Patellar computer-assisted surgery and intraoperative kinematics

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The primary reason for someone to get a knee replacement is to reduce his or her pain due to arthritis. Unfortunately, some people still have considerable pain after the surgery, often in the vicinity of the kneecap (called anterior knee pain). The reasons for this pain are usually unknown. Pain and other problems with the implant are often attributed to incorrect tracking of the kneecap (patella) on the thigh bone (femur) due to less-than-optimal placement of the components during surgery. Computer-assisted surgery (CAS) uses information about the patient's anatomy and the location of the surgeon's tools to guide the surgeon to place the components in the best position; however, so far, this has focused on the large knee bones (femur and tibia) and not the patella. We are proposing four related projects to answer the following questions: (1) Can a novel computer-assisted method be developed to improve the patellar cut, and is it more accurate than the traditional approach? (2) Can an improved method be developed to measure the movement of the patella before and after placing the components and is the accuracy comparable to a gold standard, namely computed-tomography (CT)? (3) Can these systems be successfully implemented clinically, based on the accuracy of the resulting cut angle compared to the non-CAS approach, the extra time required, and the clinical results? (4) Does resurfacing the knee with implant components have a significant effect on patellar kinematics measured intraoperatively? In the longterm, our goals are to achieve symmetric patellar bone cuts and balanced patellar tracking to improve patient quality of life and implant longevity, and to use intraoperative kinematic measurements to improve implant design and surgical technique.