Literature review of the relationship and relative factors between anterior knee pain and patellofemoral joint after total knee arthroplasty

Abstract

Anterior knee pain continues to be a major problem following total knee arthroplasty (TKA). Patellofemoral joint is closely associated to the occurrence of the anterior knee pain, so it is also called patellofemoral joint pain. Overstuff of patellofemoral joint and patella maltracking are the main factors for anterior part of the post-operative pain. They are resulted from the change of native morphology and Q angle of patellofemoral joint after operation. Instead of non-modifiable patients' congenital and genetic factors, they are mainly related to the improper surgical techniques and the mismatch between prostheses and native patellofemoral morphology. The reason of the mismatch is that the prosthesis is unable to cover all kinds of differences of the patellofemoral morphology among races and genders. In addition, some surgical techniques, including patellar replacement, circumpatellar denervation, femoral and patellar prostheses location, and the selection of the type of prosthesis, also affect the occurrence of anterior knee pain. The above mentioned factors may eventually lead to excessive and uneven distribution of the patella-femoral loads, which would compress and simulate the peripheral nerves around the joint. Ultimately, they result in the anterior knee pain. Therefore, the following effective strategies could lead to relief anterior knee pain and improve patients overall satisfaction after TKA, including improvements of prostheses design, patellar resurfacing, circumpatellar denervation, infrapatellar fat padpreservation or using mobile-bearing rotating-platform.