Abstract
Few studies have been conducted to investigate kinematics and kinetics of the patellofemoral joint under physiological muscle forces and ankle joint loads. In this study, a preliminary design of a customised total knee implant was proposed and created. To compare the influences of different patella treatment scenarios, a dynamic knee simulation model was created with patient-specific muscle forces and ankle joint loads that are calculated from an OpenSim musculoskeletal model. The goal is to improve patellar implant-bone connection and restore patellofemoral joint mobility. Identical dynamic boundary conditions were applied on an unresurfaced patella and three different dome-shaped patellar implants. It was found that the unresurfaced patella and patellar implants resulted in different motions of patellar internal rotation and medial tilt. The size of the dome-shaped patellar implant affected the motion and loading of the patellofemoral joint. When the exposed patella bone was not fully covered by the patellar implant, the patella bone then contacted the femoral component during knee flexion. This would most likely lead to anterior knee pain and subsequent revision.
Highlights
Patellar resurfacing during total knee arthroplasty (TKA) remains controversial
No significant differences in patellofemoral compressive and shear forces were observed between the two patellar implant designs
At 0.04 s into the squatting simulation, the constraints on both patella and ankle joints were removed to allow the finite element (FE) model to reach a new balance through its self-adjustment of the two contact pairs
Summary
Patellar resurfacing during total knee arthroplasty (TKA) remains controversial. It is usually performed in the presence of anterior knee pain, inflammatory arthritis, patellar mal-tracking and damaged articular cartilage. To study the influence of resurfaced and unresurfaced patellae on the motions and loading of the patellofemoral joint, methods such as in-vitro experiments[2,3,4,5] and computational simulations[6,7,8,9] have usually been implemented. Fitzpatrick and Rullkoetter[7] studied the patellofemoral joint motions and contact stresses of three different commercial implants using fluoroscopy tibiofemoral kinematics to drive an FE model and applying a 1000-N ramped load on the quadriceps muscle
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