Related Experiment Video
Updated: Jun 9, 2026
Treatment of Ankle Osteoarthritis with Total Ankle Replacement Through a Lateral Transfibular Approach
Published on: January 24, 2018
Sagittal alignment changes predict patellar osteosclerosis after total knee arthroplasty without resurfacing
Shunsuke Utsumi1, Takashi Aki1, Yu Mori1
1Department of Orthopaedic Surgery Tohoku University Graduate School of Medicine Sendai Japan.
Purpose:
Total knee arthroplasty (TKA) is an effective treatment for knee osteoarthritis; however, some patients experience post-operative anterior knee pain related to patellofemoral (PF) loading. Subchondral patellar osteosclerosis on radiographs may indirectly reflect increased PF stress. This study examined whether changes in posterior tibial slope (PTS) and femorotibial posterior overhang (FTPO) are associated with patellar osteosclerosis after TKA without patellar resurfacing.
Methods:
A total of 94 knees (71 patients) that underwent TKA without patellar resurfacing for medial OA using the Journey II Bi-Cruciate Stabilized (BCS) system were retrospectively reviewed. Knees were classified according to the presence of post-operative patellar osteosclerosis. Group differences were evaluated using the Mann-Whitney U test, and correlations between ΔPTS and ΔFTPO were assessed with Spearman's coefficient. Receiver operating characteristic (ROC) analysis and multivariable logistic regression were performed to determine cut-off values and independent predictors.
Results:
Patellar osteosclerosis developed in 26 out of 94 knees (27.7%). The osteosclerosis group showed significantly greater post-operative reductions in both PTS and FTPO (p < 0.001). ΔPTS and ΔFTPO were positively correlated (r = 0.35, p = 0.0006). ROC analysis identified cut-offs of ΔPTS ≤ -0.28° (AUC = 0.91) and ΔFTPO ≤ 0.68 mm (AUC = 0.84). Multivariable analysis confirmed that more negative ΔPTS (odds ratio [OR] = 0.49, 95% confidence interval [CI] = 0.34-0.71) and smaller ΔFTPO (OR = 0.78, 95% CI = 0.65-0.93) independently predicted patellar osteosclerosis.
Conclusion:
Post-operative reductions in PTS and relative femoral anteriorization were associated with patellar osteosclerosis after TKA without patellar resurfacing. These sagittal alignment changes may contribute to increased PF joint stress and anterior knee pain. Although PF pressure and symptoms were not directly evaluated, avoiding excessive PTS reduction and femoral anteriorization may help minimize PF overloading.
Level Of Evidence:
Level III.