Abstract
Purpose
To determine whether knee pain or functional impairment after total knee arthroplasty (TKA) without patellar resurfacing are correlated with preoperative patellar morphology or postoperative patellar orientation. The hypotheses were that patellar shape, increased tilt and lateral displacement would be associated with pain and functional impairment.
Methods
From a consecutive series of 152 knees that received a cemented postero-stabilized TKA, the Oxford Knee Score (OKS) and the Knee injury and Osteoarthritis Outcome Score (KOOS) were collected at a minimum follow-up of 12 months. Uni- and multi-variable linear regression analyses were performed to determine associations between the collected clinical scores and patient demographics and patellar morphology, measured from pre- and post-operative frontal, lateral and skyline view radiographs.
Results
The OKS was 75 ± 23, whereas the KOOS pain, stair climbing, and descent were respectively 77 ± 24, 3.9 ± 1.1 and 3.8 ± 1.2. OKS was not associated with any radiographic outcomes, whereas KOOS pain was better for knees with larger medial patellar facets. The KOOS stair climbing and descent were also better for knees with larger medial patellar facets.
Conclusion
The findings of this study partly confirm the hypotheses that pain and functional impairments after TKA without patellar resurfacing are associated with patellar shape. No association was revealed between postoperative patellar orientation and function nor pain. Quantitative consideration of patellar congruency could therefore prevent pain and improve function after TKA without patellar resurfacing.
Level of evidence
Retrospective study, Level III.
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References
Adravanti P, Tecame A, de Girolamo L, Ampollini A, Papalia R (2018) Patella resurfacing in total knee arthroplasty: a series of 1280 patients at midterm follow-up. J Arthroplasty 33(3):696–699
Agarwala S, Shetty V, Karumuri LK, Vijayvargiya M (2018) Patellar resurfacing versus nonresurfacing with patellaplasty in total knee arthroplasty. Indian J Orthop 52(4):393–398
Atkin DM, Fithian DC, Marangi KS, Stone ML, Dobson BE, Mendelsohn C (2000) Characteristics of patients with primary acute lateral patellar dislocation and their recovery within the first 6 months of injury. Am J Sports Med 28(4):472–479
Austin PC, Steyerberg EW (2015) The number of subjects per variable required in linear regression analyses. J Clin Epidemiol 68(6):627–636
Baldini A, Anderson JA, Cerulli-Mariani P, Kalyvas J, Pavlov H, Sculco TP (2007) Patellofemoral evaluation after total knee arthroplasty. Validation of a new weight-bearing axial radiographic view. J Bone Joint Surg Am 89(8):1810–1817
Baldini A, Anderson JA, Zampetti P, Pavlov H, Sculco TP (2006) A new patellofemoral scoring system for total knee arthroplasty. Clin Orthop Relat Res 452:150–154
Bonnin M, Saffarini M, Nover L, van der Maas J, Haeberle C, Hannink G, Victor J (2017) External rotation of the femoral component increases asymmetry of the posterior condyles. Bone Joint J 99(7):894–903
Brattstroem H (1964) Shape of the intercondylar groove normally and in recurrent dislocation of patella. A clinical and X-ray-anatomical investigation. Acta Orthop Scand Suppl 68(SUPPL 68):61–148
Cicchetti D (1994) Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instruments in psychology. Psychol Assess 6(4):284–290
Clement ND, MacDonald D, Simpson AH (2014) The minimal clinically important difference in the Oxford knee score and Short Form 12 score after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 22(8):1933–1939
Dejour D, Ntagiopoulos PG, Saffarini M (2014) Evidence of trochlear dysplasia in femoral component designs. Knee Surg Sports Traumatol Arthrosc 22(11):2599–2607
Duan G, Liu C, Lin W, Shao J, Fu K, Niu Y, Wang F (2018) Different factors conduct anterior knee pain following primary total knee arthroplasty: a systematic review and meta-analysis. J Arthroplasty 33(6):1962–1971.e1963
Franck F, Ouanezar H, Jacquel A, Pibarot V, Wegrzyn J (2017) The predictive factors of secondary patellar resurfacing in computer-assisted total knee arthroplasty. A prospective cohort study. Int Orthop. https://doi.org/10.1007/s00264-017-3630-z
Fucentese SF, von Roll A, Koch PP, Epari DR, Fuchs B, Schottle PB (2006) The patella morphology in trochlear dysplasia—a comparative MRI study. Knee 13(2):145–150
Gaillard R, Lustig S, Peltier A, Villa V, Servien E, Neyret P (2016) Total knee implant posterior stabilised by a third condyle: design evolution and post-operative complications. Orthop Traumatol Surg Res 102(8):1061–1068
Grelsamer RP, Bazos AN, Proctor CS (1993) Radiographic analysis of patellar tilt. J Bone Joint Surg Br 75(5):822–824
Grelsamer RP, Meadows S (1992) The modified Insall-Salvati ratio for assessment of patellar height. Clin Orthop Relat Res 282:170–176
Gudas R, Siupsinskas L, Gudaite A, Vansevicius V, Stankevicius E, Smailys A, Vilkyte A, Simonaityte R (2018) The Patello-femoral joint degeneration and the shape of the patella in the population needing an arthroscopic procedure. Medicina (Kaunas) 54(2):21
Gunaratne R, Pratt DN, Banda J, Fick DP, Khan RJK, Robertson BW (2017) Patient dissatisfaction following total knee arthroplasty: a systematic review of the literature. J Arthroplasty 32(12):3854–3860
Ha C, Wang B, Li W, Sun K, Wang D, Li Q (2019) Resurfacing versus not-resurfacing the patella in one-stage bilateral total knee arthroplasty: a prospective randomized clinical trial. Int Orthop. https://doi.org/10.1007/s00264-019-04361-7
Inoue A, Arai Y, Nakagawa S, Inoue H, Yoshihara Y, Yamazoe S, Kubo T (2017) Differences in patellofemoral alignment as a result of patellar shape in cruciate-retaining total knee arthroplasty without patellar resurfacing at a minimum three-year follow-up. Knee 24(6):1448–1453
Iwano T, Kurosawa H, Tokuyama H, Hoshikawa Y (1990) Roentgenographic and clinical findings of patellofemoral osteoarthrosis. With special reference to its relationship to femorotibial osteoarthrosis and etiologic factors. Clin Orthop Relat Res 252:190–197
Kaseb MH, Tahmasebi MN, Mortazavi SJ, Sobhan MR, Nabian MH (2018) Comparison of clinical results between patellar resurfacing and non-resurfacing in total knee arthroplasty: a short term evaluation. Arch Bone Jt Surg 6(2):124–129
Kurtz S, Ong K, Lau E, Mowat F, Halpern M (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 89(4):780–785
Laprade J, Culham E (2003) Radiographic measures in subjects who are asymptomatic and subjects with patellofemoral pain syndrome. Clin Orthop Relat Res. https://doi.org/10.1097/01.blo.0000079269.91782.f5(414):172-182
Longo UG, Ciuffreda M, Mannering N, D’Andrea V, Cimmino M, Denaro V (2018) Patellar resurfacing in total knee arthroplasty: systematic review and meta-analysis. J Arthroplasty 33(2):620–632
Narkbunnam R, Electricwala AJ, Huddleston JI 3rd, Maloney WJ, Goodman SB, Amanatullah DF (2019) Suboptimal patellofemoral alignment is associated with poor clinical outcome scores after primary total knee arthroplasty. Arch Orthop Trauma Surg 139(2):249–254
Panni AS, Cerciello S, Maffulli N, Di Cesare M, Servien E, Neyret P (2011) Patellar shape can be a predisposing factor in patellar instability. Knee Surg Sports Traumatol Arthrosc 19(4):663–670
Planckaert C, Larose G, Ranger P, Lacelle M, Fuentes A, Hagemeister N (2018) Total knee arthroplasty with unexplained pain: new insights from kinematics. Arch Orthop Trauma Surg 138(4):553–561
Rivière C, Iranpour F, Auvinet E, Howell S, Vendittoli P-A, Cobb J, Parratte S (2017) Alignment options for total knee arthroplasty: a systematic review. Orthop Traumatol Surg Res 103(7):1047–1056
Roessler PP, Moussa R, Jacobs C, Schuttler KF, Stein T, Schildberg FA, Wirtz DC (2019) Predictors for secondary patellar resurfacing after primary total knee arthroplasty using a “patella-friendly” total knee arthroplasty system. Int Orthop 43(3):611–617
Roos EM, Lohmander LS (2003) The Knee injury and Osteoarthritis Outcome Score (KOOS): from joint injury to osteoarthritis. Health Qual Life Outcomes 1:64
Saffarini M, Demey G, Nover L, Dejour D (2016) Evolution of trochlear compartment geometry in total knee arthroplasty. Ann Transl Med 4(1):7
Saffarini M, Nover L, Tandogan R, Becker R, Moser LB, Hirschmann MT, Indelli PF (2019) The original Akagi line is the most reliable: a systematic review of landmarks for rotational alignment of the tibial component in TKA. Knee Surg Sports Traumatol Arthrosc 27(4):1018–1027
Senioris A, Saffarini M, Rahali S, Malekpour L, Dujardin F, Courage O (2016) Does patellofemoral congruence following total knee arthroplasty correlate with pain or function? Intraoperative arthroscopic assessment of 30 cases. Ann Transl Med 4(15):279
Servien E, Ait Si Selmi T, Neyret P (2003) Study of the patellar apex in objective patellar dislocation. Rev Chir Orthop Reparatrice Appar Mot 89(7):605–612
Takahashi A, Sano H, Ohnuma M, Kashiwaba M, Chiba D, Kamimura M, Sugita T, Itoi E (2012) Patellar morphology and femoral component geometry influence patellofemoral contact stress in total knee arthroplasty without patellar resurfacing. Knee Surg Sports Traumatol Arthrosc 20(9):1787–1795
van Houten AH, Heesterbeek PJ, Wymenga AB (2016) Patella position is not a determinant for anterior knee pain 10 years after balanced gap total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 24(8):2656–2662
van Jonbergen HP, Reuver JM, Mutsaerts EL, Poolman RW (2014) Determinants of anterior knee pain following total knee replacement: a systematic review. Knee Surg Sports Traumatol Arthrosc 22(3):478–499
Weeks CA, Marsh JD, MacDonald SJ, Graves S, Vasarhelyi EM (2018) Patellar resurfacing in total knee arthroplasty: a cost-effectiveness analysis. J Arthroplasty 33(11):3412–3415
White PB, Sharma M, Siddiqi A, Satalich JR, Ranawat AS, Ranawat CS (2019) Role of anatomical patella replacement on anterior knee pain. J Arthroplasty 34(5):887–892
Wiberg G (1941) Roentgenographic and anatomic studies on the femoropatellar joint, with special reference to chondromalacia patellae. Acta Orthop Scand 12:319–410
Zmistowski BM, Fillingham YA, Salmons HI, Ward DT, Good RP, Lonner JH (2019) Routine patellar resurfacing during total knee arthroplasty is not cost-effective in patients without patellar arthritis. J Arthroplasty. https://doi.org/10.1016/j.arth.2019.04.040
Acknowledgements
The authors would like to thank Jeremy Valluy and Luca Nover for their support in statistical analysis and manuscript preparation.
Funding
The authors are grateful to Ramsay Santé for funding the statistical analysis and manuscript preparation for this study.
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TASS: study design, data collection, manuscript editing. LMH: data collection, manuscript editing. PFOL: data collection, manuscript editing. KK: data collection, manuscript editing. JHM: literature review, statistical analysis, manuscript writing, figures and tables. MS: study design, literature review, manuscript writing. MPB: study design, data collection, manuscript editing.
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TASS: Receives royalties and fees from DePuy-Synthes and Symbios. LMH: Nothing to declare. PFOL: Nothing to declare. KK: Nothing to declare. JHM: Consults and receives fees from ReSurg. MS: Consults and receives fees from ReSurg. MPB: Receives royalties from DePuy-Synthes, Wright Medical, Integra and Symbios.
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All patients had provided written informed consent for the use of their data and images for research and publishing purposes and the institutional review board approved the study in advance (IRB reference number: COS-RGDS-2019-06-002-AIT SI SELMI-T).
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Aït-Si-Selmi, T., Marie-Hardy, L., O’Loughlin, P.F. et al. Patellar facet ratio affects knee pain, stair climbing and stair descent after TKA without patellar resurfacing. Knee Surg Sports Traumatol Arthrosc 28, 3796–3804 (2020). https://doi.org/10.1007/s00167-020-05868-y
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DOI: https://doi.org/10.1007/s00167-020-05868-y