共查询到20条相似文献，搜索用时 46 毫秒
1.
Background
Restoring patellar height is important in revision TKA for normal knee function and kinematics. Alteration in patellar height after revision TKA is associated with inferior extensor mechanism function. 相似文献2.
Purpose
The aim of this prospective study was to evaluate the patellar height in 90° knee flexion. 相似文献3.
Filipe Cabral Bernardo Sousa-Pinto Rui Pinto João Torres 《The Journal of arthroplasty》2017,32(2):552-557.e2
Background
Total knee arthroplasty (TKA) is the gold standard procedure for knee osteoarthritis. However, there have been conflicting reports concerning whether TKA is associated with modifications in patellar height. This controversy might be partially explained by the diversity of methods used to measure patellar height. Therefore, we aimed at assessing the reproducibility of 3 radiological indices commonly used to evaluate patellar height—Insall-Salvati (IS), Blackburne-Peel (BP), and Caton-Deschamps (CD) ratios. Additionally, we aimed at evaluating the short-term differences between preoperative and postoperative patellar heights as measured by those 3 methods.Methods
Patellar heights were blindly measured by 2 researchers using IS, BP, and CD ratios in 203 knees. Interobserver agreement was evaluated by determination of intraclass correlation coefficients (ICC) and Bland-Altman plots. Preoperative and postoperative patellar heights were compared with Wilcoxon test. The association between postoperative pain and modifications in patellar height was assessed using Mann-Whitney U test.Results
High interobserver agreement was found for IS (preoperative and postoperative ICC = 0.93), BP (preoperative ICC = 0.89; postoperative ICC = 0.91), and CD (preoperative ICC = 0.89; postoperative ICC = 0.90) ratios. Preoperative and postoperative patellar heights were not significantly different whatever the method used. Postoperative pain was reported after 23% procedures and was significantly associated with wider patellar height variations as measured by the BP ratio (P = .018).Conclusion
The methods evaluated appear to be reproducible. Although patellar height tended to be lower when measured postoperatively, this difference was not significant for any of the methods studied. 相似文献4.
Chiang CC Huang CK Chen WM Lin CF Tzeng YH Liu CL 《Archives of orthopaedic and trauma surgery》2011,131(7):949-954
Introduction
For treatment of displaced transverse patellar fractures, open reduction and internal fixation is the standard reconstructive method. The role of percutaneous osteosynthesis is still unclear and worth of further investigation. Our hypothesis is that satisfactory reduction and rigid fixation is possible for the treatment of displaced transverse patellar fractures with some percutaneous techniques. Here, we present and evaluate a minimally invasive technique for these patellar fractures. 相似文献5.
6.
Background
Changes of patellar position (height, tilt, and shift) and arthritis of the patellofemoral joint might potentially influence outcome after unicompartmental knee replacement.Objectives
The purpose of this work is to evaluate the influence of the aforementioned parameters on postoperative outcome.Methods
Literature analysis via PubMed.Results
A total of 12 relevant studies (three about Patellar height, two about patellar tilt and shift, seven about patellofemoral osteoarthritis) could be identified. Regarding Patellar height, two out of three studies demonstrated a postoperative decrease. With regard to patellar tilt and shift, only one study identified postoperative lateralization of the patella to be a predictor for poor outcome. The radiological appearance of arthritis of the patellofemoral joint does not significantly influence postoperative knee function except for cases where only the lateral patellar facet is affected. Anterior knee pain has no influence on clinical outcome.Conclusion
Literature data do not allow for a precise statement about the possible influence of patellar position on the outcome after unicompartmental knee replacement. With proper patient selection, good results can be achieved despite patellofemoral osteoarthritis. 相似文献7.
8.
Background
Changing the kinematic behaviour of patellar movement could be one of the reasons for anterior knee pain after implantation of a total knee arthroplasty (TKA). The aim of the current study was to measure the potential influence on patellar kinematics of patellar resurfacing during TKA. 相似文献9.
Introduction
We described in 1981 a method to evaluate patellar height in normal and symptomatic knees on sagittal X-ray view. This index is a frequently used method, yet it is not suitable after a total knee arthroplasty (TKA).Material and method
The original method measures the distance between the distal margin of the articular surface of the patella (point A) and the anterosuperior angle of the tibial plateau (point T), then the length of the patellar articular surface (AP). The index is AT/AP ratio (normal values range from 0.8 to 1.2). After TKA, the T landmark is no longer available, so we must define a new T’ landmark. This point is situated at the intersection between the line perpendicular to the tibial posterior cortex elevated at the tip of the fibular head and the tibial anterior cortex. This remarkable landmark can be identified before and after TKA, with a new relative index AT’/AP ratio. This modified method allows the comparison of patella height before and after TKA.Results
We have used this modified index with the collaboration of several authors during the testing of different models of TKA, with an accurate reproducibility. Repeatability (usually called intra-observer reliability) was good, with intra-class correlation coefficients (ICCs) between 0.58 and 0.75 among the observers. Reproducibility (usually called inter-observer reliability) was also considered as good, with ICC ranging from 0.64 to 0.72.Discussion
Patella height measurement has to be assessed with the original method (AT/AP) to detect patella infera that could influence the surgical approach. The correlation between original and modified indexes has to be assessed. The modification of patella height after TKA could be evaluated through the modified index and compared with functional results.10.
Background:
Restoration of proper joint line (JL) position and patellar height in revision total knee arthroplasty (TKA) is essential in the recovery of knee function and kinematics. We determined whether the JL position and patellar height could be restored in patients undergoing septic and aseptic revision TKA.Materials and Methods:
We retrospectively reviewed 70 patients (74 knees) who had revision TKA between September 2004 and December 2010. Forty seven knees had a two stage revision for infected TKA and 27 knees for aseptic failure. The JL position, patellar height and patellar tendon (PT) length were measured and compared between primary TKA and post revision. The clinical scores including a hospital for special surgery (HSS), Knee Society Score (KSS), Western Ontario and McMaster Universities (WOMAC) and range of motion (ROM) were compared.Results:
The overall JL increased from 17.51 mm to 18.37 mm post revision, the Insall-Salvati (IS) ratio declined from 0.98 to 0.92, and the PT length declined from 42.92 mm to 39.45 mm. 9 of the 21 patellar baja knees improved to normal patellar height. After revision, the JL in the septic group (17.02 mm) was significantly lower than the aseptic group (20.74 mm). The changes of the JL position and IS ratio in the septic group were significantly larger than the aseptic groups (P < 0.05). JL position had a positive correlation to the IS ratio and PT length post revision. The knee function scores including HSS, KSS, WOMAC scores, and ROM all improved post revision compared to pre revision (P < 0.05), and the septic group had a lower knee function compared to the aseptic group. JL position and IS ratio post revision had no correlation to the HSS, KSS, WOMAC scores, and ROM.Conclusions:
JL position can be sufficiently restored with appropriate distal femoral augment reconstruction after revision TKA, but the patellar height cannot be well improved, especially in the septic revision with obvious PT contracture. No correlation was found between the JL position and patellar height to the knee function post revision TKA. 相似文献11.
A. Jawhar S. Sohoni V. Shah H. P. Scharf 《Archives of orthopaedic and trauma surgery》2014,134(1):91-97
Introduction
Patellofemoral related complications after total knee arthroplasty (TKA) remain clinically relevant. The hypothesis of the present study was that the patellar height changes more than 10 % of its preoperative height after TKA. Possible influences of age, gender, side and navigation system on patellar height were evaluated separately in subgroups.Materials and methods
A total of 107 knees were enrolled after primary TKA. The patellar height was determined for each patient preoperatively, 1 week and 1 year postoperatively on routinely performed standing lateral view radiographs at 30° knee flexion. Insall–Salvati index (ISI), modified Insall–Salvati index (MIS) as well as Miura–Kawamura index (MKI) were determined for the whole cohort.Results
One week after TKA the ISI, MIS and MKI changed by more than 10 % in 24 (22 %), 33 (30 %) and 54 (50 %) cases, respectively. Moreover, the 1 year follow-up revealed a decrease or increase of ISI in 30 (28 %), MIS in 47 (44 %) and MK in 65 (61 %) knees. The frequency of patella alta, norma and baja preoperatively as well as 1 week and 1 year postoperatively were not significantly different. Significant differences of patellar height changes were not noted between the defined subgroups.Conclusions
The present study demonstrates that TKA leads, at 1 week and 1 year follow-up, to patellar height alteration more than 10 % in a significant number of knee joints. However, with the use of ISI and MIS the changes of patellar height did not exceed the defined thresholds to be classified as patella alta or baja. 相似文献12.
Purpose
Femoro-patellar complications are one of the most common problems after total knee arthroplasty (TKA). TKA components that reduce patellar loads and preserve physiological patellar kinematics should reduce these problems. Therefore, we evaluated the patellar kinematics and the retro-patellar contact characteristics in both the intact knee and in the TKA-knee. 相似文献13.
Romain Gaillard Christopher Bankhead Nicolaas Budhiparama Cécile Batailler Elvire Servien Sébastien Lustig 《The Journal of arthroplasty》2019,34(3):469-477
Background
The aim of this study is to assess clinical results of total knee arthroplasty (TKA) with pre-operative patella alta or patella baja, compared to TKA with pre-operative normal patellar height.Methods
Patella height was measured using the Blackburne-Peel (BP) method in an initial, prospective cohort of 4103 TKAs performed at a single center. Three groups were defined: normal patella height (0.54 < BP index ≤ 1.06), patella alta (BP index >1.06), and patella baja (BP index ≤0.54). Pre-operative and post-operative clinical and radiological characteristics were collected and compared. All prostheses used a system of posterior stabilization by a third condyle. The primary outcome measure was the post-operative Knee Society Score. Statistical analysis was performed using Student’s t-test and chi-squared test, with P < .05.Results
Two hundred twenty-three TKAs with pre-operative patella alta, 307 TKAs with pre-operative patella baja, and 2248 with pre-operative normal patella height, mean follow-up 39.3 months (range 24-239), were ultimately included. Post-operatively, there was no difference between the 3 groups in terms of Knee Society Score (knee and function scores). Patella baja statistically decreased the maximal flexion (118.2° vs 115.5°, P = .002) and increased the rate of patellar fracture (0.9% vs 2%, P = .05). Finally, survival rates were similar in the 3 groups with each above 91% (±2%) at 10 years.Conclusion
Clinical and radiological results for TKAs with pre-operative patella alta and patella baja were comparable to TKAs with a normal pre-operative patellar height. Risk of post-operative patellar fracture increased for patients with pre-operative patella baja. 相似文献14.
Devdatta Suhas Neogi Ji Hoon Bae Chang Woo Seok Hong Chul Lim 《Journal of orthopaedics and traumatology》2014,15(1):47-54
Background
Though a number of series with long-term results have been published, there is still a paucity of literature on the role of patellar height after unicompartment knee arthroplasty (UKA). The present study was conducted with a hypothesis that patella baja may lead to a poor outcome at follow-up.Materials and methods
A retrospective review of 134 knees was performed and patellar height calculated before and after UKA by Blackburne-Peel index (BPI) and the Insall-Salvati ratio (ISR) on true lateral radiographs of the patients in 30° of flexion taken pre-operatively and at 1 year, 2 years and final follow-up (minimum 5 years). Statistical analysis was performed to evaluate the outcomes.Results
There was a decrease in ISR in 14.18 % and in BPI in 19.4 % at final follow-up. There was a significant decrease in BPI values while the decrease was not significant for ISR. After eliminating the pre-operative patella baja, 7.3 % developed post-operative patella baja, according to ISR, while 11.5 % developed patella baja as per BPI. At final follow-up there was a statistically significant decrease in stair climbing scores in patients with patella baja when compared to patients with normal ISR.Conclusion
Patients with a decrease in patellar height as per ISR have a decrease in stair climbing score at mid-term follow-up while the overall KSS, and pain scores are not affected by a change in patellar height and neither is there a significant progress in patellofemoral osteoarthritis among patients with patella baja compared to normal patella. 相似文献15.
Marco Valoroso Mo Saffarini Giuseppe La Barbera Cécile Toanen Gerjon Hannink Luca Nover David H. Dejour 《The Journal of arthroplasty》2017,32(12):3598-3602
Background
The goal of patellofemoral arthroplasty (PFA) is to replace damaged cartilage and correct underlying deformities to reduce pain and prevent maltracking. We aimed to determine how PFA modifies patellar height, tilt, and tibial tuberosity-trochlear groove (TT-TG) distance. The hypothesis was that PFA would correct trochlear dysplasia or extensor mechanism malalignment.Methods
The authors prospectively studied a series of 16 patients (13 women and 3 men) aged 64.9 ± 16.3 years (range 41-86 years) who received PFA. All knees were assessed preoperatively and 6 months postoperatively using frontal, lateral, and “skyline” x-rays, and computed tomography scans to calculate patellar tilt, patellar height, and TT-TG distance.Results
The interobserver agreement was excellent for all parameters (intraclass correlation coefficient >0.95). Preoperatively, the median patellar tilt without quadriceps contraction (QC) was 17.5° (range 5.3°-33.4°) and with QC was 19.8° (range 0°-52.0°). The median Caton-Deschamps index was 0.91 (range 0.80-1.22) and TT-TG distance was 14.5 mm (range 4.0-22.0 mm). Postoperatively, the median patellar tilt without QC was 0.3° (range ?15.3° to 9.5°) and with QC was 6.1° (range ?11.5° to 13.3°). The median Caton-Deschamps index was 1.11 (range 0.81-1.20) and TT-TG distance was 10.1 mm (range 1.8-13.8 mm).Conclusion
The present study demonstrates that beyond replacing arthritic cartilage, trochlear-cutting PFA improves patellofemoral congruence by correcting trochlear dysplasia and standardizing radiological measurements as patellar tilt and TT-TG. The association of lateral patellar facetectomy improves patellar tracking by reducing the patellar tilt. 相似文献16.
Mitsuru Hanada Masaaki Takahashi Hiroshi Koyama Yukihiro Matsuyama 《European journal of orthopaedic surgery & traumatology : orthopedie traumatologie》2014,24(4):567-570
Purpose
The purposes of this study were to examine patellar height at preoperation and postoperation, and compare the change of patellar height between opening wedge high tibial osteotomy (HTO) and closed wedge HTO by using Insall-Salvati (IS) ratio and our original method.Methods
Twenty patients (26 knees) were included. There were 6 males (6 knees) and 14 females (20 knees). Sixteen knees underwent closed method and 10 knees underwent opening method. Patellar height was measured at preoperation, immediately after the operation (postoperation) and 1 year after the operation according to IS ratio and modified Blumensaat (MB) ratio. We defined MB ratio as the ratio of distance from Blumensaat line to the midpoint of patellofemoral joint of patella against the length of Blumensaat line.Results
In opening wedge HTO, though IS ratio significantly increased postoperatively compared with preoperative IS ratio, IS ratio at 1 year after operation was not significantly different from preoperative values. MB ratio at postoperation and that at 1 year after the operation significantly decreased compared with preoperative MB ratio. In closed wedge HTO, there was no difference between preoperative and postoperative values of both IS ratio and MB ratio.Conclusions
In the postoperative period after opening wedge HTO, IS ratio was significantly increased, whereas MB ratio was decreased. We recommend that patients with low preoperative MB ratio must be treated with closed wedge HTO. 相似文献17.
Dickschas J Harrer J Pfefferkorn R Strecker W 《Archives of orthopaedic and trauma surgery》2012,132(3):289-298
Introduction
A femoropatellar syndrome may be caused by a deformity in the torsional axis of the femur or the tibia. The two cardinal symptoms are anterior knee pain and patellar instability. 相似文献18.
William B Lutes Michael A Flierl Michael R Dayton Steven J Morgan 《Journal of orthopaedic surgery and research》2009,4(1):38-4
Background
Total knee arthroplasty represents a common orthopedic surgical procedure. Achieving proper alignment of its components with the predrilled patellar and tibial peg holes prior to polymerization of the bone cement can be challenging. 相似文献19.
William G. Hamilton Deborah J. Ammeen Nancy L. Parks Nitin Goyal Gerard A. Engh C. Anderson Engh 《The Journal of arthroplasty》2017,32(6):1803-1807
Background
Little data exist on the influence of patellar thickness on postoperative motion or complications after total knee arthroplasty (TKA). This study addresses the following questions: Is postoperative motion influenced by change in composite patellar thickness? Is change in patellar thickness associated with more complications? And do more complications occur in the knees with a patellar bone remnant (<12 mm) and a native patellar thickness <18 mm?Methods
In total, 3655 TKAs were performed by 3 surgeons over a 28-year interval. All knees had caliper measurement of patellar thickness before the patellar cut, after implantation of the component and postoperative motion recorded in the database 1 or 2 years after TKA.Results
Patellar composite thickness was the same (1034 knees), thicker (1617 knees), and thinner (1004 knees). A significant but weak relationship was identified between the change in patellar thickness and motion (P < .01, ρ = ?0.046); an increase in “composite patellar thickness” of 10 mm would result in a 3° loss of knee motion. Significant differences were identified between change in thickness and manipulations (P < .05), ruptures (P = .01), and patellar clunk/crepitus (P < .01). Examining knees with bone remnant thicknesses (<12 mm/≥12 mm), there was no difference in fractures (P = .26). No extensor ruptures occurred in knees with remnant thickness <12 mm. Comparing knees with native bone thickness (≤18 mm/>18 mm), significant differences were found in fractures (P < .01) and patellar radiolucencies (P = .01).Conclusion
As this data does not demonstrate a strong tendency toward losing motion when the patellar thickness is increased, the authors recommend avoiding compromise of the patellar bone stock and tendon insertion. When native patellar bone is thin (<18 mm), we recommend maintaining 12 mm of patellar bone stock and accept the increase in composite thickness. 相似文献20.
Bédard M Vince KG Redfern J Collen SR 《Clinical orthopaedics and related research》2011,469(8):2346-2355