Retropatellar contact characteristics before and after total knee arthroplasty

Purpose: Qualitative analysis of the retropatellar contact characteristics after total knee arthroplasty. Material and Methods: Six cadaveric knees were investigated before and after implantation of a Genesis I knee prosthesis without and with patellar resurfacing in different positions. Joint contact characteristics were evaluated with Fuji Prescale film type ‘Super Low’ and analyzed qualitatively in nine quadrants. The pressure was determined from a 5-s loading duration in four different knee positions between 45° and 120° of flexion. The femoral component of the prosthesis was implanted in neutral as well as in internal and external rotation. A quadriceps force of 280 N with either a predominant medial or lateral pulling direction was applied. Results: Without prosthesis the largest contact area is between 60° and 90° of flexion. A lateral muscle force direction as well as an external rotation increased the frequency of loading in the medial quadrants. After implantation of the prosthesis the central and superior quadrants were predominantly contacted irrespective of the flexion angle. No marked differences between the flexion angles were found. Implantation of the patellar resurfacing led to contact in the three central quadrants. Conclusion: Implantation of the endoprosthesis leads to increased contact in slight and extreme flexion angles. Especially the central areas are increasingly loaded. No predominant influence of the rotation of the femoral component or the direction of the muscle pull was found. An improved distribution of the contact area could not be demonstrated after patellar resurfacing.