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Role of positioning of femoral component in the anterior–posterior direction on postoperative anterior pain in TKA

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Abstract

Introduction and purpose

The patellofemoral joint has proved to be the most problematic element of modern TKA for postoperative anterior knee pain; the positioning of the femoral component constitutes a critical phase in this issue. The objective of our study was to evaluate the possible role of either anterior positioning or posterior positioning of the femoral shield compared to the reference plane represented by the anterior cortex, on the anterior knee pain after knee arthroplasty.

Methods

Forty-eight patients treated with TKA were followed up approximately 12 months. None of them have been submitted to any patellar treatment. We observed the position of femoral shield with respect to the anterior cortical line of femur dividing patients into three groups: patients with significant notching, patients with no notching (shield corresponding to anterior cortical line) and patients with anterior positioning of shield. We evaluated clinical and functional outcomes with KSS, anterior knee pain with Kujala’s score and adverse events such as periprosthetic fractures.

Results

We found a better clinical and functional result for patients with femoral shield positioned in line with anterior cortical cortex with respect to both TKAs with femoral notching and to protruding anterior femoral components; there were no main differences in anterior postoperative score by Kujala’s system. We observed a periprosthetic fracture in a patient with an important femoral notching.

Conclusions

We cannot consider our study as an objective conclusion to the argument. We need more RCTs in order to study the proper influence of either notching or protrusion of femoral shield component onto anterior postoperative pain. Anyway positioning of femoral shield in anterior–posterior direction could be an interesting new critical object of study about anterior knee pain after TKA.

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Funding

No funding has been provided for this study.

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Authors and Affiliations

  1. Service of Orthopedics and Trauma Surgery, S. Maria della Misericordia Hospital, Piazza Menghini, 1, 06129, Perugia, Italy

    Pierluigi Antinolfi & Francesco Manfreda

  2. Department of Orthopedics and Traumatology, University of Perugia, Perugia, Italy

    Ippazio Ricchiuto, Rosario Petruccelli & Auro Caraffa

Authors
  1. Pierluigi Antinolfi
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  2. Francesco Manfreda
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  3. Ippazio Ricchiuto
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  4. Rosario Petruccelli
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  5. Auro Caraffa
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Correspondence to Francesco Manfreda.

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The authors declare that they have no conflicts of interest.

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No experimental procedures have been conducted. All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Antinolfi, P., Manfreda, F., Ricchiuto, I. et al. Role of positioning of femoral component in the anterior–posterior direction on postoperative anterior pain in TKA. Eur J Orthop Surg Traumatol 30, 1049–1056 (2020). https://doi.org/10.1007/s00590-020-02666-7

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  • DOI: https://doi.org/10.1007/s00590-020-02666-7

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