Does patellofemoral congruence following total knee arthroplasty correlate with pain or function? Intraoperative arthroscopic assessment of 30 cases
Identifieur interne : 000068 ( France/Analysis ); précédent : 000067; suivant : 000069Does patellofemoral congruence following total knee arthroplasty correlate with pain or function? Intraoperative arthroscopic assessment of 30 cases
Auteurs : Antoine Senioris [France] ; Mo Saffarini [France, Suisse] ; Said Rahali [France] ; Louis Malekpour [France] ; Franck Dujardin [France] ; Olivier Courage [France]Source :
- Annals of Translational Medicine [ 2305-5839 ] ; 2016.
Abstract
Anterior knee pain (AKP) is observed in total knee arthroplasty (TKA) both with and without patellar resurfacing, and neither patellar denervation nor secondary resurfacing are effective for treating the symptoms. The exact causes for pain remain unclear, though abnormal patellofemoral forces due to patellar malalignment or inadequate implant design can play an important role. The purpose of this study was to arthroscopically evaluate patellofemoral congruence after wound closure following TKA without patellar resurfacing and correlate it to patellar morphology and postoperative pain and function.
The authors prospectively studied 30 patients that received uncemented mobile-bearing TKA. Patellofemoral congruence was assessed arthroscopically after wound closure by estimating the contact area between the native patella and the prosthetic trochlea (> two-thirds, > one-third, < one-third). The findings were correlated to preoperative assessments of patellar geometry (Wiberg classification using X-rays) and clinical outcomes [Knee Society Score (KSS), AKP on Visual Analogic Scale (VAS), and patient satisfaction].
Knees of 22 women and 8 men aged 69.8 years (range, 61–84 years) were analyzed at 16 months (range, 12–23 months). Preoperative patellar geometry was Wiberg type A in 11, type B in 12 and type C in 7 knees. Postoperative KSS was 79.1 (range, 50.0–94) and the VAS for AKP was 1.6±1.3 (median, 1; range, 0–5). Patellar congruence was correlated with patellar morphology (P<0.001) but not correlated with any clinical outcomes (KSS, VAS or satisfaction). There were also no statistical correlations between patellar morphology or patellofemoral congruence and patient characteristics.
While patellar morphology and patellofemoral congruence are strongly related, they are not associated with clinical outcomes or patient demographics. Considering that numerous incongruent patellofemoral joints were pain-free, and conversely, many perfectly congruent patellofemoral joints had anterior pain, the authors suppose that pain is probably caused by mechanisms other than patellofemoral pressures.
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DOI: 10.21037/atm.2016.07.21
PubMed: 27570773
PubMed Central: 4980378
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Intraoperative arthroscopic assessment of 30 cases</title><author><name sortKey="Senioris, Antoine" sort="Senioris, Antoine" uniqKey="Senioris A" first="Antoine" last="Senioris">Antoine Senioris</name><affiliation wicri:level="1"><nlm:aff id="aff1">Department of Orthopaedic Surgery, Ramsay Générale de Santé, Hôpital Privé de l’Estuaire, Le Havre,<country>France</country>;</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff2">Department of Orthopaedic Surgery, Rouen University Hospital, Rouen,<country>France</country>;</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Saffarini, Mo" sort="Saffarini, Mo" uniqKey="Saffarini M" first="Mo" last="Saffarini">Mo Saffarini</name><affiliation wicri:level="1"><nlm:aff id="aff3">Department of Medical Research, Alliance 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type="main">Does patellofemoral congruence following total knee arthroplasty correlate with pain or function? Intraoperative arthroscopic assessment of 30 cases</title><author><name sortKey="Senioris, Antoine" sort="Senioris, Antoine" uniqKey="Senioris A" first="Antoine" last="Senioris">Antoine Senioris</name><affiliation wicri:level="1"><nlm:aff id="aff1">Department of Orthopaedic Surgery, Ramsay Générale de Santé, Hôpital Privé de l’Estuaire, Le Havre,<country>France</country>;</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff2">Department of Orthopaedic Surgery, Rouen University Hospital, Rouen,<country>France</country>;</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Saffarini, Mo" sort="Saffarini, Mo" uniqKey="Saffarini M" first="Mo" last="Saffarini">Mo Saffarini</name><affiliation wicri:level="1"><nlm:aff id="aff3">Department of Medical Research, Alliance Scientifique SAS, Lyon,<country>France</country>;</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff4">Department of Medical Technology, Accelerate Innovation Management SA, Geneva,<country>Switzerland</country></nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Rahali, Said" sort="Rahali, Said" uniqKey="Rahali S" first="Said" last="Rahali">Said Rahali</name><affiliation wicri:level="1"><nlm:aff id="aff1">Department of Orthopaedic Surgery, Ramsay Générale de Santé, Hôpital Privé de l’Estuaire, Le Havre,<country>France</country>;</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff2">Department of Orthopaedic Surgery, Rouen University Hospital, Rouen,<country>France</country>;</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Malekpour, Louis" sort="Malekpour, Louis" uniqKey="Malekpour L" first="Louis" last="Malekpour">Louis Malekpour</name><affiliation wicri:level="1"><nlm:aff id="aff1">Department of Orthopaedic Surgery, Ramsay Générale de Santé, Hôpital Privé de l’Estuaire, Le Havre,<country>France</country>;</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff2">Department of Orthopaedic Surgery, Rouen University Hospital, Rouen,<country>France</country>;</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Dujardin, Franck" sort="Dujardin, Franck" uniqKey="Dujardin F" first="Franck" last="Dujardin">Franck Dujardin</name><affiliation wicri:level="1"><nlm:aff id="aff2">Department of Orthopaedic Surgery, Rouen University Hospital, Rouen,<country>France</country>;</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Courage, Olivier" sort="Courage, Olivier" uniqKey="Courage O" first="Olivier" last="Courage">Olivier Courage</name><affiliation wicri:level="1"><nlm:aff id="aff1">Department of Orthopaedic Surgery, Ramsay Générale de Santé, Hôpital Privé de l’Estuaire, Le Havre,<country>France</country>;</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author></analytic><series><title level="j">Annals of Translational Medicine</title><idno type="ISSN">2305-5839</idno><idno type="eISSN">2305-5847</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Anterior knee pain (AKP) is observed in total knee arthroplasty (TKA) both with and without patellar resurfacing, and neither patellar denervation nor secondary resurfacing are effective for treating the symptoms. The exact causes for pain remain unclear, though abnormal patellofemoral forces due to patellar malalignment or inadequate implant design can play an important role. The purpose of this study was to arthroscopically evaluate patellofemoral congruence after wound closure following TKA without patellar resurfacing and correlate it to patellar morphology and postoperative pain and function.</p></sec><sec><title>Methods</title><p>The authors prospectively studied 30 patients that received uncemented mobile-bearing TKA. Patellofemoral congruence was assessed arthroscopically after wound closure by estimating the contact area between the native patella and the prosthetic trochlea (> two-thirds, > one-third, < one-third). The findings were correlated to preoperative assessments of patellar geometry (Wiberg classification using X-rays) and clinical outcomes [Knee Society Score (KSS), AKP on Visual Analogic Scale (VAS), and patient satisfaction].</p></sec><sec><title>Results</title><p>Knees of 22 women and 8 men aged 69.8 years (range, 61–84 years) were analyzed at 16 months (range, 12–23 months). Preoperative patellar geometry was Wiberg type A in 11, type B in 12 and type C in 7 knees. Postoperative KSS was 79.1 (range, 50.0–94) and the VAS for AKP was 1.6±1.3 (median, 1; range, 0–5). Patellar congruence was correlated with patellar morphology (P<0.001) but not correlated with any clinical outcomes (KSS, VAS or satisfaction). There were also no statistical correlations between patellar morphology or patellofemoral congruence and patient characteristics.</p></sec><sec><title>Conclusions</title><p>While patellar morphology and patellofemoral congruence are strongly related, they are not associated with clinical outcomes or patient demographics. Considering that numerous incongruent patellofemoral joints were pain-free, and conversely, many perfectly congruent patellofemoral joints had anterior pain, the authors suppose that pain is probably caused by mechanisms other than patellofemoral pressures.</p></sec></div></front></TEI><affiliations><list><country><li>France</li><li>Suisse</li></country></list><tree><country name="France"><noRegion><name sortKey="Senioris, Antoine" sort="Senioris, Antoine" uniqKey="Senioris A" first="Antoine" last="Senioris">Antoine Senioris</name></noRegion><name sortKey="Courage, Olivier" sort="Courage, Olivier" uniqKey="Courage O" first="Olivier" last="Courage">Olivier Courage</name><name sortKey="Dujardin, Franck" sort="Dujardin, Franck" uniqKey="Dujardin F" first="Franck" last="Dujardin">Franck Dujardin</name><name sortKey="Malekpour, Louis" sort="Malekpour, Louis" uniqKey="Malekpour L" first="Louis" last="Malekpour">Louis Malekpour</name><name sortKey="Malekpour, Louis" sort="Malekpour, Louis" uniqKey="Malekpour L" first="Louis" last="Malekpour">Louis Malekpour</name><name sortKey="Rahali, Said" sort="Rahali, Said" uniqKey="Rahali S" first="Said" last="Rahali">Said Rahali</name><name sortKey="Rahali, Said" sort="Rahali, Said" uniqKey="Rahali S" first="Said" last="Rahali">Said Rahali</name><name sortKey="Saffarini, Mo" sort="Saffarini, Mo" uniqKey="Saffarini M" first="Mo" last="Saffarini">Mo Saffarini</name><name sortKey="Senioris, Antoine" sort="Senioris, Antoine" uniqKey="Senioris A" first="Antoine" last="Senioris">Antoine Senioris</name></country><country name="Suisse"><noRegion><name sortKey="Saffarini, Mo" sort="Saffarini, Mo" uniqKey="Saffarini M" first="Mo" last="Saffarini">Mo Saffarini</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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