Femoral Rotation and Patellar Positioning After TKA

Study Overview
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Brief Summary
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Analysis of patellar positioning in the trochlear groove after TKA with and without the use of dynamic tensioner.

Detailed Description
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It appears that by precisely adjusting femoral component rotation and its relation to soft tissues in the area we can achieve better function of the patellofemoral joint and thus reduce the occurrence of anterior knee pain. Achieving proper femoral component rotation is challenging, as the bony landmarks are difficult to identify. This goal may be accomplished by using a dynamic tensioner - a device that intraoperatively measures joint gap stiffness in extension and 90 degrees flexion. This is especially important in knees with high grade arthritis and limb malalignment, where ligaments' and tendons' efficiency is affected.The aim of this study was to analyze patella positioning in the trochlear groove on CT scans of patients undergoing TKR with use of a dynamic tensioner and compare it to the ones undergoing standard measured-resection technique. Secondary outcome was to assess the frequency of anterior knee pain, range of motion and patient-reported outcome 3 and 12 months after the surgery.

Official Title
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Establishing Femoral Component Rotation Using a Dynamic Tensioner Does Not Improve Patellar Position After Total Knee Replacement With Use of Anatomic Implants - Matched-cohort Study

Conditions
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Patella Disorder, Knee Pain Chronic, Prosthetic Complication, Knee Osteoarthritis, Joint Pain, Joint Instability

Intervention / Treatment
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* Other: Use of dynamic tensioner


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: age over 60 BMI < 40 ablity to walk for 10meters leg length discrepancy <5mm knee flexion > 90 degrees hip extension < 0 degrees hip flexion > 90 degrees III / IV level of osteoarthritis in Kellgren - Lawrence scale Exclusion Criteria: varus/valgus/ fixed flexion deformity > 15 degrees revision TKA prior UKA

Ages Eligible for Study
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Minimum Age: 60 Years
Maximum Age: 99 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Patella positioning after TKR + FUZION<br>Patients who underwent TKR - femoral component rotation established with a use of a dynamic tensioner (FUZION) | Other: Use of dynamic tensioner<br>* Assessment of femoral component rotation with a use of a dynamic tensioner in extension and 90 degrees of flexion. The tensioner was put between tibial plane cut and posterior condyles of the femur and tensioned to the same thickness of insert as in the full extension<br>|
| Patella positioning after standard TKR<br>Patients who underwent standard TKR performed with measured resection technique | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Patella positioning in the trochlear groove on computed tomography (CT) after TKR | Analysis of CT scans of patients undergoing TKR in 30 degrees of knee flexion in the days following the procedure | January 2021 - August 2021 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Range of motion after TKR | Assessment of range of motion 3 and 12 months after the surgery in the group with standard TKR and dynamic tensioner TKR | January 2021 - January 2022 | 
| Patient-reported outcome after TKR | Assessment of patient-reported outcome 3 and 12 months after the surgery in the group with standard TKR and dynamic tensioner TKR | January 2021 - January 2022 | 
| Prevalence of anterior knee pain after TKR | Assessment of the frequency of anterior knee pain 3 and 12 months after the surgery in the group with standard TKR and dynamic tensioner TKR | January 2021 - January 2022 |