Patients were queried at most recent follow-up or via phone interview for symptoms including PCC (defined as an audible clunk or crepitation during knee ROM) and anterior knee pain. Despite previously reported data, the current study shows that there was no difference in the rate of anterior knee pain, patellar clunk, or crepitus between the PFC Sigma and Attune implants. Typical symptoms of bursitis include pain, tenderness even without motion, swelling, and loss of movement. Patellofemoral crepitus after total knee arthroplasty: etiology and preventive measures. When reviewing mobile vs fixed bearing Attune designs, those authors found no difference in PCC incidence.18, Indelli et al19 also examined outcomes between the fixed bearing PFC Sigma and Attune implants. For the Sigma group, mobile bearing components were significantly associated with higher rates of overall PCC (32.4% vs 15.0%, P=.043), painful PCC (20.6% vs 5.0%, P=.016), anterior knee pain (17.6% vs 1.3%, P=.003), and PCC requiring a return trip to the operating room (17.6% vs 1.3%, P=.003). A single-surgeon retrospective review of primary PFC Sigma (DePuy Synthes, Warsaw, Indiana) or Attune TKA (DePuy Synthes) was performed. Excellent long-term outcomes have been obtained in patients undergoing PS TKA.22 However, patellofemoral symptoms, including PCC and anterior knee pain, can develop in a subset of patients, which has been reported as high as 33%, depending on the implant evaluated.8–10, Patellar clunk, thought to be caused by impingement of fibrous overgrowth at the superior patellar pole, typically describes painful catching of the patella while the knee is extended.5–8,12,16 Patellar crepitus refers to a clicking, popping, grinding, or snapping phenomenon during knee motion that may be audible, experienced by the patient during motion, or solely detected by the examiner.7,9,14–20 Symptoms range from painful to asymptomatic and have been reported using inconsistent terminology in previous literature regarding PS TKA.5–20 Asymptomatic crepitation may not represent a clinically significant complication but still may be associated with higher patient dissatisfaction.10,11,16,23 Recently, the combination of mechanical patellofemoral symptoms has been grouped in PCC.13,20, To address the risk of PCC, the Attune design has features that were incorporated specifically to address patellofemoral symptoms, including a lower intercondylar box height ratio (<0.7) and a thinner and narrower anterior trochlear flange of the femoral component compared with the PFC Sigma design.18 These changes were hypothesized to reduce overall extensor mechanism and retinacular tension, which leads to reduced quadriceps tendon-femoral contact and pressure in the transition region between the trochlea and intercondylar box. *Significant difference (P<.05). The authors believe the true incidence of anterior knee pain and PCC is underreported in the literature because many outcome measures do not capture these complications. Gout most commonly happens in the big toe. 15 Most Common Signs of Gout Once upon a time, gout or gouty arthritis was known as the “disease of kings.” It was considered to be more prevalent among overweight, wealthy men who could afford to over-indulge in alcohol and fatty foods. All patients received a periarticular injection. No clinically significant differences in range of motion, pain, or Knee Society Scores were found between groups. A person who tore their ACL or had a meniscus injury knows exactly when it happened. Projected volume of primary total joint arthroplasty in the U.S., 2014 to 2030. Secondary outcomes included postoperative knee range of motion (ROM), functional outcome scores, complications, and revisions. Pritchett JW. More research is still needed to clarify whether component design can improve anterior knee pain and PCC, and thus improve outcomes. The incidence of anterior knee pain (25.8% vs 12.5%, P=.02) and mechanical crepitation (30.9% vs 17.7%, P=.02) was significantly higher in the PFC Sigma group. In addition, final postoperative ROM for resolved cases of patellar clunk syndrome did not differ significantly from postoperative ROM for TKAs without clunk syndrome.16, In a review of 826 PS TKAs involving 5 designs, Choi et al20 found that the PCC incidence was higher in the PFC Sigma rotating platform (11 of 113 knees, 9.7%) than in the others (7 of 713 knees, 1.0%). Knee Society Scores. However, the findings echo those of Ranawat et al11 in that the true incidence of these complaints is likely higher than many previous reports and is not fully captured by commonly used outcome measures. First, the study was a small, retrospective review of patients and, therefore, suffers the inherent limitations of retrospective analyses. Attack time – the time it takes for the compressor to complete the gain reduction (or bring down the level) based on the compression ratio. Previous analyses of PS TKAs showed that the mean time for the diagnosis of patellar crepitus was within the first postoperative year.7,20. Femoral components with an increased intercondylar box ratio may permit contact between the distal quadriceps tendon and the anterior intercondylar box, leading to soft tissue irritation. Insall JN, Dorr LD, Scott RD, Scott WN. ... and to me there is a big difference in how they feel. Mean±SD KSS improved significantly from baseline for each cohort (P<.001; Figure 2). The purpose of this study was to compare the incidence of PCC between 2 different total knee implants from a single manufacturer: Attune (DePuy Synthes, Warsaw, Indiana), an updated design that incorporates the suggested trochlear and intercondylar box changes, vs PFC Sigma (DePuy Synthes), which has a previously reported incidence of patellar crepitus.11,15–20 The authors hypothesized that the patellofemoral design changes of the Attune TKA would result in lower rates of anterior knee pain and PCC. Because the femoral component is identical for both articulations, it is reasonable to suggest the bearing type may influence the development of PCC. Most changes in implant design have focused on modification of the trochlear aspect of the femoral component. Questions regarding maneuvering stairs or kneeling can allude to patellofemoral complaints, but the value of these functional issues is ultimately lost among the gamut of questioning. A total of 23 (85%) of 26 cases resolved with a single arthroscopic treatment and 2 (7.7%) more cases resolved with a second arthroscopic procedure. Instructors had given me countless demonstrations, but I could never really hear the difference between the various settings—especially when it came to the attack and release ti. No significant differences were reported in KSS pain and functional outcomes or overall satisfaction scores.
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