Patellofemoral Joint Arthroplasty: Our Experience in Isolated Patellofemoral and Bicompartmental Arthritic Knees

Abstract

INTRODUCTIONIsolated patellofemoral (PF) arthritis is rare, and there is no complete agreement about the best surgical treatment. The operative treatments are total knee arthroplasty and patellofemoral replacement (PFR). The incidence of many early complications of PF arthroplasty has decreased with the introduction of newer designs. Nowadays, the main cause of revision surgery is the progression of tibiofemoral osteoarthritis. In the past, PF arthroplasty was contraindicated in patients with evidence of osteoarthritis or pain in medial or lateral tibiofemoral compartments. The improvement in implant designs and surgical techniques has allowed the addition of a monocompartmental arthroplasty for the medial or lateral tibiofemoral compartment. In this work, we evaluate our first experience with PF arthroplasty and its combination with unicompartmental knee arthroplasty.MATERIALS AND METHODSFrom May 2014 to March 2016, we treated 14 patients. An isolated PF arthroplasty was performed in six knees (five patients), and a combined PF and unicompartmental knee arthroplasty was performed in nine cases. We observed a significant improvement in the clinical and functional Knee Society Scores (KSSs) after surgery in our patients.RESULTSWe obtained good results in our cases both for clinical and functional KSSs. Patellar clunk was recorded in one case.DISCUSSION AND CONCLUSIONWe are going toward a new attitude in which partial osteoarthritic changes could be treated with partial resurfacing prosthetic solutions such as unicompartmental, bi–unicompartmental or PFR alone, or unicompartmental combined, which respects the cruciates and achieves maximal bone preservation, which is vital, particularly, for young patients.

Patellofemoral Arthroplasty: Current Concepts and Review of the Literature

“…Parratte et al 71 reported a 54% survivorship at 17-year follow-up in 77 knees with a good satisfaction rate. Also, Sabatini et al 23 reported an improvement in functional and clinical scores at 18-month follow-up in a case series of six knees treated with isolated PFA and nine knees treated with combined PFA and UKA. However, few studies are available that have evaluated the association of PFA and UKA, with small numbers and short follow-ups.…”

“… 68 This procedure can be performed in young patients or in elderly patients with severe comorbidities because of the less invasiveness of the surgery compared with TKA. 23 Some authors have described promising results for PFA associated to UKA. Argenson et al 67 reported optimal ROM and no postoperative pain in 17 patients treated with unlinked PFA and UKA.…”

“…A prerequisite for the success of PFA is a proper patient selection to avoid complications. 5 17 23 24 25 The most common indication for PFA is severe primary isolated PFOA that affects daily activities without relief from conservative treatment. PFA is also indicated in patients with posttraumatic PFOA, isolated trochlear dysplasia, patellar subluxation, or failure of previous extensor mechanism unloading procedures, such as Fulkerson or Maquet osteotomy.…”

“… 4 11 28 Active infection and evidence or high suspicion of chronic regional pain syndrome are also contraindications to PFA. 11 23 Quadriceps atrophy, patellar tendon scarring, patella baja, and excessive BMI (>30) represent relative contraindications to PFA, as have been correlated to poorer outcome. 11 23 Hence, the ideal candidate for PFA is a middle age patient affected by isolated, debilitating noninflammatory PFOA not responsive to conservative treatment and with normal limb alignment.…”

“…11 23 Quadriceps atrophy, patellar tendon scarring, patella baja, and excessive BMI (>30) represent relative contraindications to PFA, as have been correlated to poorer outcome. 11 23 Hence, the ideal candidate for PFA is a middle age patient affected by isolated, debilitating noninflammatory PFOA not responsive to conservative treatment and with normal limb alignment. 4 The main indications and contraindications are summarized in Table 1 .…”