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Journal of Orthopaedic Surgery and Research
Published in: Journal of Orthopaedic Surgery and Research 1/2012

Open Access 01-12-2012 | Research article

Differences in the stress distribution in the distal femur between patellofemoral joint replacement and total knee replacement: a finite element study

Authors: Hans-Peter W van Jonbergen, Bernardo Innocenti, Gian Luca Gervasi, Luc Labey, Nico Verdonschot

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2012

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Abstract

Background

Patellofemoral joint replacement is a successful treatment option for isolated patellofemoral osteoarthritis. However, results of later conversion to total knee replacement may be compromised by periprosthetic bone loss. Previous clinical studies have demonstrated a decrease in distal femoral bone mineral density after patellofemoral joint replacement. It is unclear whether this is due to periprosthetic stress shielding. The main objective of the current study was to evaluate the stress shielding effect of prosthetic replacement with 2 different patellofemoral prosthetic designs and with a total knee prosthesis.

Methods

We developed a finite element model of an intact patellofemoral joint, and finite element models of patellofemoral joint replacement with a Journey PFJ prosthesis, a Richards II prosthesis, and a Genesis II total knee prosthesis. For each of these 4 finite element models, the average Von Mises stress in 2 clinically relevant regions of interest were evaluated during a simulated squatting movement until 120 degrees of flexion.

Results

During deep knee flexion, in the anterior region of interest, the average Von Mises stress with the Journey PFJ design was comparable to the physiological knee, while reduced by almost 25% for both the Richards II design and the Genesis II total knee joint replacement design. The average Von Mises stress in the supracondylar region of interest was similar for both patellofemoral prosthetic designs and the physiological model, with slightly lower stress for the Genesis II design.

Conclusions

Patellofemoral joint replacement results in periprosthetic stress-shielding, although to a smaller degree than in total knee replacement. Specific patellofemoral prosthetic design properties may result in differences in femoral stress shielding.
Appendix
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Metadata
Title
Differences in the stress distribution in the distal femur between patellofemoral joint replacement and total knee replacement: a finite element study
Authors
Hans-Peter W van Jonbergen
Bernardo Innocenti
Gian Luca Gervasi
Luc Labey
Nico Verdonschot
Publication date
01-12-2012
Publisher
BioMed Central
Published in
Journal of Orthopaedic Surgery and Research / Issue 1/2012
Electronic ISSN: 1749-799X
DOI
https://doi.org/10.1186/1749-799X-7-28

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