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Patellofemoral kinematics during deep knee flexion after total knee replacement: a computational simulation

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

Abstract

Purpose

Actions requiring deep knee flexion, such as kneeling and squatting, are challenging to perform after total knee replacement (TKR), though many manufactures emphasize that their knee prostheses could safely achieve high flexion. Little is known about the patellofemoral kinematics during deep flexion. This study aimed to track the movement of the patella during kneeling and squatting through dynamic computational simulation.

Methods

A validated knee model was used to analyse the patellar kinematics after TKR, including shifting, tilting and rotation. The data were captured from full extension to 135° of knee flexion. For kneeling, an anterior force of 500 N was applied perpendicularly on the tibial tubercle as the knee flexed from 90° to 135°. For squatting, a ground reaction force was applied through the tibia from full extension to 135° of flexion.

Results

This study found that patellar shifting and rotation in kneeling were similar to those while squatting. However, during kneeling, the patella had a greater medial tilt and showed signs of abrupt patellar tilt owning to an external force being concentrated on the tibial tubercle.

Conclusions

In terms of squatting and kneeling movements, the latter is a more strenuous action for the patellofemoral joint after TKR due to the high forces acting on the tibial tubercle. It is suggested that overweight patients or those requiring high flexion should try to avoid kneeling to reduce the risk of the polyethylene wear. Further modification of trochlear geometry may be required to accommodate abrupt changes in patellar tilting.

Level of evidence

II.

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Acknowledgments

The authors are pleased to acknowledge the financial supports of the National Science Council (NSC 100-2221-E-195-001-MY2, NSC 102-2221-E-195-001) and computational support by the Institute of Biomedical Engineering, National Yang-Ming University. And we wish to thank Colin J. McClean for his assistance in language editing and proofreading of this manuscript.

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Authors and Affiliations

  1. Biomechanics Research Laboratory, Mackay Memorial Hospital, New Taipei City, Taiwan

    Chang-Hung Huang, Lin-I Hsu, Ting-Kuo Chang, Yung-Chang Lu & Chun-Hsiung Huang

  2. Department of Physical Therapy and Assistive Technology, National Yang-Ming University, No. 155, Sec. 2, Li-Nung St., Taipei, 112, Taiwan

    Lin-I Hsu & Chen-Sheng Chen

  3. Institute of Biomedical Engineering, National Yang-Ming University, Taipei, Taiwan

    Chang-Hung Huang, Kun-Jhih Lin, Cheng-Kung Cheng & Chun-Hsiung Huang

  4. Department of Orthopaedic Surgery, Mackay Memorial Hospital, No. 45, Minsheng Rd., Tamshui District, New Taipei City, 25160, Taiwan

    Ting-Kuo Chang, Yung-Chang Lu & Chun-Hsiung Huang

  5. Department of Cosmetic Application and Management, Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan

    Yung-Chang Lu

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  1. Chang-Hung Huang
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Correspondence to Yung-Chang Lu or Chen-Sheng Chen.

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Kun-Jhih Lin and Lin-I Hsu have contributed equally to this article.

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Huang, CH., Hsu, LI., Lin, KJ. et al. Patellofemoral kinematics during deep knee flexion after total knee replacement: a computational simulation. Knee Surg Sports Traumatol Arthrosc 22, 3047–3053 (2014). https://doi.org/10.1007/s00167-013-2819-y

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  • DOI: https://doi.org/10.1007/s00167-013-2819-y

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