Patellofemoral Arthroplasty: Current Concepts and Review of the Literature

Abstract

Patellofemoral osteoarthritis (PFOA) can be associated with anterior knee pain, stiffness, and functional impairment. Some authors report that PFOA affects approximately 9% of patients older than 40 years with a greater prevalence in females. Etiology of PFOA is multifactorial and is related to the presence of abnormal stresses at the PF joint due to knee- and patient-related factors. The need for a joint preserving treatment by isolated replacement of the injured compartment of the knee led to the development of PF arthroplasty (PFA). When a correct PF replacement is performed, PFA preserves physiologic tibiofemoral joint, thus allowing patients for a rapid recovery with a high satisfaction. The outcomes for PFA are quite variable with a trend toward good to excellent results, mainly owing to the improvement in surgical techniques, patient selection, and implant design. The development of the second generation of PFA improved the outcomes, which is attributed to the different trochlear designs. Recently, encouraging results have been provided by the association of PFA and unicompartmental knee arthroplasty (UKA). In many studies, the main cause of PFA failure is progression of tibiofemoral OA. The aim of this brief review of literature is to summarize the clinical features, indications and contraindications, surgical techniques, complications, and outcomes of PFA.

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“…UKA involves surgical removal of damaged bone and cartilage of only the medial compartment or lateral compartment of the tibiofemoral joint, and then replacement with a corresponding metallic femoral component and a tibial component with a polyethylene insert [ 13 ]. PFA involves surgical removal of damaged bone and cartilage from the patella’s underside and the trochlear groove of the femur, followed by replacement with metal and plastic components [ 14 ].…”

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“…Например, экономические преимущества и осложнения этого метода, возможность сочетания эндопротезирования ПФС с одномыщелковым протезированием коленного сустава, частота конверсий эндопротеза ПФС на тотальный протез и др. Особое внимание авторы уделяют отдаленным результатам лечения, эффективности эндопротезирования ПФС и его перспективам [19][20][21][22].…”

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“…To address these concerns, the second generation of PFJA designs contained a larger anterior flange, wider trochlea groove with distal modifications to avoid impingement on the anterior cruciate ligament and tibiofemoral articulation, with improved instrumentation. 17,18 The trochlear component was applied using the onlay technique, which allowed greater control of femoral component positioning in flexion, translation, and rotation to assist in addressing underlying bony abnormalities. 19…”

“…Currently, reported metrics such as registry survival do not represent these benefits, most publications are case series with fewer than 100 patients, and there are no published large, high-quality randomized controlled trials comparing PFJA with TKA. 17,18,32 While appropriate selection criteria have not been validated, the presence of underlying trochlea dysplasia is associated with improved outcomes and reduced revision rates in comparison with patients who have no underlying structural cause for patellofemoral OA, 36-38 which may require further consideration.…”