AI Article Synopsis
- Biomechanical studies indicate that total knee arthroplasty (TKA) does not consistently restore patellofemoral (PF) tracking to normal levels, partly due to limitations in current implant designs.
- The research involved a retrospective analysis of 233 TKAs in 199 patients, focusing on the removal thickness of the anterior femoral condyles to better align with prosthesis design, specifically targeting optimal anterior resection without causing notching.
- Results showed an average of 7.9 mm and 11.5 mm resection from the medial and lateral femur, respectively, and highlighted that traditional techniques often do not adequately restore the anterior femoral offset, suggesting that future implants should address this to improve outcomes.
Article Abstract
Purpose: Biomechanical studies suggest that PF tracking is not reliably restored to physiological values in TKA despite surgical technique optimization. A clinical observation is that current TKA designs may not replicate anterior femoral offset. The aim was to examine the intraoperative resection thicknesses of the anterior femoral condyles during TKA and correlate these findings relative to modern prostheses.
Methods: This was a retrospective analysis of 199 patients who underwent 233 TKAs using a single implant design with measured anterior femoral condylar resection thicknesses. The aim was to restore posterior condylar offset whilst minimizing overstuffing of the anterior compartment of the knee by choosing the smallest prosthesis to allow for the maximal anterior resection as close to the cortex without inducing notching. Prosthetic measurements from 7 commonly used TKAs were collected by analysis of 3D models of median sized explants.
Results: An average of 7.9 mm (SD 2.5 mm, range 2-16.5 mm) and 11.5 mm (SD 2.5 mm, range 2-21 mm) was resected from the medial and lateral aspects of the anterior femur, respectively. The average anterior flange thickness for the prosthesis data set was 6.6 mm (SD 0.6 mm, range 6.1-7.9 mm) medially and 7.6 mm (SD 0.7 mm, range 6.8-9.0 mm) laterally. Comparison across patients who received the median prosthesis size of 5 (SD 1.3, range 2-8) was inadequately restored by 1.4 mm (p < 0.00001) medially and 3.4 mm (p < 0.00001) laterally.
Conclusion: Host anatomy is not routinely restored during TKA. The surgical teaching to aim for an anterior femoral osteotomy close to the anterior cortex will result in understuffing of the PFJ and based on current prosthesis designs, the risk of overstuffing is not as significant as once believed. Future prostheses and surgical techniques should aim to restore not only posterior femoral but also anterior femoral offset.
Level Of Evidence: IV, Case series.
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Source |
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| http://dx.doi.org/10.1007/s00167-019-05610-3 | DOI Listing |
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