Clifford W. Colwell

The effects of patellar thickness on patellofemoral forces after resurfacing

The purpose of this study was to determine the effect of patellar bone and patellar implant thickness on patellofemoral forces after resurfacing in total knee arthroplasty. Seven cadaver knees were tested using an Oxford Knee Testing Rig. This model gave the specimens 6° freedom while dynamic data were collected. Each knee was tested from full extension to 95° knee flexion. Knees were implanted with Press Fit Condylar femoral, tibial, and patellar implants. The effect of varying patellar thickness on patellofemoral forces was determined by using custom modular oval-domed polyethylene patellar components with progressive thickness increments of 2 mm. Patellofemoral forces were measured by a custom-designed uniaxial patellar load cell. Statistically significant increases in patellofemoral compression forces were found from 70° to 95° flexion with increased patellar bone and patellar implant thickness.

Effects of patellar thickness on compression and shear forces in total knee arthroplasty

Ten unembalmed cadaveric knees were disected to the capsule preserving the ligamentous and tendinous structures. A posterior cruciate ligament sparing total condylar knee arthroplasty was implanted routinely. A force transducer that measured compression force and shear was implanted into each patella. For each knee, 3 thicknesses of the patellar composite (osteotomized patella, transducer, polyethylene component) were evaluated: (1) precut patellar thickness, (2) precut plus 2 mm, and (3) precut plus 4 mm. The knees were tested in an Oxford Knee Testing Rig, which allowed dynamic testing with 6 ° of freedom. Values of patellar forces were obtained throughout a range of motion of 0 ° to 95 ° flexion. At higher flexion angles (45 ° and above), the total patellofemoral shear forces for the precut plus 2 mm and the precut plus 4 mm composites were altered significantly from the precut thickness. Increasing the patellar thickness results in a significant increase in shear forces, potentially leading to early loosening of the component or increased wear or both. Therefore, bone conserving resections that increase the patellar composite thickness above the precut thickness should be avoided.

Highly Cross-linked Polyethylene in Total Hip Arthroplasty

Although total hip arthroplasty is a common and highly successful procedure, its long-term durability has been undermined by the cellular response to polyethylene wear debris and the subsequent effects on periprosthetic bone. Research elucidating the effects of sterilization on polyethylene wear has facilitated the development of a more wear-resistant material-highly cross-linked polyethylene. Laboratory testing has demonstrated that highly cross-linked polyethylene has markedly improved wear resistance compared with conventional polyethylene under a variety of conditions. Early clinical data have supported these results. To make informed decisions about this already widely available and frequently used product, the practicing orthopaedic surgeon should have a basic understanding of the production process as well as knowledge of the most current laboratory and clinical data.