Does navigated patellar resurfacing in total knee arthroplasty result in proper bone cut, motion and clinical outcomes?. (October 2019)

• Record Type: Journal Article
• Authors: Belvedere, Claudio; Ensini, Andrea; Tamarri, Silvia; d'Amato, Michele; Barbadoro, Paolo; Feliciangeli, Alessandro; Rao, Anish; Leardini, Alberto
• Is Part Of: Clinical biomechanics. Volume 69(2019)
• Page Start: 168
• Page End: 177
• Publication Date: 2019-10
• Subjects: BC Belvedere Claudio -- EA Ensini Andrea -- TS Tamarri Silvia -- DM d'Amato Michele -- PB Barbadoro Paolo -- FA Feliciangeli Alessandro -- RA Rao Anish -- LA Leardini Alberto; Total knee arthroplasty -- Computer-assisted surgery -- Surgical navigation -- Patellar resurfacing -- Tibio-femoral kinematics -- Patello-femoral kinematics; Biomechanics -- Periodicals; Osteopathic medicine -- Periodicals; Biomechanics -- Periodicals; Osteopathic Medicine -- Periodicals; 612.76
• DOI: 10.1016/j.clinbiomech.2019.07.026
• Languages: English
• ISSNs: 0268-0033

Abstract

Abstract: Background: In total knee arthroplasty with patellar resurfacing, patellar bone preparation, component positioning and motion assessments are still not navigated. Only femoral/tibial component positioning is supported by computer-assistance. The aim of this study was to verify, in-vivo, whether knee surgical navigation extended to patellar resurfacing, by original instrumentation and procedures for patellar-based tracking, could achieve accurate patella preparation in terms of original thickness restoration, bone cut orientation, and normal knee motion. Methods: An additional navigation system for patellar data acquisition was used together with a standard navigation system for total knee arthroplasty in 20 patients. This supported the surgeon for patellar resurfacing via measurement of removed bone thickness, three-dimensional patellar cut orientations, and patello-femoral motion. Radiological and clinical examinations at 6 and 24-month follow-up were also performed. Findings: The medio-lateral patellar-bone cut orientation was respectively 0.5° (standard deviation: 3.0°) and 1.4° (1.7°) lateral tilt, as measured via navigation and post-operatively on the Merchant x-ray view. The cranio-caudal orientation was 3.8° (7.2°) of flexion. The thickness variation between patellar pre- and post-implantation was 0.2 (1.3) mm. Immediately after implantation, patello-femoral as well as tibio-femoral kinematics was within the normality. Good radiological and clinical examinations at 6 and 24-month follow-up were also observed. Interpretation: For the first time, the effect of patellar navigation for its resurfacing was assessed in-vivo during surgery, with very good results for thickness restoration, proper cut orientation, and normal knee motion. These results support the introduction of patella-related navigation-based surgical procedures for computer-assisted total knee arthroplasty. Highlights: In knee arthroplasty, patellar resurfacing may result in abnormal knee functioning. Patellar resurfacing is generally performed without a reliable support. In navigated knee arthroplasty, surgical monitoring may be extended to the patella. A more accurate patellar implantation is achieved via navigation. Normal overall knee motion is observed in computer-aided knee arthroplasty.