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Patellar morphology and femoral component geometry influence patellofemoral contact stress in total knee arthroplasty without patellar resurfacing

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The objective of this study was to determine the effect of patellar morphology and implant design on patellofemoral contact stress in total knee arthroplasty (TKA) without patellar resurfacing.

Methods

Radiographic investigation: One hundred and fifty-seven knees of 127 patients were included in the study. Implants used in the present series were Low Contact Stress (LCS), Genesis II and NexGen. The relationship between the pre-operative patellar facet angle and newly identified post-operative osteosclerosis was assessed. Finite element analysis: Using patient-specific patellar three-dimensional finite element models, the relationship between the patellar facet angle and mean von Mises stress within the patella was calculated at flexion angles of 15°, 45°, 75° and 105°.

Results

Radiographic investigation: Post-operative osteosclerosis was observed with decreasing patellar facet angle in the Genesis II (odds ratio = 0.72; 95% confidence interval, 0.55–0.93; P = 0.012) and NexGen implants (odds ratio = 0.87; 95% confidence interval, 0.77–0.99; P = 0.029). Patients treated with the Genesis II had significantly more advanced osteosclerosis than those treated with the other two implants. Finite element analysis: A negative correlation was found between the patellar facet angle and the mean von Mises stress for all three implants. The Genesis II showed significantly higher von Mises stress than the other two implants at flexion angles of 15°, 45° and 105°.

Conclusions

Both patellar morphology and femoral component geometry influence patellofemoral contact stress in total knee arthroplasty without patellar resurfacing.

Level of evidence

Case control study, Level III.

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Acknowledgments

Three-dimensional geometric data of each femoral component were provided by DePuy, Smith & Nephew and Zimmer under the non-disclosure agreement. We thank Dr Toru Tsuboya for his support in statistical analysis.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan

    Atsushi Takahashi, Hirotaka Sano, Mitsuhiro Kashiwaba, Daisuke Chiba, Masayuki Kamimura & Eiji Itoi

  2. Department of Orthopaedic Surgery, Sendai Red Cross Hospital, 2-43-3 Yagiyamahoncho, Taihaku-ku, Sendai, Miyagi, 982-8501, Japan

    Masahiro Ohnuma

  3. Tohoku Orthopaedic Clinic, 4-9-30 Kamiyagari, Izumiku-Ku, Sendai, Miyagi, 981-3121, Japan

    Takehiko Sugita

Authors
  1. Atsushi Takahashi
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  2. Hirotaka Sano
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  3. Masahiro Ohnuma
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  4. Mitsuhiro Kashiwaba
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Correspondence to Hirotaka Sano.

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Takahashi, A., Sano, H., Ohnuma, M. et al. Patellar morphology and femoral component geometry influence patellofemoral contact stress in total knee arthroplasty without patellar resurfacing. Knee Surg Sports Traumatol Arthrosc 20, 1787–1795 (2012). https://doi.org/10.1007/s00167-011-1768-6

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  • DOI: https://doi.org/10.1007/s00167-011-1768-6

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