Surgery (St Vincent's) - Theses
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ItemInvestigations of the patello-femoral joint in the osteoarthritic knee( 2013)Background Patello-femoral arthritis and anterior knee pain is common in patients with tibio- femoral arthritis. It is presumed that anterior knee pain is caused by patello-femoral arthritis and or malalignment. The predictors of anterior knee pain post total knee arthroplasty are unknown. There are no studies describing the nature and location of anterior knee pain. Methods A retrospective analysis of a prospectively followed cohort of 334 patients undergoing knee arthroplasty was performed. Radiological analysis of measures of patello- femoral malalignment and joint space narrowing was performed. These measures were analysed for association with anterior knee pain and function. A prospective cohort study of 105 patients was performed with minimum 12 months follow-up to analyse post-operative patello-femoral alignment in knees with and without patellar resurfacing. Statistical analysis was performed for possible clinical and radiological predictors of post-operative anterior knee pain. The location of anterior knee pain was reported in this cohort via drawings performed by patients and analysis of pre and post arthroplasty anterior knee pain location was performed. Results Patello-femoral malalignment as measured by lateral patellar tilt and lateral displacement were strongly associated with severe patello-femoral arthritis. Anterior knee pain was not associated with arthritis or malalignment of the patello-femoral joint. Knees that underwent patellar resurfacing during total knee arthroplasty had better post-operative patellar alignment compared to patellae left non-resurfaced. Better patello-femoral alignment did not correlate with improvement in function or decrease in anterior knee pain. Female gender was an independent factor associated with anterior knee pain both before and after arthroplasty. Anterior knee pain is felt more often peripherally around the patella than centrally. Anterior knee pain post-arthroplasty is most commonly similar in nature and location to pain felt pre arthroplasty. Conclusion Patello-femoral arthritis is more severe in knees with patello-femoral malalignment. The cause of anterior knee pain is multi-factorial and predicting anterior knee pain after total knee arthroplasty is difficult. Female gender was the only strong statistical predictor of anterior knee pain pre and post arthroplasty. Better patellar alignment post arthroplasty does not guarantee better function or less anterior knee pain at 12 months follow-up.