improve surgical techniques to control joint line elevation.

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Section: Discussionmentioning

confidence: 99%

Factors Affecting Squatting Ability in Total Knee Arthroplasty Using High Flexion Prosthesis

Li¹,

Sun²,

Du³

et al. 2021

TCRM

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“…Therefore, this mandated the use of additional methods of measurement, including BP or CD indices, to detect the PPI. Thus, surgeons recommended that in order to be able to distinguish between TPI and PPI, a combination of methods should be used [ 16 , 17 , 23 , 24 ]. In addition, it should be highlighted that because TKA is more strongly associated with joint line elevation than other surgical procedures, the CD and BP indices are essential in the diagnosis of patella infera following TKA [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

“…In a study on 92 primary TKAs, Konrads et al evaluated the patella height and its correlation with clinical outcome. They demonstrated that patella height could be accurately assessed using the ISI and the CDI preoperatively, with the utilization of the ISI and the dCDI postoperatively [ 16 ]. Alternatively, the BPI or mBPI can be used instead of the CDI or dCDI.…”

Section: Discussionmentioning

confidence: 99%

“…True patella infera can develop by scarring after surgery even in the second postoperative year, but not later than 24 months postoperatively [ 16 , 20 , 21 ]. Pseudo patella infera due to proximalisation of the joint line during primary total knee arthroplasty and patella infera, in general, does not deteriorate the clinical outcome of primary total knee arthroplasty if the reduction of patella height does not exceed 10% [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

“…Several approaches have been reported for estimating patella height in normal knees and after the implantation of a knee endoprosthesis [9][10][11][12][13][14][15]. These approaches have advantages and disadvantages, as well as varying levels of reliability, reproducibility, and intra-and interobserver variability [16][17][18]. These approaches relate the patella position to the femur (direct evaluation) or the tibia (indirect assessment).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Evaluation of patella height in native knees and arthroplasty: an instructional review

Konrads

Schreiner

Cober

et al. 2022

SICOT-J

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Total knee arthroplasty (TKA) is the gold standard for treating advanced knee osteoarthritis. Among the postoperative complications of TKA are true patella infera (TPI) and pseudo patella infera (PPI), which should be differentiated since TPI exhibits significantly worse clinical outcomes. Multiple radiological patella height indices (PHI) exist; some were modified or originally designed for knees with implanted endoprostheses. However, there is no consensus on measuring and comparing patella height. Due to the lack of established, simple, reliable, and reproducible concepts for assessing patella height for arthroplasty, measuring patella height and the change of patella height by or after TKA have been challenging tasks for clinicians and researchers. This is a review of the current literature on methods for measuring patella height, with special attention to the ability to differentiate between the TPI and PPI after TKA. All literature on the topic was retrieved, and references from relevant articles were investigated until the end of April 2022.

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Evaluation of modified and newly applied patella height indices in primary total knee arthroplasty

et al. 2022

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Objective The aim of this radiological study was to compare several relevant modified and newly applied patella height indices (PHI) in navigated primary total knee arthroplasty (TKA) to determine intra- and interobserver reliability in order to give a recommendation for clinical application in measuring patella height (PH) in primary TKA. Materials and methods A retrospective data analysis assessing different PHI (modified Insall-Salvati index (mISI), Caton-Deschamps index (mCDI), Blackburne-Peel index (mBPI), Plateau-Patella Angle (mPPA); Miura-Kawaramura index (MKI), Knee-Triangular index (KTI)) on lateral knee radiographs was performed by two blinded observers using the same software three months pre- and postoperatively. Concordance correlation coefficient and Pearson’s correlation respectively were determined for intra- and interobserver rating as well as a categorization according to Landis and Koch and Cohen. Results A total of 337/291 patients of a 5-year period could be analyzed pre-/postoperatively. Excellent postoperative interrater results according to the categorization of Landis and Koch were achieved for the mBPI (Pearson 0.98) > mPPA (0.90) > KTI (0.86), good results for the MKI (0.79) and the mCDI (0.69), and moderate results for the mISI (0.52) with a predominantly strong Cohen correlation in almost all cases. Preoperatively, the mBPI and the KTI were the best interrated PHI. No PH changes could be found postoperatively for the mISI, KTI, MKI, and mPPA. Conclusion The mBPI, the mPPA, and the KTI can be recommended for PH assessment in TKA. The mPPA might be the easiest one to use in a daily clinical set-up.

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Patella-height analysis and correlation with clinical outcome after primary total knee arthroplasty

Cited by 10 publications

References 15 publications

Factors Affecting Squatting Ability in Total Knee Arthroplasty Using High Flexion Prosthesis

Factors Affecting Squatting Ability in Total Knee Arthroplasty Using High Flexion Prosthesis

Evaluation of patella height in native knees and arthroplasty: an instructional review

Evaluation of modified and newly applied patella height indices in primary total knee arthroplasty

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