Determinants of patellar tracking in total knee arthroplasty

被引：44

作者：

Anglin, C. ^{[1
,2
,3
]}

Brimacombe, J. M. ^{[2
]}

Hodgson, A. J. ^{[2
]}

Masri, B. A. ^{[4
]}

Greidanus, N. V. ^{[4
]}

Tonetti, J. ^{[5
]}

Wilson, D. R. ^{[4
,6
,7
]}

机构：

[1] Univ Calgary, Dept Civil Engn, Calgary, AB T2N 1N4, Canada

[2] Univ British Columbia, Dept Mech Engn, Vancouver, BC V6T 1W5, Canada

[3] Univ Calgary, Ctr Bioengn Res & Educ, Calgary, AB T2N 1N4, Canada

[4] Univ British Columbia, Dept Orthopaed, Vancouver, BC V5Z 1M9, Canada

[5] Hop Michallon, Orthopaed & Trauma Dept, Grenoble, France

[6] Univ British Columbia, Div Orthopaed Engn Res, Vancouver, BC V5Z 1M9, Canada

[7] Vancouver Coastal Hlth Res Inst, Vancouver, BC, Canada

来源：

CLINICAL BIOMECHANICS | 2008年 / 23卷 / 07期

基金：

加拿大自然科学与工程研究理事会;

关键词：

total knee replacement; total knee arthroplasty patellar tracking; patella; femur; tibia kinematics; surgical technique; component rotation; patellar component medialization; patellar resection; patellar thickness; computer-assisted surgery;

D O I：

10.1016/j.clinbiomech.2008.04.001

中图分类号：

R318 [生物医学工程];

学科分类号：

0831 ;

摘要：

Background Optimizing patellar tracking in total knee arthroplasty is a surgical priority. Despite this, a comparison of the effects of different component placements on patellar tracking is not available; the biomechanical impact of the patellar resection angle has not been studied; and the similarity between intraoperative and postoperative effects, fundamental to improving patellar tracking, is unknown. Our objective was to compare the impact of the major controllable femoral, tibial and patellar component positions on patellar kinematics during both passive and loaded flexion. Methods. We tested eight cadaveric knee specimens in two rigs, simulating intraoperative and weightbearing flexion. Optoelectronic marker arrays were attached to the femur, tibia and patella to record kinematics throughout the range of motion. We modified posteriorstabilized fixed-bearing knee components to allow for five types of variations in component placement in addition to the neutral position: femoral component rotation, tibial component rotation, patellar resection angle, patellar component medialization and additional patellar thickness, for a total of I I individual variations. Findings. The major determinants of patellar tilt and shift were patellar component medialization, patellar resection angle and femoral component rotation. The relative order of these variables depended on the structure (bone or component), kinematic parameter (tilt or shift) and flexion angle (early or late flexion). Effects of component changes were consistent between the intraoperative and weightbearing rigs. Interpretation. To improve patellar tracking, and thereby the clinical outcome, surgeons should focus on patellar component medialization, patellar resection angle and femoral component rotation. These have been linked with anterior knee pain as well. Neither tibial component rotation nor patellar thickness should be adjusted to improve patellar tracking. (c) 2008 Elsevier Ltd. All rights reserved.

引用

页码：900 / 910

页数：11

共 39 条

[1]

Akagi M, 1999, CLIN ORTHOP RELAT R, P155

[2] Intraoperative vs. weightbearing patellar kinematics in total knee arthroplasty: A cadaveric study [J].