Three-dimensional motion analysis of the patellar component in total knee arthroplasty by the image matching method using image correlations.

In total knee arthroplasty (TKA), the patella is significantly associated with range of motion and gait performance. Currently, no highly accurate methods are available that can measure the 3D in vivo behavior of the TKA patellar component, as the component is made of x-ray-permeable ultra-high molecular weight polyethylene. Previously, we developed a computer simulation that matches CT scan and unidirectional radiographic images using image correlations, and applied it to kinematic studies of natural and TKA knees. The examination of the measurement accuracy for the patellar bone of a fresh-frozen pig knee joint yielded a root mean square error of 0.2 mm in translation and 0.2° in rotation. In this study, we recruited four patients who had a TKA and investigated 3D movements of the patellar component during squatting. We could visualize the patellar component using the position of the holes drilled for the component peg, and estimated and visualized the contact points between the patellar and femoral components. The principles and the utility of the simulation method are reported. This analytical method is useful for evaluating the pathologies and post-surgical conditions of the knee and other joints.