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The Effect of Stuffing the Patellofemoral Compartment on the Outcome of Total Knee Arthroplasty
Jeffery L. Pierson, MD1; Merrill A. Ritter, MD2; E. Michael Keating, MD2; Philip M. Faris, MD2; John B. Meding, MD2; Michael E. Berend, MD2; Kenneth E. Davis, MS2
1 Joint Replacement Surgeons of Indiana, St. Vincent Center for Joint Replacement, 8402 Harcourt Road, Indianapolis, IN 46260. E-mail address: jlpierso@stvincent.org
2 Joint Replacement Surgeons of Indiana Research Foundation, Center for Hip and Knee Surgery; St. Francis Hospital Mooresville, 1201 Hadley Road, Mooresville, IN 46158
View Disclosures and Other Information
Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from Biomet. In addition, one or more of the authors or a member of his or her immediate family received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from a commercial entity (Biomet and Zimmer: royalties, consulting). No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
Investigation performed at the Center for Hip and Knee Surgery, St. Francis Hospital, Mooresville, Indiana, and the Center for Joint Replacement, St. Vincent Hospital, Indianapolis, Indiana

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2007 Oct 01;89(10):2195-2203. doi: 10.2106/JBJS.E.01223
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Abstract

Background: The effect of so-called stuffing of the patellofemoral compartment at the time of total knee arthroplasty (that is, increasing the anterior patellar displacement, the anteroposterior femoral size, or the combined anteroposterior patellofemoral size) has not been well studied. The purpose of the present study was to evaluate the effect of stuffing the patellofemoral compartment on the outcome of primary total knee arthroplasty.

Methods: A retrospective review of 1100 primary total knee arthroplasties that had been performed in 1997 and 1998 was conducted. Eight hundred and thirty arthroplasties (75.5%) met the diagnostic and minimum two-year follow-up criteria for inclusion in this report. Radiographic measurements were made to determine preoperative and postoperative anterior patellar displacement, anteroposterior femoral size, combined anteroposterior patellofemoral size, anterior femoral offset, and posterior femoral offset. Regression analysis was performed to determine the effects of changes in these variables on the range of motion, the Knee Society Knee Score, the Knee Society Function Score, the Knee Society Pain Score, and the rate of lateral retinacular release.

Results: Preoperative to postoperative changes in anterior patellar displacement, anteroposterior femoral size, combined anteroposterior patellofemoral size, anterior femoral offset, and posterior femoral offset had no clinically meaningful effect on the range of motion of the knee or on any of the Knee Society scores. Increases in anterior patellar displacement were associated with a lower probability of the need for a lateral retinacular release. Increases in measured anteroposterior femoral size were associated with a higher probability of the need for lateral release. Even when combined, however, these relationships explained only 10.1% of the observed variance in the need for lateral retinacular release. Moreover, analyses indicated that patient gender, large as opposed to medium patellar size, and absolute femoral component size influenced the likelihood of lateral release more than did anterior patellar displacement and measured anteroposterior femoral size.

Conclusions: Our findings do not support the widely held belief that stuffing of the patellofemoral joint results in adverse outcomes after total knee arthroplasty. Furthermore, the need for lateral release appears to be multifactorial and likely involves a more complex set of factors. Thus, without evidence of other identifiable causes of failure, we do not recommend revision for the treatment of pain of an overstuffed knee joint.

Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.

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    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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    Jeffrey L. Pierson, M.D.
    Posted on January 31, 2008
    Dr. Pierson et al. respond to Dr. Yadav
    St. Vincent Center for Joint Replacement, Indianapolis, Indiana

    Thank you for your interest in our study(1). While the mediolateral position of the femoral component was not the subject of our investigation, all of the surgeons use the same philosophical strategy in performing total knee arthroplasty. Specifically, the femoral component mediolateral position is referenced off of the lateral aspect of the femur. That is, the component is "lateralized". This philosophy is based upon our belief that "lateralization" of the femoral component in total knee arthroplasty improves patellofemoral tracking and may reduce the need for a lateral retinacular release, particularly when compared to "medialization" of the femoral component.

    Reference:

    1. Pierson JL, ritter MA, Keating EM, Faris PM, Meding JB, Berend ME, Davis KE. The effect of stuffing the patellofemoral compartment on the outcome of total knee arthroplasty. J Bone Joint Surg Am. 2007;89:2195-203.

    SIDDHARTH YADAV
    Posted on January 23, 2008
    The Effect of Stuffing the Patellofemoral Compartment on the Outcome of Total Knee Arthroplasty
    Indian Orthopaedic Association

    To The Editor:

    In this article(1), the authors did not report whether the femoral component was lateralized or medialized on the distal femur.

    Knowing the medial/lateral position of the femoral component is critical in assessing the function of the patellofemoral compartment.

    The author did not receive any outside funding or grants in support of his research for or preparation of this work. Neither he nor a member of his immediate family received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the author, or a member of his immediate family, is affiliated or associated .

    Reference:

    1. Pierson JL, Ritter MA, Keating EM, Faris PM, Meding JB, Berend ME, Davis KE. The effect of stuffing the patellofemoral compartment on the outcome of total knee arthroplasty. J Bone Joint Surg Am. 2007;89:2195.

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