Patellofemoral arthroplasty influences tibiofemoral kinematics: the effect of patellar thickness |
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Authors: | Hilde Vandenneucker Luc Labey Jan Victor Jos Vander Sloten Kaat Desloovere Johan Bellemans |
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Institution: | 1. Department of Orthopaedics, University Hospital Leuven, Weligerveld 1, 3212, Pellenberg-Lubbeek, Belgium 2. European Centre for Knee Research, Smith and Nephew, Technologielaan 11 bis, 3001, Leuven, Belgium 3. Department of Orthopaedics and Traumatology, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium 4. Biomechanics Section, University of Leuven, Celestijnenlaan 300c, 3001, Leuven, Belgium 5. Department of Rehabilitation Sciences, University Hospital Leuven, Weligerveld 1, 3212, Pellenberg-Lubbeek, Belgium
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Abstract: | Purpose Although controversy still remains, isolated patellofemoral arthroplasty recently gained in popularity as a treatment option for patellofemoral osteoarthritis. It has compared to total knee arthroplasty the advantage of preserving the tibiofemoral articulation, which in theory would allow the preservation of natural tibiofemoral kinematics. Today, however, no data exist to support this assumption. This study was therefore performed in order to investigate the effect of isolated patellofemoral arthroplasty on the native three-dimensional tibiofemoral kinematic behaviour and whether a change in patellar thickness would have an influence. Methods Six fresh-frozen cadavers were fixed on a custom-made mechanical knee rig. Full 3D kinematics was analysed during passive flexion–extension cycles, open chain extension, with and without mechanical resistance, as well as deep knee squats, using infrared motion capture cameras and retroflective markers. Measurements were taken for the native knee and after prosthetic trochlear resurfacing with and without patellar resurfacing in three different patellar thicknesses. Results Compared to the natural knee, patellofemoral arthroplasty resulted in significant changes in tibiofemoral kinematics, which were most pronounced in the most loaded motor tasks. Increased internal tibial rotation was noted in the mid- and high flexion ranges, reaching at 120° of flexion a mean difference of 4.5° ± 4.3° (p < 0.0001) during squat motion, over the whole flexion range during open chain motion and in deeper flexion beyond 50° (mean at 70°, 1.9° ± 3.7°) during resisted open chain. During squats, also, a more posterior translation of the lateral femoral condyle was observed. The effect was accentuated in case of patella overstuffing, whereas kinematics was closer to normal with patellar thinning. Conclusion Isolated patellofemoral arthroplasty alters natural tibiofemoral kinematics, and the effects become more pronounced in case of increased patellar thickness. Therefore, it might be recommended to aim for a slight over-resection of patellar bone if sufficient bone stock is available. |
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