Kinematically aligned TKA restores physiological patellofemoral biomechanics in the sagittal plane during a deep knee bend

Purpose

Although patellofemoral complications after kinematically aligned (KA) TKA are infrequent, the patellar flexion angle and proximal–distal patellar contact location through flexion, and incidence of patellar loss of contact at full extension are unknown. The present study determined whether the patellar flexion angle and proximal–distal patellar contact location of a KA TKA performed with anatomic, fixed-bearing, posterior cruciate-retaining (PCR) components differed from those of the native contralateral knee during a deep knee bend, and determined the incidence of patellar loss of contact at full extension for KA TKA only.

Methods

During a deep knee bend from full extension to maximum flexion, both knees were imaged in a lateral view using single-plane fluoroscopy for 25 patients with a calipered KA TKA and a healthy native knee in the contralateral limb. The patellar flexion angle and proximal–distal patellar contact location were measured on images from full extension to maximum flexion in 30° increments. Paired t tests at each flexion angle determined the significance of the difference between the KA TKA knees and the native contralateral knees. In the KA TKA knees, the incidence of patellar loss of contact at full extension was determined. Patient-reported outcome scores also were recorded including the Oxford Knee Score.

Results

Mean patellar flexion angles were not different between the KA TKA knees and the native contralateral knees throughout the motion arc. The largest statistically significant difference in the mean proximal–distal patellar contact locations was 4 mm. The incidence of patellar loss of contact in the KA TKA knees at full extension was 8% (2 of 25 patients). The median Oxford Knee Score was 46 out of 48.

Conclusions

Calipered KA TKA performed with anatomic, fixed-bearing, PCR components restored patellar flexion angles to native and largely restored the proximal–distal patellar contact locations, which at most differed from the native contralateral knee by approximately 10% of the mean proximal–distal patellar length. In the KA TKA knees, the incidence of patellar loss of contact was infrequent. These objective biomechanical results are consistent with the relatively high subjective patient-reported outcome scores herein and support the low incidence of patellofemoral complications following KA TKA previously reported.

Level of evidence

Therapeutic, level III.