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The Effect of Stuffing the Patellofemoral Compartment on the Outcome of Total Knee Arthroplasty

¹ Joint Replacement Surgeons of Indiana, St. Vincent Center for Joint Replacement, 8402 Harcourt Road, Indianapolis, IN 46260. E-mail address: jlpierso{at}stvincent.org
² Joint Replacement Surgeons of Indiana Research Foundation, Center for Hip and Knee Surgery; St. Francis Hospital Mooresville, 1201 Hadley Road, Mooresville, IN 46158

Investigation performed at the Center for Hip and Knee Surgery, St. Francis Hospital, Mooresville, Indiana, and the Center for Joint Replacement, St. Vincent Hospital, Indianapolis, Indiana

Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from Biomet. In addition, one or more of the authors or a member of his or her immediate family received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from a commercial entity (Biomet and Zimmer: royalties, consulting). No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Methods: A retrospective review of 1100 primary total knee arthroplasties that had been performed in 1997 and 1998 was conducted. Eight hundred and thirty arthroplasties (75.5%) met the diagnostic and minimum two-year follow-up criteria for inclusion in this report. Radiographic measurements were made to determine preoperative and postoperative anterior patellar displacement, anteroposterior femoral size, combined anteroposterior patellofemoral size, anterior femoral offset, and posterior femoral offset. Regression analysis was performed to determine the effects of changes in these variables on the range of motion, the Knee Society Knee Score, the Knee Society Function Score, the Knee Society Pain Score, and the rate of lateral retinacular release.

Results: Preoperative to postoperative changes in anterior patellar displacement, anteroposterior femoral size, combined anteroposterior patellofemoral size, anterior femoral offset, and posterior femoral offset had no clinically meaningful effect on the range of motion of the knee or on any of the Knee Society scores. Increases in anterior patellar displacement were associated with a lower probability of the need for a lateral retinacular release. Increases in measured anteroposterior femoral size were associated with a higher probability of the need for lateral release. Even when combined, however, these relationships explained only 10.1% of the observed variance in the need for lateral retinacular release. Moreover, analyses indicated that patient gender, large as opposed to medium patellar size, and absolute femoral component size influenced the likelihood of lateral release more than did anterior patellar displacement and measured anteroposterior femoral size.

Conclusions: Our findings do not support the widely held belief that stuffing of the patellofemoral joint results in adverse outcomes after total knee arthroplasty. Furthermore, the need for lateral release appears to be multifactorial and likely involves a more complex set of factors. Thus, without evidence of other identifiable causes of failure, we do not recommend revision for the treatment of pain of an overstuffed knee joint.

Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.

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