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Patellofemoral complications are a major cause of revision surgery following total knee arthroplasty (TKA). High forces occurring at the patellofemoral articulation coupled with a small patellofemoral contact area pose substantial design challenges. In this study, the three-dimensional (3D) in vivo mechanics of domed and anatomically shaped patellar components were compared with those of native patellae.Ten normal knees, 10 treated with an LCS-PS (low contact stress-posterior stabilized) TKA (anatomically shaped patellar component), and 10 treated with a PFC Sigma RP-PS (press-fit condylar Sigma rotating platform-posterior stabilized) TKA (domed patellar component) were analyzed under fluoroscopic surveillance while the patient performed a weight-bearing deep knee bend from full knee extension to maximum knee flexion. Relevant bone geometries were segmented out from computed tomography (CT) scans, and computer-assisted-design (CAD) models of the implanted components were obtained from the manufacturer. Three-dimensional patellofemoral kinematics were obtained using a 3D-to-2D registration process. Contact mechanics were calculated using a distance map between the articulating patellar and femoral surfaces.Both patellar component designs exhibited good rotational kinematics and tracked well within the femoral trochlea when compared with the normal patella. The contact areas in the TKA groups peaked at 60° of knee flexion (mean and standard deviation, 201 ± 63.4 mm2 for the LCS-PS group and 218 ± 95.4 mm2 for the Sigma RP-PS group), and the areas were substantially smaller than those previously reported for the normal patella. Contact points in the TKA groups stayed close to the center of the patellar components.Both designs performed satisfactorily, although patellofemoral contact areas were reduced in comparison with those in the native patella.Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.