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Journal of Orthopaedic Surgery and... Mar 2021The decision to resurface the patella as part of total knee arthroplasty may be influenced by the surgeon's preference, education, training, tradition and geographic... (Comparative Study)
Comparative Study Review
BACKGROUND
The decision to resurface the patella as part of total knee arthroplasty may be influenced by the surgeon's preference, education, training, tradition and geographic location. Advocates for non-resurfacing or selectively resurfacing may claim no difference in patient reported outcomes, and that resurfacing is associated with increased risks such as extensor mechanism injury or malalignment, problems with the design of the patella component and technical issues intraoperatively.
AIMS
To critically examine factors that should be considered in addition to patient reported outcomes in the decision process of resurfacing or non-resurfacing of the patella in total knee arthroplasty.
METHOD
A comprehensive literature search was conducted to identify factors that may influence decision making in addition to knee specific patient reported outcome measures such as surgical risks, patient quality of life, procedure cost, re-operation rate, implant design, surgeons learning curve and the fate of remaining cartilage in native patellae.
RESULTS
Patient-reported outcomes are equivocal for resurfacing and non-resurfacing. Critical analysis of the available literature suggests that the complications of resurfacing the patella are historic, which is now lower with improved implant design and surgical technique. Routine resurfacing was cost-effective in the long term (potential saving £104 per case) and has lower rates of revision (absolute risk reduction 4%). Finally, surgical judgment in selective resurfacing was prone to errors.
CONCLUSION
Patella resurfacing and non-resurfacing had similar patient-reported outcomes. However, patella resurfacing was cost-effective and was associated with a lower rate of re-operation compared to non-resurfacing.
Topics: Arthroplasty, Replacement, Knee; Cost-Benefit Analysis; Humans; Patella; Reoperation
PubMed: 33706779
DOI: 10.1186/s13018-021-02295-8 -
Musculoskeletal Surgery Jun 2023Patella maltracking is among the most frequent causes of poor outcomes and early failure after total knee arthroplasty (TKA), with an incidence that ranges from 1 to... (Review)
Review
PURPOSE
Patella maltracking is among the most frequent causes of poor outcomes and early failure after total knee arthroplasty (TKA), with an incidence that ranges from 1 to 20%. Even if there is agreement between authors regarding the preoperative and intraoperative management of patella maltracking in TKA, less clear are postoperative conducts. The purpose of this systematic review is to summarize and compare surgical techniques used to treat patella maltracking after TKA.
METHODS
A systematic review of the literature was performed with a primary search on Medline through PubMed. The PRISMA 2009 flowchart and checklist were used to edit the review. Screened studies had to provide clinical, functional and radiological results and complications of the proposed treatment to be included in the review.
RESULTS
A total of 21 articles were finally included. Three main types of surgical procedures and other minor techniques have been identified to manage patella maltracking after TKA. The choice of the proper technique to use in the specific case depends on several factors, first of all the malpositioning of the prosthetic components.
CONCLUSION
Patella maltracking after TKA represents a frequent and challenging problem for orthopedic surgeons. Treatments described in the literature are often able to correct an abnormal patellar tracking; nevertheless, authors report variable percentages of residual knee pain and dissatisfaction in re-treated patients. Therefore, it would be desirable to prevent the maltracking condition at the time of primary arthroplasty, using proper surgical precautions.
Topics: Humans; Arthroplasty, Replacement, Knee; Patella; Knee Joint; Radiography
PubMed: 36197592
DOI: 10.1007/s12306-022-00764-9 -
Diagnostic and Interventional Imaging 2016Various types of knee arthroplasty implants are available depending on the number of knee compartments to be replaced and ligament stability. Unlike unicompartmental... (Review)
Review
Various types of knee arthroplasty implants are available depending on the number of knee compartments to be replaced and ligament stability. Unlike unicompartmental arthroplasty, the aim of total knee replacement is to maintain normal knee alignment. EOS X-ray imaging in the coronal and sagittal planes is the best modality for measuring the reference axes of the knee, but may by complemented by CT scans in the transverse plane. In addition to implant-related complications such as loosening and polyethylene wear, complications of the knee extensor mechanism are sometimes observed. Conventional radiography remains the first-line diagnostic modality in the event of post-knee replacement pain or instability. Ultrasound and CT imaging may also be helpful to make diagnosis.
Topics: Arthroplasty, Replacement, Knee; Bursitis; Fibrosis; Fractures, Bone; Humans; Joint Instability; Knee Prosthesis; Ossification, Heterotopic; Osteolysis; Patella; Postoperative Complications; Prosthesis Design; Prosthesis Failure; Prosthesis-Related Infections; Synovial Membrane; Synovitis; Tendinopathy; Tendon Injuries
PubMed: 27423710
DOI: 10.1016/j.diii.2016.02.015 -
Computational and Mathematical Methods... 2022Memory alloy patella claws for treating patella fractures have been used for more than 30 years with many desirable features including fast healing, quick recovery, and...
Memory alloy patella claws for treating patella fractures have been used for more than 30 years with many desirable features including fast healing, quick recovery, and avoidance of top abrasion of Kirschner wires and other complications. However, there are many models and it is difficult to choose the accurate claw for the patient. In this study, a finite element model of the butterfly-shaped patellar claw made of shape memory alloy was established, its mechanical structure was analyzed, and its clinical application was monitored. We used Solidworks Simulation software for modeling and mainly analyzed the force of the compression ring of the butterfly-shaped patellar claw. Clinically, we chose a closed fresh patella fracture case. After finite element analysis, the maximum stress that the compression ring of the butterfly-shaped patellar claw can withstand is 568.1 MPa. In this range, it always has elastic deformation resistance. The butterfly-shaped patella claw is fixed on the patella and will not break when subjected to a maximum force of 150 N on the encircling arm, and at the same time, there will be no pressure failure due to plastic deformation. A total of 27 cases were clinically used for the assessment of the clinical efficacy of the newly designed butterfly-shaped patella claws. The average follow-up time was 15.5 months, and the average fracture healing time was 8-12 weeks. All patients can get out of bed with crutches within 2 to 3 days after surgery. Among them, there were 15 cases with excellent functional ratings, 10 cases with good ratings, 2 cases with acceptable ratings, and no cases with poor ratings. The designed butterfly-shaped patella claws can provide an effective method for the treatment of patella fractures.
Topics: Adolescent; Adult; Biomechanical Phenomena; Computational Biology; Computer Simulation; Computer-Aided Design; Elastic Modulus; Female; Finite Element Analysis; Fracture Fixation, Internal; Humans; Internal Fixators; Intra-Articular Fractures; Male; Middle Aged; Nickel; Patella; Prosthesis Design; Shape Memory Alloys; Software; Stress, Mechanical; Tensile Strength; Titanium; Treatment Outcome; Young Adult
PubMed: 35154357
DOI: 10.1155/2022/2008668 -
Biomedical Journal Oct 2023Pain-associated knee joint disorders are common in daily life. Practically, knee pain should be divided into the origin from the isolated tibiofemoral (TF), isolated... (Review)
Review
Pain-associated knee joint disorders are common in daily life. Practically, knee pain should be divided into the origin from the isolated tibiofemoral (TF), isolated patellofemoral (PF) joint, or a combination thereof. The TF joint controls the actions of level walking, while the PF joint controls knee flexion-extension. Owing to its sufficient inherent stability, non-traumatic disorders of the isolated TF joint in young individuals are uncommon. In contrast, because of its insufficient inherent stability, non-traumatic disorders of the isolated PF joint are common in young individuals. Patellar malalignment (PM) associated with knee pain is common in all age groups, and the most common predisposing factor is imbalanced peripatellar soft-tissue tension. The outward forces acting on the patella are caused by pulling from the quadriceps femoris during knee flexion to extension (manifested by the quadriceps angle [Q-angle]), and sliding backward of the iliotibial band (ITB) during knee extension to flexion. Once the muscle power of the vastus medialis (especially the vastus medialis obliquus [VMO]) decreases, which lowers the counteracting effect against outward forces, the patella displaces or rotates laterally. The reduced contact surface between the patella and the femoral condyle significantly increases the compressive pressure and injures the articular cartilage. Subsequently, progressive PF degeneration occurs. Although other factors may also cause PM, they are relatively uncommon. In principle, nonsurgical treatment of PM should be considered first, while surgical treatment should follow established indications. Some nonsurgical techniques are currently widely used that feature high satisfaction rates. Surgical techniques are continuously being developed, and their success rates have gradually improved. This study aimed to review the current literature for relevant studies and report related publications of the author's institution to emphasize the universality and importance of PM management. Conceptually, simply focusing on problems of the TF joint cannot treat all knee disorders.
Topics: Humans; Patella; Knee Joint; Patellofemoral Joint; Quadriceps Muscle; Pain
PubMed: 37678711
DOI: 10.1016/j.bj.2023.100658 -
Aging Dec 2020In this study, we investigated whether the measurement of patellar tracking can be used as a diagnostic parameter of patellofemoral joint disease. Patellar tracking is... (Review)
Review
In this study, we investigated whether the measurement of patellar tracking can be used as a diagnostic parameter of patellofemoral joint disease. Patellar tracking is defined as the movement of the patella in relation to the femorotibial joint within the full range of flexion and extension of the knee joint. The PubMed, EMBASE, Medline, PsychINFO, and AMED databases were used to find relevant articles. Analyzed were the patellar tracking coordinate system and the measurement objects, precision, methods used in those studies, as well as the results obtained. Origin points for coordinate systems varied across the studies. The research object and methods of patellar tracking varied in the studies. Most studies focused on a static description of the internal and external displacement and the internal and external inclination. The , noninvasive, and six degrees of freedom evaluation of patellar tracking reflect patellar motion more comprehensively, though each of these methods does so in different ways. Dynamic and quantitative evaluation of patellar tracking is still lacking in clinical work. Accurate and quantitative patellar tracking measurement could provide clinicians with a comprehensive evaluation of the stability of the knee joint.
Topics: Biomechanical Phenomena; Humans; Knee Joint; Patella; Patellofemoral Joint; Range of Motion, Articular
PubMed: 33260153
DOI: 10.18632/aging.202161 -
Scientific Reports Dec 2022The positional relationship between patellar and femoral articular surfaces may vary according to the degree of posterior rotation of the tibial condyle, which may...
The positional relationship between patellar and femoral articular surfaces may vary according to the degree of posterior rotation of the tibial condyle, which may influence the patellar configuration. We hypothesized that the configuration of the patella has a rhomboid transformation similar to that of the tibial condyle. This cohort study included 313 patients with knee pain who underwent lateral-view knee digital radiography. The length of the long axis, short axis of the patella, and patellar tendon length of the patellofemoral joint were measured. The patella axis ratio (length of long/short axis) as patellar configuration and Insall-Salvati ratio were calculated. Correlations between the configuration of the tibial condyle and the three length parameters and the Insall-Salvati ratio were assessed. Posterior rotation and the rhomboid transformation of the tibial condyle were positively correlated with the length of the long axis of the patella and negatively correlated with the Insall-Salvati ratio. The more the tibial articular surface shifted posteriorly due to posterior rotation and rhomboid transformation of the tibial condyle, the longer the long axis of the patella was, and the smaller the Insall-Salvati ratio was. The long axis of the patella became longer due to rhomboid transformation, similar to the tibial condyle.
Topics: Humans; Cohort Studies; Patella; Tibia; Patellar Ligament; Knee Joint
PubMed: 36528672
DOI: 10.1038/s41598-022-26459-6 -
Veterinary Medicine and Science May 2023A 2-day-old Cleveland Bay colt was referred to the Equine Emergency Service of the Farm Animal and Equine Veterinary Medical Center at North Carolina State University's...
A 2-day-old Cleveland Bay colt was referred to the Equine Emergency Service of the Farm Animal and Equine Veterinary Medical Center at North Carolina State University's College of Veterinary Medicine for evaluation of decreased nursing behaviour and right hindlimb lameness of 2 days' duration. When assisted to stand, the foal was unable to extend either hindlimb or bear weight on the hindlimbs, the right patella was luxated laterally and unable to be reduced, and the foal assumed a crouched position. Stifle radiographs revealed minimal, heterogeneous, ill-defined ossification of both patellae. Due to the severity of the musculoskeletal defects, humane euthanasia was elected. Post-mortem examination identified a congenital malformation of both patella bones with failure of ossification and cardiac changes suggestive of right atrioventricular valve dysplasia. Histology of the patellae showed no evidence of osteoid deposition or ossification. To our knowledge, bilateral congenital patellar aplasia has not been previously described in foals.
Topics: Animals; Horses; Male; Patella; Hindlimb; Animals, Domestic; Horse Diseases
PubMed: 36734120
DOI: 10.1002/vms3.1083 -
Journal of Orthopaedic Research :... Apr 2023The role of patella height is discussed controversially in total knee arthroplasty (TKA). Therefore, this computational study aims to systematically analyze the...
The role of patella height is discussed controversially in total knee arthroplasty (TKA). Therefore, this computational study aims to systematically analyze the biomechanical effect of different patella heights on patellofemoral (PF) forces and kinematics after cruciate-retaining (CR) TKA. We implemented a CR bicondylar TKA with a dome patellar button in a validated dynamic musculoskeletal multibody model of a male human knee joint. Retropatellar dynamics (contact force [N], shear force [N], patellar shift [mm], tilt [°], and rotation [°]) were evaluated during dual-limb squat motion (flexion from 0° to 90°) with simulated active muscle forces and the effects of different patella heights (Blackburne-Peel [BP] ratio of 0.39, 0.49, 0.65, 0.85, 1.01, and 1.1 were systematically examined). As active knee flexion increased, PF contact force also increased. Patella alta (BP = 1.1) resulted in higher PF contact forces compared to normal patella height (BP = 0.65) by up to 16%. Contrarily, patella baja was associated with decreased PF forces by 7%. Compared to patella baja (BP = 0.39), patella alta (BP = 1.1) considerably increased the contact force by up to 25%. Different patellar heights mainly affected PF shear forces during early knee flexion. Concerning PF kinematics, patella alta (BP = 1.1) yielded a greater lateral tilt of more than 4° and higher patellar rotation by up to 3° during deep knee flexion, compared to normal patella height (BP = 0.65). Our computational study indicates that patella alta is associated with the highest PF contact and shear force after the implantation of a CR bicondylar TKA. This should be considered in PF disorders following TKA.
Topics: Male; Humans; Arthroplasty, Replacement, Knee; Patella; Biomechanical Phenomena; Patellofemoral Joint; Knee Joint; Bone Diseases; Range of Motion, Articular; Knee Prosthesis
PubMed: 35949157
DOI: 10.1002/jor.25425 -
The Journal of International Medical... Apr 2020To compare a modified two-tension-band (MTTB) technique with the AO tension band in treating patellar fractures.
OBJECTIVE
To compare a modified two-tension-band (MTTB) technique with the AO tension band in treating patellar fractures.
METHODS
This retrospective study included patients treated with AO tension band (group 1) or MTTB (group 2). Data obtained during serial follow-up evaluations of time to bony union, range of motion (ROM), Hospital for Special Surgery (HSS) score and complication rates, were analysed.
RESULTS
Fractures healed in all 51 patients included in the study (group 1, = 28; group 2, = 23), with no statistically significant between-group difference in time to bony union. Regarding function results, group 2 had better HSS scores at 3 and 6 months postoperatively; however, at 1 year postoperatively, both groups had similar HSS scores and achieved acceptable flexion and ROM. The overall complication rate was significantly lower in group 2, but average costs were higher in group 2 versus group 1.
CONCLUSION
MTTB provides secure fixation and improved knee function at 3 and 6 months postoperatively, and has a lower complication rate with early mobilization, compared with the AO tension-band technique.
Topics: Bone Screws; Bone Wires; Fracture Fixation, Internal; Fractures, Bone; Humans; Patella; Retrospective Studies; Treatment Outcome
PubMed: 31878827
DOI: 10.1177/0300060519893495