The influence of compressive forces across the patellofemoral joint on patient-reported outcome after bi-cruciate stabilized total knee arthroplasty

Bone Joint J. 2018 Dec;100-B(12):1585-1591. doi: 10.1302/0301-620X.100B12.BJJ-2018-0693.R1.


Aims: Patellofemoral problems are a common complication of total knee arthroplasty. A high compressive force across the patellofemoral joint may affect patient-reported outcome. However, the relationship between patient-reported outcome and the intraoperative patellofemoral contact force has not been investigated. The purpose of this study was to determine whether or not a high intraoperative patellofemoral compressive force affects patient-reported outcome.

Patients and methods: This prospective study included 42 patients (42 knees) with varus-type osteoarthritis who underwent a bi-cruciate stabilized total knee arthroplasty and in whom the planned alignment was confirmed on 3D CT. Of the 42 patients, 36 were women and six were men. Their mean age was 72.3 years (61 to 87) and their mean body mass index (BMI) was 24.4 kg/m 2 (18.2 to 34.3). After implantation of the femoral and tibial components, the compressive force across the patellofemoral joint was measured at 10°, 30°, 60°, 90°, 120°, and 140° of flexion using a load cell (Kyowa Electronic Instruments Co., Ltd., Tokyo, Japan) manufactured in the same shape as the patellar implant. Multiple regression analyses were conducted to investigate the relationship between intraoperative patellofemoral compressive force and patient-reported outcome two years after implantation.

Results: No patient had anterior knee pain after total knee arthroplasty. The compressive force across the patellofemoral joint at 140°of flexion was negatively correlated with patient satisfaction (R 2 = 0.458; β = -0.706; p = 0. 041) and Forgotten Joint Score-12 (FJS-12; R 2 = .378; β = -0.636; p = 0. 036). The compressive force across the patellofemoral joint at 60° of flexion was negatively correlated with the patella score (R 2 = 0.417; β = -0.688; p = 0. 046).

Conclusion: Patient satisfaction, FJS-12, and patella score were affected by the patellofemoral compressive force at 60° and 140° of flexion. Reduction of the patellofemoral compressive forces at 60° and 140° of flexion angle during total knee arthroplasty may improve patient-reported outcome, but has no effect on anterior knee pain.

Keywords: Patellofemoral compressive force; Patient-reported outcome measure; Total knee arthroplasty.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Arthroplasty, Replacement, Knee / methods*
  • Biomechanical Phenomena
  • Female
  • Femur / physiopathology
  • Femur / surgery
  • Follow-Up Studies
  • Humans
  • Imaging, Three-Dimensional
  • Knee Prosthesis*
  • Male
  • Middle Aged
  • Osteoarthritis, Knee / surgery
  • Patellofemoral Joint / diagnostic imaging
  • Patellofemoral Joint / physiopathology*
  • Patellofemoral Joint / surgery
  • Patient Reported Outcome Measures*
  • Pressure
  • Prospective Studies
  • Range of Motion, Articular
  • Tibia / physiopathology*
  • Tibia / surgery
  • Tomography, X-Ray Computed