Effect of total knee replacement design and surgical technique on patello-femoral joint performance: an explicit finite element study

Yeung, Kwok Tai Cathay (2007) Effect of total knee replacement design and surgical technique on patello-femoral joint performance: an explicit finite element study. University of Southampton, School of Engineering Sciences, Doctoral Thesis , 238pp.


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There is an increasing demand for total knee replacements (TKR). Young patients are
placing increasing functional demands on modern TKR. Clinical experience has also
shown the need for high flexion in patients after TKR. In this study, assessment of TKR
performance subjected to deep knee bend was investigated.
Patellar resurfacing in TKR is assumed to release pain and restore knee function.
Despite the recent advance and success in TKR operation, patellar resurfacing has been
associated with an increase in complications at the patello-femoral joint, and hence
revisions following TKR. Complications include poor tracking, instability, wear, loosening
and fractures. These complications have been attributed in part to the component design
features (e.g. sagittal radius, depth, and orientation of the trochlear groove of the femur
and the geometry of the patellar component surface) and surgical technique (e.g.
component alignment and ligament balance). However, the influence of these factors on
the overall performance of TKR has not been investigated extensively.
The objective of the study was to determine the variation of patellar kinematics (tracking
motion) and contact mechanics (contact force, area, pressure and stress) induced by
component design and surgical technique. A three-dimensional finite element (FE)
model of a PFC-Sigma TKR, including the tibio-femoral and patello-femoral joints was
developed. Explicit FE analysis was used to simulate TKR under a deep knee flexion.
The models predicted substantial increase in patellar pressure and stress with nonconforming
patello-femoral articulating surfaces. Femoral groove orientation affected
patellar tracking and contact mechanics. Extending femoral groove distally reduced
patello-femoral contact stress at high flexion angles. Also, externally rotating the femoral
component and adjusting the line of action of quadriceps pull would be beneficial by
reducing patellar lateral force. The FE model used in the current study provided insight
into the effect of component design parameters and surgical technique on patellofemoral
kinematics and contact mechanics.

Item Type: Thesis (Doctoral)
Subjects: R Medicine > RD Surgery
T Technology > TA Engineering (General). Civil engineering (General)
Q Science > QP Physiology
Divisions : University Structure - Pre August 2011 > School of Engineering Sciences > Engineering Materials & Surface Engineering
ePrint ID: 64812
Accepted Date and Publication Date:
June 2007Made publicly available
Date Deposited: 16 Jan 2009
Last Modified: 31 Mar 2016 12:49
URI: http://eprints.soton.ac.uk/id/eprint/64812

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