J Knee Surg
DOI: 10.1055/s-0038-1635112
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Patellofemoral Imbalance in a Balanced Total Knee Arthroplasty: How Does it Occur?

Perry Jaymes Evangelista
1  Department of Orthopaedic Surgery, New York University Langone Medical Center, New York, New York
,
Nathan Lenz
2  Knee Product Development, Smith and Nephew Inc., Advanced Surgical Devices, Memphis, Tennessee
,
Scott Laster
2  Knee Product Development, Smith and Nephew Inc., Advanced Surgical Devices, Memphis, Tennessee
,
Neil P. Sheth
3  Department of Orthopaedic Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
,
Ran Schwarzkopf
1  Department of Orthopaedic Surgery, New York University Langone Medical Center, New York, New York
› Author Affiliations
Further Information

Publication History

10 August 2017

28 January 2018

Publication Date:
07 March 2018 (eFirst)

Abstract

Despite the overall successful outcomes following primary total knee arthroplasty (TKA) and the concept that a well-balanced TKA yields a more successful result, concerns still remain in the reported literature regarding the patellofemoral joint. Diminished outcomes have been associated with poorly balanced or placed patella implants. The effect of different techniques to achieve flexion–extension balance and the use of posterior stabilized (PS) versus cruciate retaining (CR) implant designs on patellofemoral balancing has not been previously studied. The purpose of this study is to utilize a validated computational analysis software to simulate the effects of varying implant positions and sizes of femoral components. The patellofemoral retinaculum (PFR) load was significantly affected by some conditions, while others did not reach significance. The proximal-distal implant position with knee flexion angle (p < 0.001), the implant size (p < 0.001), and the implant bearing type (CR/PS) (p < 0.05) were significant. For the proximal-distal implant position and knee flexion angle, a more proximal implant position (elevating the joint line) increased the PFR load from 15 to 30°, and a more proximal implant position reduced retinaculum load from 60 to 135°. However, at 45°, implant position does not affect retinaculum load. Achieving the appropriate balance between the dynamic nature of both the tibiofemoral and the patellofemoral interaction in TKA has proven to be complex and challenging to manage. Balancing of a TKA is essential to the proper functioning and overall longevity of the implant. These results demonstrate that patellofemoral balance is affected by implant size and position during flexion–extension gap balancing.