• Pier Francesco Indelli, Massimiliano Marcucci, Gennaro Pipino, Sophie Charlton, Christian Carulli, and Massimo Innocenti.
• Centro Eccellenza Sostituzioni Articolari Toscana (CESAT), Clinica Ortopedica Universita' di Firenze, Florence, Italy, pierfrancesco.indelli@unifi.it.
• Arch Orthop Trauma Surg. 2014 Jan 1;134(1):59-64.

IntroductionAnterior knee pain following TKA performed utilizing the PFC Sigma system still represents a cause of failure. The purpose of this study was to evaluate whether or not a recent change in the femoral design (PFC Sigma PS) had a positive impact on the patello-femoral complication rate.Materials And MethodsA consecutive series of 100 TKA using the PFC Sigma PS system was followed prospectively for a minimum of 3 years. All patellae were replaced and a standard lateral release was never performed. Radiographic analysis following the Knee Society Score (KSS) included antero-posterior weight-bearing, lateral and bilateral axial radiographs. TKA rotational alignment was recorded at the final follow-up in 30 consecutive knees by performing a CT evaluation.ResultsGood to excellent clinical results according to the KSS were achieved in 94% of the knees. Survival without need of reoperation for any reason was 98% at 3 years minimum follow-up; two reoperations were done for removal of fibromatous intra-articular tissue ("Clunk syndrome"). There were no revisions for septic or aseptic loosening of the components. The mean ROM improved from 104° preoperatively to 115° (97°-132°) postoperatively: postoperative flexion was 120° or more in 58 % of the knees. Severe anterior knee pain was present in 9% of patients. Radiographic evaluation showed 90 knees with a tibio-femoral anatomical axis between 8° and 2° of valgus (±3° from the intraoperative goal). CT evaluation of 30 consecutive knees showed that the femoral component positioning in relationship to the trans-epicondylar axis had only 2.80° of external rotation (±2.10°) with respect to a planned external rotation of 3°. This difference was statistically significant.ConclusionsAlthough the PFC Sigma PS system provides good and predictable results for tricompartmental arthritis of the knee, anterior mechanism complications still represent a reason for dissatisfaction in a substantial group of patients.

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