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Open AccessArticle

Musculoskeletal Multibody Simulation Analysis on the Impact of Patellar Component Design and Positioning on Joint Dynamics after Unconstrained Total Knee Arthroplasty

1
Biomechanics and Implant Technology Research Laboratory, Department of Orthopaedics, Rostock University Medical Center, 18057 Rostock, Germany
2
Aesculap AG Research and Development, 78532 Tuttlingen, Germany
3
Department of Orthopaedic Surgery, Ludwig Maximilians University Munich, Physical Medicine and Rehabilitation, Campus Grosshadern, 81377 Munich, Germany
4
Department of Modern Mechanical Engineering, Waseda University, Tokyo 169-0072, Japan
*
Author to whom correspondence should be addressed.
Materials 2020, 13(10), 2365; https://doi.org/10.3390/ma13102365
Received: 28 February 2020 / Revised: 7 May 2020 / Accepted: 16 May 2020 / Published: 21 May 2020
Patellofemoral (PF) disorders are considered a major clinical complication after total knee replacement (TKR). Malpositioning and design of the patellar component impacts knee joint dynamics, implant fixation and wear propagation. However, only a limited number of studies have addressed the biomechanical impact of the patellar component on PF dynamics and their results have been discussed controversially. To address these issues, we implemented a musculoskeletal multibody simulation (MMBS) study for the systematical analysis of the patellar component’s thickness and positioning on PF contact forces and kinematics during dynamic squat motion with virtually implanted unconstrained cruciate-retaining (CR)-TKR. The patellar button thickness clearly increased the contact forces in the PF joint (up to 27%). Similarly, the PF contact forces were affected by superior–inferior positioning (up to 16%) and mediolateral positioning (up to 8%) of the patellar button. PF kinematics was mostly affected by the mediolateral positioning and the thickness of the patellar component. A medialization of 3 mm caused a lateral patellar shift by up to 2.7 mm and lateral patellar tilt by up to 1.6°. However, deviations in the rotational positioning of the patellar button had minor effects on PF dynamics. Aiming at an optimal intraoperative patellar component alignment, the orthopedic surgeon should pay close attention to the patellar component thickness in combination with its mediolateral and superior–inferior positioning on the retropatellar surface. Our generated MMBS model provides systematic and reproducible insight into the effects of patellar component positioning and design on PF dynamics and has the potential to serve as a preoperative analysis tool. View Full-Text
Keywords: joint replacement; knee joint; total knee arthroplasty; patellar component; musculoskeletal multibody simulation; patellofemoral joint joint replacement; knee joint; total knee arthroplasty; patellar component; musculoskeletal multibody simulation; patellofemoral joint
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MDPI and ACS Style

Kebbach, M.; Darowski, M.; Krueger, S.; Schilling, C.; Grupp, T.M.; Bader, R.; Geier, A. Musculoskeletal Multibody Simulation Analysis on the Impact of Patellar Component Design and Positioning on Joint Dynamics after Unconstrained Total Knee Arthroplasty. Materials 2020, 13, 2365.

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