Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 8/2016

01-08-2016 | Knee

Patella position is not a determinant for anterior knee pain 10 years after balanced gap total knee arthroplasty

Authors: Albert H. van Houten, Petra J. C. Heesterbeek, Ate B. Wymenga

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 8/2016

Login to get access

Abstract

Purpose

Incidence of anterior knee pain after total knee arthroplasty (TKA) is reported to be between 4 and 49 %. The incidence of AKP at long-term follow-up and possible determinants after cruciate cruciate-retaining TKA were investigated.

Methods

A 10-year follow-up of a cohort of 55 patients (63 TKAs), who received the balanSys™ cruciate-retaining total knee system (Mathys Ltd, Bettlach, Switzerland) between 1999 and 2002, was performed. Patients had undergone the balanced gap technique, with either a fixed bearing or an AP-glide bearing. Standardised diagnostic questions regarding AKP were collected and categorised into two groups: those with and without AKP. The lateral patellar tilt, patellar displacement measurement and modified Insall-Salvati ratio were used for patella position evaluation on skyline radiographs. The Knee Society Score (KSS), the Knee Osteoarthritis Outcome Score (KOOS) and Numerical Rating Scales (NRS) for pain and satisfaction were obtained at follow-up.

Results

Sixteen patients in the study population experienced AKP. Incidence of AKP (fixed bearing 13/44; AP-glide bearing baring 3/17) was not dependent on type of insert (n.s.). There were no statistical differences in patella position and tibiofemoral contact point between the AKP group and the no AKP group (n.s.). KSS, KOOS, NRS-pain and NRS-satisfaction were significantly lower for the patients with AKP (all p < 0.05).

Conclusion

Twenty-six percentage of the patients experienced AKP 10 years after balanced gap TKA. Postoperative patella positioning was not found to be a determinant for anterior knee pain after TKA. However, patellar displacement does not seem completely favourable. Moreover, type of bearing was not found a determinant for AKP at long-term follow-up.

Level of evidence

Lower quality prospective cohort study (<80 % follow-up, patients enrolled at different time points in disease), Level II.
Literature
1.
Aglietti P, Baldini A, Buzzi R, Lup D, De Luca L (2005) Comparison of mobile-bearing and fixed-bearing total knee arthroplasty: a prospective randomized study. J Arthroplasty 20(2):145–153CrossRefPubMed
2.
Baldini A, Anderson JA, Zampetti P, Pavlov H, Sculco TP (2006) A new patellofemoral scoring system for total knee arthroplasty. Clin Orthop Relat Res 452:150–154CrossRefPubMed
3.
Barrack RL, Schrader T, Bertot AJ, Wolfe MW, Myers L (2001) Component rotation and anterior knee pain after total knee arthroplasty. Clin Orthop Relat Res 392:46–55CrossRefPubMed
4.
Becher C, Heyse TJ, Kron N, Ostermeier S, Hurschler C, Schofer MD, Fuchs-Winkelmann S, Tibesku CO (2009) Posterior stabilized TKA reduce patellofemoral contact pressure compared with cruciate retaining TKA in vitro. Knee Surg Sports Traumatol Arthrosc 17(10):1159–1165CrossRefPubMed
5.
Berger RA, Crossett LS, Jacobs JJ, Rubash HE (1998) Malrotation causing patellofemoral complications after total knee arthroplasty. Clin Orthop Relat Res 356:144–153CrossRefPubMed
6.
Biau D, Mullins MM, Judet T, Piriou P (2006) Mobile versus fixed-bearing total knee arthroplasty: mid-term comparative clinical results of 216 prostheses. Knee Surg Sports Traumatol Arthrosc 14(10):927–933CrossRefPubMed
7.
Blackburne JS, Peel TE (1977) A new method of measuring patellar height. J Bone Jt Surg Br 59(2):241–242
8.
Breugem SJ, Sierevelt IN, Schafroth MU, Blankevoort L, Schaap GR, van Dijk CN (2008) Less anterior knee pain with a mobile-bearing prosthesis compared with a fixed-bearing prosthesis. Clin Orthop Relat Res 466(8):1959–1965CrossRefPubMedPubMedCentral
9.
Breugem SJ, van Ooij B, Haverkamp D, Sierevelt IN, van Dijk CN (2014) No difference in anterior knee pain between a fixed and a mobile posterior stabilized total knee arthroplasty after 7.9 years. Knee Surg Sports Traumatol Arthrosc 22(3):509–516CrossRefPubMed
10.
Burnett RS, Boone JL, McCarthy KP, Rosenzweig S, Barrack RL (2007) A prospective randomized clinical trial of patellar resurfacing and nonresurfacing in bilateral TKA. Clin Orthop Relat Res 464:65–72PubMed
11.
Campbell DG, Duncan WW, Ashworth M, Mintz A, Stirling J, Wakefield L, Stevenson TM (2006) Patellar resurfacing in total knee replacement: a ten-year randomised prospective trial. J Bone Jt Surg Br 88(6):734–739CrossRef
12.
Chonko DJ, Lombardi AV Jr, Berend KR (2004) Patella baja and total knee arthroplasty (TKA): etiology, diagnosis, and management. Surg Technol Int 12:231–238PubMed
13.
Classen T, Wegner A, von Knoch M (2009) Modification of the Blackburne-Peel ratio for improved application in total knee arthroplasty. Orthopade 38(12):1229–1234CrossRefPubMed
14.
de Groot IB, Favejee MM, Reijman M, Verhaar JA, Terwee CB (2008) The Dutch version of the knee injury and osteoarthritis outcome score: a validation study. Health Qual Life Outcomes 6:16CrossRefPubMedPubMedCentral
15.
de Jong RJ, Heesterbeek PJ, Wymenga AB (2010) A new measurement technique for the tibiofemoral contact point in normal knees and knees with TKR. Knee Surg Sports Traumatol Arthrosc 18(3):388–393CrossRefPubMed
16.
Dejour D, Ntagiopoulos PG, Saffarini M (2014) Evidence of trochlear dysplasia in femoral component designs. Knee Surg Sports Traumatol Arthrosc 22(11):2599–2607CrossRefPubMed
17.
Erak S, Rajgopal V, Macdonald SJ, McCalden RW, Bourne RB (2009) Ten-year results of an inset biconvex patella prosthesis in primary knee arthroplasty. Clin Orthop Relat Res 467(7):1781–1792CrossRefPubMedPubMedCentral
18.
Grelsamer RP, Meadows S (1992) The modified Insall-Salvati ratio for assessment of patellar height. Clin Orthop Relat Res 282:170–176PubMed
19.
Heesterbeek PJ, Beumers MP, Jacobs WC, Havinga ME, Wymenga AB (2007) A comparison of reproducibility of measurement techniques for patella position on axial radiographs after total knee arthroplasty. Knee 14(5):411–416CrossRefPubMed
20.
Heesterbeek PJ, Keijsers NL, Wymenga AB (2011) Femoral component rotation after balanced gap total knee replacement is not a predictor for postoperative patella position. Knee Surg Sports Traumatol Arthrosc 19(7):1131–1136CrossRefPubMed
21.
Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 248:13–14PubMed
22.
Ji HM, Ha YC, Baek JH, Ko YB (2015) Advantage of minimal anterior knee pain and long-term survivorship of cemented single radius posterior-stabilized total knee arthroplasty without patella resurfacing. Clin Orthop Surg 7(1):54–61CrossRefPubMedPubMedCentral
23.
Kievit AJ, Breugem SJ, Sierevelt IN, Heesterbeek PJ, van de Groes SA, Kremers KC, Koeter S, Haverkamp D (2013) Dutch translation of the Kujala Anterior Knee Pain Scale and validation in patients after knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 21(11):2647–2653CrossRefPubMed
24.
Kim YH, Yoon SH, Kim JS (2009) Early outcome of TKA with a medial pivot fixed-bearing prosthesis is worse than with a PFC mobile-bearing prosthesis. Clin Orthop Relat Res 467(2):493–503CrossRefPubMed
25.
Li N, Tan Y, Deng Y, Chen L (2014) Posterior cruciate-retaining versus posterior stabilized total knee arthroplasty: a meta-analysis of randomized controlled trials. Knee Surg Sports Traumatol Arthrosc 22(3):556–564CrossRefPubMed
26.
Liabaud B, Patrick DA Jr, Geller JA (2013) Is the posterior cruciate ligament destabilized after the tibial cut in a cruciate retaining total knee replacement? An anatomical study. Knee 20(6):412–415CrossRefPubMed
27.
Ostermeier S, Hurschler C, Windhagen H, Stukenborg-Colsman C (2006) In vitro investigation of the influence of tibial slope on quadriceps extension force after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 14(10):934–939CrossRefPubMed
28.
Petersen W, Rembitzki IV, Bruggemann GP, Ellermann A, Best R, Koppenburg AG, Liebau C (2014) Anterior knee pain after total knee arthroplasty: a narrative review. Int Orthop 38(2):319–328CrossRefPubMed
29.
Sensi L, Buzzi R, Giron F, De Luca L, Aglietti P (2011) Patellofemoral function after total knee arthroplasty: gender-related differences. J Arthroplasty 26(8):1475–1480CrossRefPubMed
30.
Shemshaki H, Dehghani M, Eshaghi MA, Esfahani MF (2012) Fixed versus mobile weight-bearing prosthesis in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 20(12):2519–2527CrossRefPubMed
31.
Skwara A, Tibesku CO, Ostermeier S, Stukenborg-Colsman C, Fuchs-Winkelmann S (2009) Differences in patellofemoral contact stresses between mobile-bearing and fixed-bearing total knee arthroplasties: a dynamic in vitro measurement. Arch Orthop Trauma Surg 129(7):901–907CrossRefPubMed
32.
Smith H, Jan M, Mahomed NN, Davey JR, Gandhi R (2011) Meta-analysis and systematic review of clinical outcomes comparing mobile bearing and fixed bearing total knee arthroplasty. J Arthroplasty 26(8):1205–1213CrossRefPubMed
33.
van de Groes SA, Koeter S, de Waal Malefijt M, Verdonschot N (2014) Effect of medial-lateral malpositioning of the femoral component in total knee arthroplasty on anterior knee pain at greater than 8 years of follow-up. Knee 21(6):1258–1262CrossRefPubMed
34.
van Hal CT, van Hellemondt GG, Wymenga AB, Jacobs WC (2007) The anterior-posterior laxity after total knee arthroplasty inserted with a ligament tensor. Knee Surg Sports Traumatol Arthrosc 15(8):1019–1022CrossRefPubMed
35.
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):478–499CrossRefPubMed
36.
van Stralen RA, Heesterbeek PJ, Wymenga AB (2015) Different femorotibial contact points between fixed- and mobile-bearing TKAs do not show clinical impact. Knee Surg Sports Traumatol Arthrosc 23(11):3368–3374CrossRefPubMed
37.
Woolson ST, Northrop GD (2004) Mobile- versus fixed-bearing total knee arthroplasty: a clinical and radiologic study. J Arthroplasty 19(2):135–140CrossRefPubMed
Metadata
Title
Patella position is not a determinant for anterior knee pain 10 years after balanced gap total knee arthroplasty
Authors
Albert H. van Houten
Petra J. C. Heesterbeek
Ate B. Wymenga
Publication date
01-08-2016
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 8/2016
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-015-3930-z

Other articles of this Issue 8/2016

Knee Surgery, Sports Traumatology, Arthroscopy 8/2016 Go to the issue

Knee

Comparison of alternate references for femoral rotation in female patients undergoing total knee arthroplasty

Knee

Total knee arthroplasty after failed high tibial osteotomy: a systematic review of open versus closed wedge osteotomy

Knee

Total knee arthroplasty in patients with Charcot joints

Knee

Posterior reference guides do not always maintain the size of posterior femoral condyles in TKA

Knee

Extent of vertical cementing as a predictive factor for radiolucency in revision total knee arthroplasty

Knee

Comparison of the short form-12 (SF-12) health status questionnaire with the SF-36 in patients with knee osteoarthritis who have replacement surgery