Patellofemoral Design Enhancements Reduce Long-term Complications of Postero-stabilized Total Knee Arthroplasty

Overview

Journal Knee Surg Sports Traumatol Arthrosc

Publisher Wiley

Specialties Emergency Medicine
General Surgery
Orthopedics

Date 2018 Sep 12

PMID 30203198

Citations 2

Authors

Nicolas Jan

Christian Fontaine

Henri Migaud

Gilles Pasquier

Jeremy Valluy

Mo Saffarini

Sophie Putman

Affiliations

Soon will be listed here.

Abstract

Purpose: Few studies investigated whether trochlear and patellar design enhancements improve long-term outcomes of total knee arthroplasty (TKA). This study aimed to compare the long-term survival and complication rates of two consecutive generations of the same TKA system with identical tibiofemoral geometry, but different patellofemoral designs.

Methods: The authors retrieved the records of 93 patients (104 knees) operated with the HLS II system and 116 patients (122 knees) operated with HLS Evolution system. Patients were evaluated preoperatively and at a minimum of 10 years noting all complications. Kaplan-Meier (KM) survival was compared for two endpoints: (1) revision of all components and (2) revision of any component.

Results: From the HLS II series, the incidence of revision of all components was 6.4%, and of any component was 9.8%. From the HLS Evolution series, the incidence of revision of all components was 4.1%, and of any component was 5.1%. Comparing the survival at equivalent follow-up of 14 years, considering revision of all components, the HLS II had higher survival than the HLS Evolution (98.9% vs 95.9%), while considering revision of any component, the HLS II had lower survival than the HLS Evolution (93.0% vs 94.9%). The differences in survival of the two implants were not significant, neither at equivalent follow-up of 14 years (n.s.), nor at maximum follow-up of each cohort (n.s.). The complication rate was higher for the HLS II series compared to the HLS Evolution (28% vs 12%, p = 0.009), but patellofemoral complications were not more frequent (8% vs 6%, n.s.).

Conclusions: Though the differences in survival of the two implants were not significant, conflicting findings are observed due to partial revisions for patellar fractures (5 in the HLS II series and 1 in the HLS Evolution series) which could be related to patellofemoral design enhancements. This study highlights the importance of patello-femoral geometry, which is often overlooked in TKA.

Level Of Evidence: Retrospective comparative study, Level III.

Citing Articles

The patellofemoral morphology and the normal predicted value of tibial tuberosity-trochlear groove distance in the Chinese population.

Li Z, Liu G, Tian R, Kong N, Li Y, Li Y BMC Musculoskelet Disord. 2021; 22(1):575.

PMID: 34162383 PMC: 8223279. DOI: 10.1186/s12891-021-04454-8.

Implant survival of 3rd-condyle and post-cam posterior-stabilised total knee arthroplasty are comparable at follow-up > 10 years: a systematic review.

Dejour D, Muller J, Saffarini M, Timoteo M, Chambat P, Deschamps G Knee Surg Sports Traumatol Arthrosc. 2021; 30(3):1001-1024.

PMID: 33660055 DOI: 10.1007/s00167-021-06507-w.

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