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Kinematically aligned TKA restores physiological patellofemoral biomechanics in the sagittal plane during a deep knee bend

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Although patellofemoral complications after kinematically aligned (KA) TKA are infrequent, the patellar flexion angle and proximal–distal patellar contact location through flexion, and incidence of patellar loss of contact at full extension are unknown. The present study determined whether the patellar flexion angle and proximal–distal patellar contact location of a KA TKA performed with anatomic, fixed-bearing, posterior cruciate-retaining (PCR) components differed from those of the native contralateral knee during a deep knee bend, and determined the incidence of patellar loss of contact at full extension for KA TKA only.

Methods

During a deep knee bend from full extension to maximum flexion, both knees were imaged in a lateral view using single-plane fluoroscopy for 25 patients with a calipered KA TKA and a healthy native knee in the contralateral limb. The patellar flexion angle and proximal–distal patellar contact location were measured on images from full extension to maximum flexion in 30° increments. Paired t tests at each flexion angle determined the significance of the difference between the KA TKA knees and the native contralateral knees. In the KA TKA knees, the incidence of patellar loss of contact at full extension was determined. Patient-reported outcome scores also were recorded including the Oxford Knee Score.

Results

Mean patellar flexion angles were not different between the KA TKA knees and the native contralateral knees throughout the motion arc. The largest statistically significant difference in the mean proximal–distal patellar contact locations was 4 mm. The incidence of patellar loss of contact in the KA TKA knees at full extension was 8% (2 of 25 patients). The median Oxford Knee Score was 46 out of 48.

Conclusions

Calipered KA TKA performed with anatomic, fixed-bearing, PCR components restored patellar flexion angles to native and largely restored the proximal–distal patellar contact locations, which at most differed from the native contralateral knee by approximately 10% of the mean proximal–distal patellar length. In the KA TKA knees, the incidence of patellar loss of contact was infrequent. These objective biomechanical results are consistent with the relatively high subjective patient-reported outcome scores herein and support the low incidence of patellofemoral complications following KA TKA previously reported.

Level of evidence

Therapeutic, level III.

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Acknowledgements

The authors would like to thank the individuals who participated in this study for their contribution to the advancement of education and research. The authors would also like to thank Sipeng Wang for assistance with the development of the analysis software and image processing. Lastly, the authors would like to thank Savannah Axume Gamero, Yash Taneja, and Caitlyn Munch for assistance with image processing.

Funding

Financial support was provided by Zimmer-Biomet, Award Number IRU2016-101K:Knees.

Author information

Authors and Affiliations

  1. Department of Biomedical Engineering, University of California Davis, One Shields Avenue, Davis, CA, 95616, USA

    Stephanie Nicolet-Petersen, Stephen Howell & Maury L. Hull

  2. Department of Orthopaedic Surgery, Ambulatory Care Center, 4860 Y Street, Suite 3800, Sacramento, CA, 95817, USA

    Augustine Saiz, Trevor Shelton & Maury L. Hull

  3. Department of Mechanical Engineering, University of California Davis, One Shields Avenue, Davis, CA, 95616, USA

    Maury L. Hull

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  1. Stephanie Nicolet-Petersen
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  2. Augustine Saiz
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  4. Stephen Howell
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Corresponding author

Correspondence to Maury L. Hull.

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Conflict of interest

S.M. Howell is a paid consultant for THINK Surgical and Medacta, Inc. M.L. Hull receives research support from Zimmer-Biomet and Medacta, Inc. Remaining authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the University of California Davis Institutional Review Board (IRB#954288).

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Nicolet-Petersen, S., Saiz, A., Shelton, T. et al. Kinematically aligned TKA restores physiological patellofemoral biomechanics in the sagittal plane during a deep knee bend. Knee Surg Sports Traumatol Arthrosc 28, 1497–1507 (2020). https://doi.org/10.1007/s00167-019-05547-7

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