Notas / Notes - Active Congress.......

JUEVES / THURSDAY
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TKA WITHOUT PATELLAR COMPONENT
Leo A. Whiteside, MD
Missouri Bone and Joint Center
St. Louis, Missouri, (USA)
Resurfacing the patella in total knee arthroplasty is commonly
recommended as the preferred treatment, but other studies
report superior results of not resurfacing the patella especially
in qualities of the knee related to quadriceps function such
as stair climbing. One reason for this discrepancy in the literature
may be design of the femoral component. Design
features of the patellofemoral surface have a distinct effect
on kinematics of the knee, patellar stability, and shear stresses,
so it would be likely that design features of the femoral
surface that articulates with the patella also would affect
postoperative anterior knee pain and revision rates. Various
femoral component designs have been available during the
past two decades, and the contact stresses on the unresurfaced
patella vary greatly among these designs. The
femoral implants that produced the highest stresses on the
unresurfaced patella were those with a shallow patellar groove
and wide intercondylar notch. Those with deeper patellar
grooves and supporting lateral flange surfaces had low
contact stress similar to that of the normal patellofemoral
joint. This suggests that the variation in the reported clinical
results of not resurfacing the patella could be explained by
the differences in design features of the femoral component.
A clinical and laboratory study was done to test the hypothesis
that reported differences in clinical results of unresurfaced
patellae in total knee arthroplasty are because of differences
in design of the femoral component. Thirty-eight knees had
an Ortholoc II femoral component (shallow patellar groove,
wide intercondylar notch, and flat femoral surface). Thirteen
knees had severe and three had moderate anterior knee
pain. Fifteen required patellar resurfacing later. Two hundred
twenty-two knees had Advantim femoral components (deepened
and extended patellar groove, narrow intercondylar
notch, and rounded femoral surfaces). None of these knees
had severe anterior knee pain. Eighteen percent had mild
anterior knee pain on stairs postoperatively. Three hundred
thirty knees had Profix femoral components (deepened and
extended patellar groove, rounded femoral surfaces, and
extended lateral patellar support). Ten percent of Profix
knees had mild anterior knee pain. This rate was statistically
signifi-cantly less than that of the knees with Advantim femoral
components (p