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. 2015;86(4):444-50.
doi: 10.3109/17453674.2015.1005907. Epub 2015 Jan 13.

The influence of component alignment on patellar kinematics in total knee arthroplasty

Armin Keshmiri  1 , Günther Maderbacher, Clemens Baier, Ernst Sendtner, Jens Schaumburger, Florian Zeman, Joachim Grifka, Hans R Springorum
Affiliations

The influence of component alignment on patellar kinematics in total knee arthroplasty

Armin Keshmiri et al. Acta Orthop. 2015.

Abstract

Background and purpose: Postoperative anterior knee pain is one of the most frequent complications after total knee arthroplasty (TKA). Changes in patellar kinematics after TKA relative to the preoperative arthritic knee are not well understood. We compared the patellar kinematics preoperatively with the kinematics after ligament-balanced navigated TKA.

Patients and methods: We measured patellar tracking before and after ligament-balanced TKA in 40 consecutive patients using computer navigation. Furthermore, the influences of different femoral and tibial component alignment on patellar kinematics were analyzed using generalized linear models.

Results: After TKA, the patellae shifted statistically significantly more laterally between 30° and 60°. The lateral tilt increased at 90° of flexion whereas the epicondylar distance decreased between 45° and 75° of flexion. Sagittal component alignment, but not rotational component alignment, had a significant influence on patellar kinematics.

Interpretation: There are major differences in patellar kinematics between the preoperative arthritic knee and the knee after TKA. Combined sagittal component alignment in particular appears to have a major effect on patellar kinematics. Surgeons should be especially aware of altering preoperative sagittal alignment until the possible clinical relevance has been investigated.

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Figures

Figure 1.
Figure 1.
Intraoperative setup.
Figure 2.
Figure 2.
Screenshot of patellar tracking in the arthritic knee (left panel) and after TKA (right panel).
Figure 3.
Figure 3.
Pre- and postoperative patellar kinematics (mediolateral shift: medial, +; lateral, −; axial tilt: medial, −; lateral, +; coronal rotation: external, −; internal, +; epicondylar distance (mm) during range of motion: open triangle (preoperatively) and closed circle (postoperatively)). Mean values with standard errors. Asterisks above the x-axis indicate significant differences during range of motion.
See this image and copyright information in PMC

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