Patellar component medialization in total knee arthroplasty

Hofmann, Aaron A.; Tkach, Thomas K.; Evanich, Christopher J.; Camargo, Marcelo P.; Zhang, Yongde

doi:10.1016/s0883-5403(97)90061-9

Cited by 67 publications

(29 citation statements)

References 13 publications

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“…Furthermore, when there is resurfacing of the patella, a conscious medialization of the patellar component could compensate for a medially displaced prosthetic groove, and medialization of the patellar component has been suggested as a means of improving patellar tracking (Brick andScott 1988, Yoshii et al 1992). Although some good initial results of patellar component medialization in TKA have been described (Hofmann et al 1997, Lewonowski et al 1997, it seems better to strive for an anatomical positioning of the TKA than to compensate for a medial error of the femoral component by placing a medially displaced patella prosthesis. The conclusion of our study is that the trochlea is medialized by TKA.…”

Section: Discussionmentioning

confidence: 99%

The trochlea is medialized by total knee arthroplasty: An intraoperative assessment in 61 patients

et al. 2007

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Section: Discussionmentioning

confidence: 99%

The trochlea is medialized by total knee arthroplasty: An intraoperative assessment in 61 patients

et al. 2007

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“…Maltracking may result from improper component design, poor component positioning, excessively tight soft tissues, or poor surgical technique [11][12][13][14][15]. While lateral retinacular release is sometimes used intraoperatively to improve maltracking, this may mask other problems such as component malrotation, and is associated with several avoidable postoperative problems including pain and morbidity, avascular necrosis, patellar fracture and longer rehabilitation [16][17][18].…”

Section: Introductionmentioning

confidence: 99%

In vivopatellar kinematics during total knee arthroplasty

Anglin

et al. 2008

Computer Aided Surgery

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Patellar maltracking after total knee arthroplasty often results in complications, including anterior knee pain, instability and impingement, and is therefore better resolved intraoperatively. Many factors can affect patellar kinematics during knee replacement, including component position, implant design, joint alignment, and soft tissue tensions. However, to our knowledge, the impact of arthroplasty on patellar kinematics has not been previously reported in vivo. A computer-assisted surgery (CAS) system was developed to measure the pre-arthroplasty patellar kinematics, display the distance between this path and the surface of the planned femoral component, and compare the post-arthroplasty path to the pre-arthroplasty path. Three surgeons from three centers used this CAS system to measure the in vivo pre-and post-arthroplasty kinematics of 18 patients. There was a small, but consistent, proximal shift in the tibial joint lines (mean: 4.2 mm), resulting in pseudo patella-baja, i.e., relatively more distal contact of the patella on the femoral component. This led to significant changes in proximodistal and anteroposterior patellar positioning as well as patellar flexion following arthroplasty (p50.008). Mediolateral shift, tilt and internal/external spin had the greatest magnitudes of change (mean: 4.1 mm, 4.6 and 4.6 , respectively) relative to their mean pre-arthroplasty ranges (averaging 2.1 mm, 5.8 and 5.8 , respectively); however, these changes were distributed almost equally medially and laterally, indicating no surgical bias in any one direction. Female patients had more lateral tilt on average than male patients throughout flexion (p50.004 post-arthroplasty, p50.03 prearthroplasty, in later flexion), as well as other kinematic differences; there may therefore be potential for improving overall kinematic results by focusing on gender differences during research, design and surgery. This study demonstrated the feasibility of using a CAS system to measure patellofemoral kinematics. Intraoperative awareness of patellar tracking, including knowledge of the tibiofemoral joint line, could have an impact on the surgical plan and thereby improve the postoperative outcome.

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“…Weight bearing of the operated knee was allowed from the second postoperative day and crutches were used as tolerated. The mean hospital stay was 8 days (range: [5][6][7][8][9][10][11][12][13][14][15][16]. The type of anesthesia used, operative time, tourniquet time, estimated blood loss, postoperative transfusion, wound condition and improvement of the ROM were all recorded for each patient.…”

Section: Methodsmentioning

confidence: 99%

Native femoral sulcus as a guide for the position of the femoral component in primary total knee arthroplasty

Chiu

2005

Knee Surg Sports Traumatol Arthrosc

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A prospective randomized study was conducted to evaluate the effects of using the native femoral sulcus as a guide for the positioning of the femoral component in primary total knee arthroplasty (TKA), especially for patellar tracking. Between 2000 and 2002, 420 cases of primary TKA were collected. All the TKAs were performed with the same approach. The cases were randomly separated into two groups. In group 1 (consisting of 202 knees), the femoral insertion of the posterior cruciate ligament and the midline of the lateral-medial femoral condyles were used as a guide for the midline position of the femoral component; while in group 2 (consisting of 218 knees), the native femoral sulcus was used as the guide for the femoral component. Intraoperatively, no thumb technique was used to check the patellar tracking. In group 1, 16 knees (7.9%) received lateral retinacular releases, while none received lateral retinacular release in group 2 (P<0.0001). The average (range) follow-up period was 40 (30-56) months. In postoperative radiographic evaluation, two knees (1%) of lateral tilting of the patella were noted in group 1; while two knees (0.91%) of lateral tilting of the patella were noted in group 2 (P=0.751). In conclusion, native femoral sulcus could be a very effective and simple guide for the medial-lateral position of the femoral component, especially for patellar tracking. The prostheses used in this series were all Nexgen LPS-FLEX PCL Substituting (Zimmer, Warsaw) prostheses.

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Patellar component medialization in total knee arthroplasty

Cited by 67 publications

References 13 publications

The trochlea is medialized by total knee arthroplasty: An intraoperative assessment in 61 patients

The trochlea is medialized by total knee arthroplasty: An intraoperative assessment in 61 patients

In vivopatellar kinematics during total knee arthroplasty

Native femoral sulcus as a guide for the position of the femoral component in primary total knee arthroplasty

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