Anterior knee pain and evidence of osteoarthritis of the patellofemoral joint should not be considered contraindications to mobile-bearing unicompartmental knee arthroplasty

Abstract Background Unicompartmental knee arthroplasty (UKA) is an effective treatment for end-stage, symptomatic unicompartmental osteoarthritis of the knee joint. However, patellofemoral joint degeneration is a contraindication to medial UKA. Therefore, the objective of this study was to evaluate the biomechanical effect of medial UKA using fixed-bearing (FB) and mobile-bearing (MB) design prostheses on the patellofemoral joint. Methods A three-dimensional finite-element model of a normal knee joint was developed using medical image data. We performed statistical analysis for each model. The differences in contact stress on the patellofemoral joint and the quadriceps force between the FB and MB designs were evaluated under a deep-knee-bend condition. Results At an early flexion angle, the results of contact stress showed no significant difference between the FB and MB medial UKA models compared with the intact model. However, at high flexion angles, we observed a significant increase in contact stress with the FB models compared with the intact model. On the contrary, in the case of the MB models, we found no statistically significant increment compared with the intact model. A larger quadriceps force was needed to produce an identical flexion angle for both the FB and MB UKA designs than for the intact model. At high flexion angles, a significant increase quadriceps force whit the FB model compared with the intact model. Conclusions Our results indicate that with medial UKA, the contact stress increased and greater quadriceps force was applied to the patellofemoral joint. However, performing UKA on a patellofemoral joint with osteoarthritis should not be difficult, unless anterior knee pain is present, because the increase in contact stress is negligible.

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Effects of contact stress on patellarfemoral joint and quadriceps force in fixed and mobile-bearing medial unicompartmental knee arthroplasty

10.21203/rs.2.23811/v2 ◽

2020 ◽

Author(s):

Hyuck Min Kwon ◽

Jin-Ah Lee ◽

Yong-Gon Koh ◽

Kwan Kyu Park ◽

Kyoung-Tak Kang

Keyword(s):

Knee Joint ◽

Contact Stress ◽

Knee Arthroplasty ◽

Unicompartmental Knee Arthroplasty ◽

Patellofemoral Joint ◽

Mobile Bearing ◽

Osteoarthritis Of The Knee ◽

Unicompartmental Knee ◽

Significant Difference ◽

Quadriceps Force

Abstract Background Unicompartmental knee arthroplasty (UKA) is an effective treatment for end-stage, symptomatic unicompartmental osteoarthritis of the knee joint. However, patellofemoral joint degeneration is a contraindication to medial UKA. Therefore, the objective of this study was to evaluate the biomechanical effect of medial UKA using fixed-bearing (FB) and mobile-bearing (MB) design prostheses on the patellofemoral joint. Methods A three-dimensional finite-element model of a normal knee joint was developed using medical image data. We performed statistical analysis for each model. The differences in contact stress on the patellofemoral joint and the quadriceps force between the FB and MB designs were evaluated under a deep-knee-bend condition.Results At an early flexion angle, the results of contact stress showed no significant difference between the FB and MB medial UKA models and the intact model. However, at large flexion angles, we observed a significant increase in contact stress with the FB models. On the contrary, in the case of the MB models, we found no statistically significant increment compared with the intact model. Our results indicate that with medial UKA, the contact stress increased and greater quadriceps force was applied to the patellofemoral joint. However, performing UKA on a patellofemoral joint with osteoarthritis should not be difficult, unless anterior knee pain is present, because the increase in contact stress is negligible. Conclusions Our results show no significant difference in contact stress on the patellofemoral joint between the medial UKA and intact knee joint models. Such a mechanism was easily found in MB medial UKA. Therefore, this study biomechanically showed that degenerative changes in the patellofemoral joint should not be considered an absolute contraindication to treatment with medial UKA.

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Effects of contact stress on patellarfemoral joint and quadriceps force in fixed and mobile-bearing medial unicompartmental knee arthroplasty

10.21203/rs.2.23811/v3 ◽

2020 ◽

Author(s):

Hyuck Min Kwon ◽

Jin-Ah Lee ◽

Yong-Gon Koh ◽

Kwan Kyu Park ◽

Kyoung-Tak Kang

Keyword(s):

Knee Joint ◽

Contact Stress ◽

Knee Arthroplasty ◽

Unicompartmental Knee Arthroplasty ◽

Patellofemoral Joint ◽

Mobile Bearing ◽

Osteoarthritis Of The Knee ◽

Unicompartmental Knee ◽

Significant Difference ◽

Quadriceps Force

Abstract Background Unicompartmental knee arthroplasty (UKA) is an effective treatment for end-stage, symptomatic unicompartmental osteoarthritis of the knee joint. However, patellofemoral joint degeneration is a contraindication to medial UKA. Therefore, the objective of this study was to evaluate the biomechanical effect of medial UKA using fixed-bearing (FB) and mobile-bearing (MB) design prostheses on the patellofemoral joint.Methods A three-dimensional finite-element model of a normal knee joint was developed using medical image data. We performed statistical analysis for each model. The differences in contact stress on the patellofemoral joint and the quadriceps force between the FB and MB designs were evaluated under a deep-knee-bend condition.Results At an early flexion angle, the results of contact stress showed no significant difference between the FB and MB medial UKA models and the intact model. However, at large flexion angles, we observed a significant increase in contact stress with the FB models. On the contrary, in the case of the MB models, we found no statistically significant increment compared with the intact model. Our results indicate that with medial UKA, the contact stress increased and greater quadriceps force was applied to the patellofemoral joint. However, performing UKA on a patellofemoral joint with osteoarthritis should not be difficult, unless anterior knee pain is present, because the increase in contact stress is negligible.Conclusions Our results show no significant difference in contact stress on the patellofemoral joint between the medial UKA and intact knee joint models. Such a mechanism was easily found in MB medial UKA. Therefore, this study biomechanically showed that degenerative changes in the patellofemoral joint should not be considered an absolute contraindication to treatment with medial UKA.

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Anterior knee pain causes after total knee arthroplasty

Proceedings of the National Academy of Sciences of Belarus Medical series ◽

10.29235/1814-6023-2021-18-2-160-168 ◽

2021 ◽

Vol 18 (2) ◽

pp. 160-168

Author(s):

O. L. Eismont

Keyword(s):

Total Knee Arthroplasty ◽

Knee Pain ◽

Knee Arthroplasty ◽

Anterior Knee Pain ◽

Patellofemoral Joint ◽

Varus Deformity ◽

Valgus Deformity ◽

Total Knee ◽

Anterior Knee ◽

Average Angle

The objective of the study was to determine the causes of postoperative anterior knee pain after total knee arthroplasty for preventing its occurrence and improving the surgery results.The treatment results of 77 (112 cases) patients with cruciate-retaining total knee arthroplasty without patellar replacement were analyzed. The study involved 62 (80.5 %) women and 15 (19.5 %) men. The average age (Me (25‒75 %)) of the patients was 65 (60‒70) years. There were 97 cases (87 %) with varus deformity of the knee joint, 15 cases with valgus deformity (13 %). The average angle of varus deformity was 11.22 ± 3.81°, the average angle of valgus deformity was 11 ± 4.27°. After the anterior pain appeared, patients were examined in 2‒3, 4‒5 and 6‒7 months after surgery using clinical, X-ray (anterior-posterior, lateral and axial projections, topogram of lower extremities), and EMG methods.The causes of anterior postoperative knee pain were: implant components misplacement, patellar microcirculation disorders (chondrolysis, avascular necrosis due to circular patella denervation), patellofemoral joint imbalance, and functional causes. Pain manifested itself at active leg loading and knee motion because of implant components misplacement within 2‒3 months in 34 cases (94 %), 4‒5 months ‒ in 2 cases (6 %). Patellar microcirculation disorders within 4‒5 months ‒ in 5 cases (21 %), 6‒7 months ‒ in 19 (79 %) cases. Imbalance in the patellofemoral joint within 2‒3 months ‒ in 29 cases (69 %), 4‒5 months ‒ in 13 cases (31 %). Functional causes of pain appeared within 2‒3 months ‒ in 7 cases (70 %), 4‒5 months ‒ in 3 cases (30 %).The causes of postoperative anterior pain in total knee arthroplasty can be incorrect surgical technique, changes in patellar blood supply or in the biomechanics of the patellofemoral joint due to the imbalance of the thigh muscles.

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A Dutch Survey on Circumpatellar Electrocautery in Total Knee Arthroplasty

The Open Orthopaedics Journal ◽

10.2174/1874325001004010201 ◽

2010 ◽

Vol 4 (1) ◽

pp. 201-203 ◽

Cited By ~ 21

Author(s):

Hans-Peter W. van Jonbergen ◽

Alexander F.W. Barnaart ◽

Cees C.P.M. Verheyen

Keyword(s):

Total Knee Arthroplasty ◽

The Netherlands ◽

Knee Pain ◽

Knee Arthroplasty ◽

Anterior Knee Pain ◽

Patellar Resurfacing ◽

Orthopedic Surgeons ◽

Unicompartmental Knee Arthroplasties ◽

Total Knee ◽

Anterior Knee

Introduction: Anterior knee pain following total knee arthroplasty is estimated to occur in 4-49% of patients. Some orthopedic surgeons use circumpatellar electrocautery (diathermy) to reduce the prevalence of postsurgical anterior knee pain; however, the extent of its use is unknown. Materials and Methodology: In April 2009, a postal questionnaire was sent to all 98 departments of orthopedic surgery in The Netherlands. The questions focused on the frequency of total knee arthroplasties, patellar resurfacing, and the use of circumpatellar electrocautery. Results: The response rate was 92%. A total of 18,876 TKAs, 2,096 unicompartmental knee arthroplasties, and 215 patellofemoral arthroplasties are performed yearly in The Netherlands by the responding orthopedic surgeons. Of the orthopedic surgeons performing TKA, 13% always use patellar resurfacing in total knee arthroplasty for osteoarthritis, 49% use selective patellar resurfacing, and 38% never use it. Fifty-six percent of orthopedic surgeons use circumpatellar electrocautery when not resurfacing the patella, and 32% use electrocautery when resurfacing the patella. Conclusion: There is no consensus among Dutch orthopedic surgeons on the use of patellar resurfacing or circumpatellar electrocautery in total knee replacement performed for osteoarthritis. A prospective clinical trial is currently underway to fully evaluate the effect of circumpatellar electrocautery on the prevalence of anterior knee pain following total knee arthroplasty.

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