title: Differences in patellofemoral contact stresses between mobile-bearing and fixed-bearing total knee arthroplasties: a dynamic in vitro measurement.
abstract: BACKGROUND
  Anterior knee pain is one of the most common problems after total knee arthroplasty (TKA). Mobile-bearing designs should improve patella tracking with a reduced rate of patella tilt as well as reduced patellofemoral contact stresses and improve knee flexion. The aim of this dynamic in vitro investigation was to evaluate the changes of patellofemoral contact stresses after TKA using fixed and mobile-bearing designs.
  
  
  METHODS
  Seven knee specimens were mounted into a knee simulator imitating an isokinetic extension of the knee. The patellofemoral contact was measured before and after tricompartimental TKA with fixed and mobile-bearing designs using pressure-sensitive films. Contact stresses were measured from 120 degrees knee flexion to full extension with a simulated force of the quadriceps muscle up to 1,200 N. Additionally all measurements were performed with simulated co-contraction of the hamstrings muscles.
  
  
  RESULTS
  Fixed-bearing TKA increases patellofemoral contact stresses compared to physiologic conditions. After patella resurfacing, contact stresses increase even more. By changing the prosthesis design to mobile bearing, maximum contact stress was measured to be punctual higher than in fixed-bearing implants. In the interval between 0 degrees -30 degrees and 70 degrees -105 degrees of flexion, obviously lower pressures were evaluated for the mobile-bearing design. With cocontraction of the hamstrings, a lower contact stress of the mobile-bearing design was evident for the complete measurement of the knee extension.
  
  
  CONCLUSIONS
  An increase of patellofemoral contact stresses after patellar resurfacing in TKA could be demonstrated. This outcome implicates a higher risk of patellofemoral complications. The mobile-bearing design showed evidently lower patellofemoral contact stresses than the fixed-bearing design.
authors.affiliation: Department of Orthopaedics and Rheumatology, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany. skwara@med.uni-marburg.de
authors.forename: Adrian
authors.initials: A
authors.lastname: Skwara
authors.forename: Carsten O
authors.initials: CO
authors.lastname: Tibesku
authors.forename: Sven
authors.initials: S
authors.lastname: Ostermeier
authors.forename: Christina
authors.initials: C
authors.lastname: Stukenborg-Colsman
authors.forename: Susanne
authors.initials: S
authors.lastname: Fuchs-Winkelmann
mesh_terms: D000368:Aged; D005269:Femur; D006801:Humans; D066298:In Vitro Techniques; D007720:Knee Prosthesis; D010329:Patella; D011474:Prosthesis Design; D013314:Stress, Mechanical