Intraoperative analysis of patellofemoral joint morphology before and after total knee arthroplasty : Afeasibility study.

Maeruan Kebbach,Rainer Bader,Enrico Mick,Stephan Kirschner,Joerg Luetzner

doi:10.1007/s00132-022-04224-x

Abstract

BackgroundPatellofemoral problems after total knee arthroplast (TKA) are frequent and often associated with a change in the geometry of the trochlear groove.ObjectiveThe present study aimed to analyze the feasibility of intraoperative examination of the patellofemoral joint geometry before and after the implantation of bicondylar total knee replacements without exposing the patient to radiation.Material and methodsThe patellofemoral joint morphology geometries of 33 patients before and after implantation of a bicondylar total knee replacement was intraoperatively analyzed using a digital scanning method. Femoral surface geometries were extracted from intraoperatively recorded tactile scanning data using an in-house algorithm. The geometries were then characterized by sulcus height, medial femoral condyle height and lateral femoral condyle height.ResultsOur preliminary results show that these key geometric parameters are only partially restored after TKA leading to a distinctly different shaped profile of the anterior distal femur. Maximum and minimum mean differences in sulcus height, medial femoral condyle height, and lateral femoral condyle height before and after surgery were 2.00 mm/−3.06 mm, 2.51 mm/−6.25 mm and 2.74 mm/−3.58 mm, respectively.ConclusionA new method for intraoperative analysis of the patellofemoral joint morphology before and after TKA without radiation exposure was developed and utilized. Even with the use of modern total knee designs, the patellofemoral articulation is considerably changed postoperatively as quantified by the key parameters of sulcus height, medial femoral condyle height, and lateral femoral condyle height. This may result in altered knee biomechanics and might explain persistent patellofemoral disorders, which are often reported by patients after TKA.

Highlights

Reduced satisfaction after total knee arthroplasty (TKA) is often associated with dysfunction during daily activities that impairs the patient’s quality of life [23]
To evaluate the sole influence of TKA rather than individual geometry on the investigated parameters, the results are presented in terms of the mean difference of preoperative and postoperative parameters (ΔSH, ΔmedCH, and ΔlatCH)
The parameters are defined as a function of the cutting angle θ, which corresponds to the location on the frontal femoral cortex (

Summary

Introduction

Reduced satisfaction after total knee arthroplasty (TKA) is often associated with dysfunction during daily activities that impairs the patient’s quality of life [23]. The demand for revision surgery is estimated to grow by 601% [17] Despite this expected increase in operations, patellofemoral joint disorders, e.g. patellar subluxation and dislocation, implant wear or anterior knee pain, remain present and constitute a major factor of insufficiency after TKA [10, 22, 28, 35, 37]. Even with the use of modern total knee designs, the patellofemoral articulation is considerably changed postoperatively as quantified by the key parameters of sulcus height, medial femoral condyle height, and lateral femoral condyle height. This may result in altered knee biomechanics and might explain persistent patellofemoral disorders, which are often reported by patients after TKA

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Conclusion