No Difference in Patellar Tracking Between Symmetrical and Asymmetrical Femoral Component Designs in TKA

Overview

Journal Knee Surg Sports Traumatol Arthrosc

Publisher Wiley

Specialties Emergency Medicine
General Surgery
Orthopedics

Date 2013 Jun 4

PMID 23728417

Citations 9

Authors

J E Stoddard

D J Deehan

A M J Bull

A W McCaskie

A A Amis

Affiliations

Soon will be listed here.

Abstract

Purpose: Poor knee extension function after total knee arthroplasty (TKA) is associated with factors including articular geometry and alignment. Femoral trochlear geometry has evolved from symmetrical to become more prominent proximal-laterally, with the groove aligned proximal-lateral to distal-medial. This study in vitro tested the hypothesis that a modern asymmetrical prosthesis would restore patellar tracking and stability to more natural behaviour than an older symmetrical prosthesis.

Methods: Six knees had their patellar tracking measured optically during active knee extension. Medial-lateral force versus displacement stability was measured at fixed angles of knee flexion. The measurements were repeated after inserting each of the symmetrical and asymmetrical TKAs.

Results: Significant differences of patellar lateral displacement stability, compared to normal, were not found at any angle of knee flexion. The patella tracked medial-laterally within 2.5 mm of the natural path with both TKAs. However, for both TKAs near knee extension, the patella was tilted laterally by approximately 6° and was also flexed approximately 8° more than in the natural knee.

Conclusion: The hypothesis was not supported: The more anatomical component design did not provide more anatomical patellar kinematics and stability.

Citing Articles

Positive clinical outcomes at 10 Years with the universal femoral component in total knee arthroplasty.

Nielsen A, Law J, Homolka L, Forrester D, Hofmann A J Orthop. 2025; 66:67-70.

PMID: 39896864 PMC: 11779656. DOI: 10.1016/j.jor.2024.12.026.

Revisiting the universal femoral component: Midterm outcomes of a modern design.

Forrester D, Law J, Grant A, Hofmann A J Orthop. 2024; 58:150-153.

PMID: 39100539 PMC: 11293520. DOI: 10.1016/j.jor.2024.06.042.

Patellar management during total knee arthroplasty: a review.

McConaghy K, Derr T, Molloy R, Klika A, Kurtz S, Piuzzi N EFORT Open Rev. 2021; 6(10):861-871.

PMID: 34760286 PMC: 8559560. DOI: 10.1302/2058-5241.6.200156.

Sagittal radius of curvature, trochlea design and ultracongruent insert in total knee arthroplasty.

Ng J, Bloch B, James P EFORT Open Rev. 2019; 4(8):519-524.

PMID: 31538002 PMC: 6719604. DOI: 10.1302/2058-5241.4.180083.

Kinematically aligned total knee arthroplasty reproduces native patellofemoral biomechanics during deep knee flexion.

Koh I, Park I, Lin C, Patel N, Chalmers C, Maniglio M Knee Surg Sports Traumatol Arthrosc. 2018; 27(5):1520-1528.

PMID: 30370439 DOI: 10.1007/s00167-018-5270-2.

References

Senavongse W, Farahmand F, Jones J, Andersen H, Bull A, Amis A . Quantitative measurement of patellofemoral joint stability: force-displacement behavior of the human patella in vitro. J Orthop Res. 2003; 21(5):780-6. DOI: 10.1016/S0736-0266(03)00061-5. View

Boyd Jr A, Ewald F, Thomas W, Poss R, Sledge C . Long-term complications after total knee arthroplasty with or without resurfacing of the patella. J Bone Joint Surg Am. 1993; 75(5):674-81. DOI: 10.2106/00004623-199305000-00006. View

Hsu H, Garg A, Walker P, Spector M, Ewald F . Effect of knee component alignment on tibial load distribution with clinical correlation. Clin Orthop Relat Res. 1989; (248):135-44. View

Wang H, Simpson K, Ferrara M, Chamnongkich S, Kinsey T, Mahoney O . Biomechanical differences exhibited during sit-to-stand between total knee arthroplasty designs of varying radii. J Arthroplasty. 2006; 21(8):1193-9. DOI: 10.1016/j.arth.2006.02.172. View

Baldini A, Anderson J, Cerulli-Mariani P, Kalyvas J, Pavlov H, Sculco T . Patellofemoral evaluation after total knee arthroplasty. Validation of a new weight-bearing axial radiographic view. J Bone Joint Surg Am. 2007; 89(8):1810-7. DOI: 10.2106/JBJS.E.00432. View

Merican A, Amis A . Iliotibial band tension affects patellofemoral and tibiofemoral kinematics. J Biomech. 2009; 42(10):1539-1546. DOI: 10.1016/j.jbiomech.2009.03.041. View

Barrack R, Burak C . Patella in total knee arthroplasty. Clin Orthop Relat Res. 2001; (389):62-73. DOI: 10.1097/00003086-200108000-00011. View

Jenny J, Boeri C . Low reproducibility of the intra-operative measurement of the transepicondylar axis during total knee replacement. Acta Orthop Scand. 2004; 75(1):74-7. DOI: 10.1080/00016470410001708150. View

Lie D, Gloria N, Amis A, Lee B, Yeo S, Chou S . Patellar resection during total knee arthroplasty: effect on bone strain and fracture risk. Knee Surg Sports Traumatol Arthrosc. 2004; 13(3):203-8. DOI: 10.1007/s00167-004-0508-6. View

10.

Heinert G, Kendoff D, Preiss S, Gehrke T, Sussmann P . Patellofemoral kinematics in mobile-bearing and fixed-bearing posterior stabilised total knee replacements: a cadaveric study. Knee Surg Sports Traumatol Arthrosc. 2010; 19(6):967-72. DOI: 10.1007/s00167-010-1320-0. View

11.

Bull A, Katchburian M, Shih Y, Amis A . Standardisation of the description of patellofemoral motion and comparison between different techniques. Knee Surg Sports Traumatol Arthrosc. 2002; 10(3):184-93. DOI: 10.1007/s00167-001-0276-5. View

12.

Chan K, Gill G . Postoperative patellar tilt in total knee arthroplasty. J Arthroplasty. 1999; 14(3):300-4. DOI: 10.1016/s0883-5403(99)90055-4. View

13.

Jenny J, Lefebvre Y, Vernizeau M, Lavaste F, Skalli W . [In vitro analysis of the continuous active patellofemoral kinematics of the normal and prosthetic knee]. Rev Chir Orthop Reparatrice Appar Mot. 2002; 88(8):797-802. View

14.

Barink M, van de Groes S, Verdonschot N, de Waal Malefijt M . The difference in trochlear orientation between the natural knee and current prosthetic knee designs; towards a truly physiological prosthetic groove orientation. J Biomech. 2005; 39(9):1708-15. DOI: 10.1016/j.jbiomech.2005.04.027. View

15.

Merican A, Ghosh K, Iranpour F, Deehan D, Amis A . The effect of femoral component rotation on the kinematics of the tibiofemoral and patellofemoral joints after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2011; 19(9):1479-87. DOI: 10.1007/s00167-011-1499-8. View

16.

Amis A, Senavongse W, Bull A . Patellofemoral kinematics during knee flexion-extension: an in vitro study. J Orthop Res. 2006; 24(12):2201-11. DOI: 10.1002/jor.20268. View

17.

Katchburian M, Bull A, Shih Y, Heatley F, Amis A . Measurement of patellar tracking: assessment and analysis of the literature. Clin Orthop Relat Res. 2003; (412):241-59. DOI: 10.1097/01.blo.0000068767.86536.9a. View

18.

Barink M, Meijerink H, Verdonschot N, Van Kampen A, de Waal Malefijt M . Asymmetrical total knee arthroplasty does not improve patella tracking: a study without patella resurfacing. Knee Surg Sports Traumatol Arthrosc. 2006; 15(2):184-91. DOI: 10.1007/s00167-006-0158-y. View

19.

Petersilge W, Oishi C, Kaufman K, Irby S, Colwell Jr C . The effect of trochlear design on patellofemoral shear and compressive forces in total knee arthroplasty. Clin Orthop Relat Res. 1994; (309):124-30. View

20.

Iranpour F, Merican A, Rodriguez Y Baena F, Cobb J, Amis A . Patellofemoral joint kinematics: the circular path of the patella around the trochlear axis. J Orthop Res. 2009; 28(5):589-94. DOI: 10.1002/jor.21051. View