Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Nov 18, 2015; 6(10): 795-803
Published online Nov 18, 2015. doi: 10.5312/wjo.v6.i10.795
Anterior knee pain following primary total knee arthroplasty
David Shervin, Katelyn Pratt, Travis Healey, Samantha Nguyen, William M Mihalko, Mouhanad M El-Othmani, Khaled J Saleh
David Shervin, Katelyn Pratt, Travis Healey, Samantha Nguyen, Mouhanad M El-Othmani, Khaled J Saleh, Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL 62794-9679, United States
William M Mihalko, Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee, Memphis, TN 38163, United States
Author contributions: Shervin D, Pratt K, Healey T, Nguyen S, Mihalko WM, El-Othmani MM and Saleh KJ contributed equally to this work, and wrote the manuscript.
Conflict-of-interest statement: Dr. Mihalko reports other from B Braun Aesculap Inc, other from Medtronic Inc, other from Stryker Inc, outside the submitted work; In addition, Dr. Mihalko has a patent Vega Knee System issued. Dr. Saleh reports grants from OREF; NIH NIAMS (R0-1), personal fees from Aesculap/B. Braun, Iroko Pharmaceuticals LLC., Watermark Inc-DSMB, Memorial Medical Center Co-Management Orthopaedic Board, other from American Orthopaedic Association - Communication Chair, AAOS Board of Specialty Societies, AAOS Osteoarthritis FP measure oversight chair,American Board of Orthopaedic Surgeons Oral Examiner, Notify LLC- Founding Partner, Journal of Bone and Joint Surgery (A) Deputy Editor, other from Aesculap/B. Braun, Elsevier Science - Book royalties, other from American Orthopaedic Association Executive Committee, American Orthopaedic Association Critical Issues Committee, BOS Research Committee Performance Measures Committee, Orthopaedic Research and Education Foundation Industry Relations Committee; OREF Clinical Research Awards Committee, outside the submitted work. Dr. El-Othmani, Dr. Shervin, Ms. Pratt, Mr. Healey and Ms. Nguyen have nothing to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Khaled J Saleh, BSc, MD, MSc, FRCS (C), MHCM, Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, PO Box 19679, Springfield, IL 62794-9679, United States.
Telephone: +1-217-5458865 Fax: +1-217-5457901
Received: May 14, 2015
Peer-review started: May 14, 2015
First decision: June 24, 2015
Revised: August 5, 2015
Accepted: September 7, 2015
Article in press: September 8, 2015
Published online: November 18, 2015

Despite improvements in technique and technology for total knee arthroplasty (TKA), anterior knee pain impacts patient outcomes and satisfaction. Addressing the prosthetic and surgical technique related causes of pain after TKA, specifically as it relates to anterior knee pain, can aid surgeons in addressing these issues with their patients. Design features of the femoral and patellar components which have been reported as pain generators include: Improper femoral as well as patellar component sizing or designs that result in patellofemoral stuffing; a shortened trochlear groove distance from the flange to the intercondylar box; and then surgical technique related issues resulting in: Lateral patellar facet syndrome; overstuffed patella/flange combination; asymmetric patellar resurfacing, improper transverse plane component rotation resulting in patellar subluxation/tilt. Any design consideration that allows impingement of extensor mechanism anatomical elements has the possibility of impacting outcome by becoming a pain generator. As the number of TKA procedures continues to increase, it is increasingly critical to develop improved, evidence based prostheses that maximize function and patient satisfaction while minimizing pain and other complications.

Keywords: Anterior knee pain, Total knee arthroplasty, Primary, Knee replacement, Arthroplasty

Core tip: Anterior knee pain continues to be problematic following primary total knee arthroplasty (TKA) procedures, oftentimes leading to revision surgery. While certain non-modifiable patient factors may lead to persistent post-operative pain, there are many modifiable elements including those related to the prosthesis and to surgical technique that also contribute. Addressing the prosthetic causes of TKA failure will allow improvements in implant design which may result in a decreased incidence of revision surgery. This paper aims to address several aspects of prosthetic design including femoral and patellar component features which may contribute to the development of anterior knee pain following TKA.