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Comparative Study
. 2012 Jun 15;7:28.
doi: 10.1186/1749-799X-7-28.

Differences in the Stress Distribution in the Distal Femur Between Patellofemoral Joint Replacement and Total Knee Replacement: A Finite Element Study

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Free PMC article
Comparative Study

Differences in the Stress Distribution in the Distal Femur Between Patellofemoral Joint Replacement and Total Knee Replacement: A Finite Element Study

Hans-Peter W van Jonbergen et al. J Orthop Surg Res. .
Free PMC article

Abstract

Background: Patellofemoral joint replacement is a successful treatment option for isolated patellofemoral osteoarthritis. However, results of later conversion to total knee replacement may be compromised by periprosthetic bone loss. Previous clinical studies have demonstrated a decrease in distal femoral bone mineral density after patellofemoral joint replacement. It is unclear whether this is due to periprosthetic stress shielding. The main objective of the current study was to evaluate the stress shielding effect of prosthetic replacement with 2 different patellofemoral prosthetic designs and with a total knee prosthesis.

Methods: We developed a finite element model of an intact patellofemoral joint, and finite element models of patellofemoral joint replacement with a Journey PFJ prosthesis, a Richards II prosthesis, and a Genesis II total knee prosthesis. For each of these 4 finite element models, the average Von Mises stress in 2 clinically relevant regions of interest were evaluated during a simulated squatting movement until 120 degrees of flexion.

Results: During deep knee flexion, in the anterior region of interest, the average Von Mises stress with the Journey PFJ design was comparable to the physiological knee, while reduced by almost 25% for both the Richards II design and the Genesis II total knee joint replacement design. The average Von Mises stress in the supracondylar region of interest was similar for both patellofemoral prosthetic designs and the physiological model, with slightly lower stress for the Genesis II design.

Conclusions: Patellofemoral joint replacement results in periprosthetic stress-shielding, although to a smaller degree than in total knee replacement. Specific patellofemoral prosthetic design properties may result in differences in femoral stress shielding.

Figures

Figure 1
Figure 1
Physiological model geometry used in this study.
Figure 2
Figure 2
Location of anterior (A), and proximal (P) regions of interest (ROI) on a lateral radiograph of a right knee following Richards II patellofemoral joint replacement.
Figure 3
Figure 3
Journey PFJ patellofemoral prosthesis: A) Actual component, B) CAD file, C) Finite element model.
Figure 4
Figure 4
Richards II patellofemoral prosthesis: A) Actual component, B) CAD file, C) Finite element model.
Figure 5
Figure 5
Genesis II total knee prosthesis: A) Actual component, B) CAD file, C) Finite element model.
Figure 6
Figure 6
Comparison of contact area versus flexion angle for numerical model and knee kinematics simulator experiment.
Figure 7
Figure 7
Average Von Mises stress in the anterior and proximal ROI in the 4 models for discrete flexion angles of simulated squat motion.

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References

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