The native femoral sulcus as the guide for the medial/lateral position of the femoral component in knee arthroplasty: Normal patellar tracking in 690/700 knees—a prospective evaluation

Chiu, Fang-Yao

doi:10.1080/17453670610046460

Cited by 10 publications

(15 citation statements)

References 14 publications

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“…Mediolateral changes may result from a shift in the groove location due to one of several reasons: translation or axial rotation of the femoral component; changes in the soft-tissue tensions; or medialization or lateralization of the patellar component. Two recent studies have reported routine (i.e., unintended) medialization of the femoral groove due to arthroplasty [50,51]. Changes in spin were probably due to either the realignment of the leg as a result of the arthroplasty, or a change in the Q-angle based on the alignment of the components.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

confidence: 99%

In vivopatellar kinematics during total knee arthroplasty

Anglin

et al. 2008

Computer Aided Surgery

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“…A myriad number of reference literature is devoted to its anatomy, sexual polymorphism, race and age transformations [2,4,7,9,11-17]. However, there is discrepancy as regards the angle meanings of the parameters and angle correlation to the linear characteristics of the femur.…”

Section: Introductionmentioning

confidence: 99%

“…The scope of the angle meaning of the anteversion, according to numerous investigations [10-18], is roughly 74°. Also the literature data of the absolute meaning of the femur's head, other linear parameters, and transformation age are unequal [8,9,11,12]. …”

Section: Introductionmentioning

confidence: 99%

Biomechanical and system analysis of the human femoral bone: correlation and anatomical approach

et al. 2007

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BackgroundThe human femur is the subsystem of the locomotor apparatus and has got four levels of its organization. This phenomenon is the result of the evolution of the locomotor apparatus, encompassing both constitutional and individual variability. The main aim of this investigation was to study the organization of the human femur as a system of collaborating anatomical structures and, on the basis of system analysis, to define the less stable parameters, whose reorganization can cause the exchange of the system's status.MethodsTwenty-five (25) linear and non-linear (angle) parameters were, therefore, investigated by specially designed tool and caliper on a material of 166 macerated human femurs of adult individuals of both sexes. The absolute values were transformed into the relative one (1.0) by the meaning of the transverse diameter of the femoral diaphysis, and handled with current methods of descriptive statistical analysis. By the value of variance (q2), the results were distributed into four major classes.ResultsThe belonging of each group to the class was subsequently estimated in grades. According to this method, the excerpt was distributed into four classes as well depending on the total grades. The Pearson's coefficient in each class was calculated between the relative values of the investigated parameters. Two generations of system parameters were subsequently defined and analyzed.ConclusionThis study has derived that the system meaning of each level of the femoral organization is related to the 'shaping effect' of femoral units' functions. Inasmuch as the angular parameters were most instable at this system, they were defined as morphological substrates of the individual variety.

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“…Initially, there is a decrease in the exertion support and as a result some reduction of average absolute values of the transverse diaphysis was observed thus leading to a relative increase in the abovementioned parameters [26][27][28][29][30][31][32]. The changes in degenerative and dystrophic hip joint diseases are confirmed by statistically establishing a decrease in the transverse proximal epiphysis size (Table 2) that can be explained by the external rotation, which is a manifestation of forced rearrangement in alleviating pain.…”

Section: Resultsmentioning

confidence: 99%

“…In spite of the fact that the statistically established distinctions from the screening group can be viewed only in the angle between the femoral neck osseous trabeculae, the range of borders of the confidence intervals increased two times in each of the examined angulated parameters. Left-sided hip arthrosis localization revealed a more significant difference of this phenomenon in comparison with the right-sided process [1][2][3][4][5][6][7]13,[23][24][25][26][27][28][29][30].…”

Section: Resultsmentioning

confidence: 99%

Structural Peculiarities of the Proximal Femur Meta-Epiphysis in the Idiopathic Coxarthrosis According to Localization

Samaha¹,

Ivanov²,

Yashina³

et al. 2013

AJMBR

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Background: The hip essentially represents the major weight-bearing joint of the human organism. It is conspicuously characterized by its mobility and complex origination, specific organization and development. The anatomic structures referred to as acetabulum and femoral head arise from the same primitive mesenchymal cells and, by the end of the 11 th week of gestation, the hip joint becomes fully formed and continues to develop throughout intrauterine life. During embryonic life, the femoral head grows at a faster rate than the acetabulum, and at the end of gestation the femoral head is approximately less than 50% covered, and after birth, the growth rate of the acetabular cartilage surpasses that of femoral head thus resulting in progressively increased coverage. Methods: Cartilaginous at birth, the ossification of acetabulum is set at around a three-month age period, while ossification centers of the proximal femur start to appear at 4 to 7-months. Several developmental abnormalities regarding the relationship between femoral head and acetabulum are therein described; all of those anatomic aberrations may technically result in hip instability, manifested by dislocation, subluxation, dysplasia and arthrosis. Results: From a biomechanical standpoint, three pathological conditions are shown to have arisen mainly at the region of the femoral neck: i) congenital coxa vara, ii) pseudoarthrosis of the neck of the femur and iii) coxarthrosis. All of the aforementioned conditions are caused and maintained by different types of mechanical stress and, in advanced stages, they may necessitate surgical interventions to alter the angle of the femoral neck in order to relieve the pressure at the level of the affected joint mainly during movement. Furthermore, we indicate that there is no standard to adopt regarding the surgical change of the femoral neck angle, though biomechanical assessment has to be worked out and established in each of the affected individual. Conclusion: Plain film radiography plays an important role in the assessment of a dysplastic hip, especially in adults, where operative management is essentially based on various radiographic measurements. Several average values of stresses and strains of the proximal femur were identified on the basis of Wolff's trajectorial hypothesis, where they revealed a trabecular architectural changes and structural remodeling in response to mechanical stress. It is concluded that these pathological conditions (congenital coxa vara, pseudoarthrosis of the neck of the femur and coxarthrosis) that were shown to have arisen mainly at the region of the femoral neck may contribute to understanding pathophysiologic and patho-anatomic peculiarities of the femoral bone.

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The native femoral sulcus as the guide for the medial/lateral position of the femoral component in knee arthroplasty: Normal patellar tracking in 690/700 knees—a prospective evaluation

Abstract: Interpretation The native femoral sulcus may be used as an effective and simple guide for the medial/lateral femoral component position.

Cited by 10 publications

References 14 publications

In vivopatellar kinematics during total knee arthroplasty

In vivopatellar kinematics during total knee arthroplasty

Biomechanical and system analysis of the human femoral bone: correlation and anatomical approach

Structural Peculiarities of the Proximal Femur Meta-Epiphysis in the Idiopathic Coxarthrosis According to Localization

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