[Patellofemoral arthroplasty]

Abstract

Objective: Isolated resurfacing of the trochlea using an inlay prosthesis without changing the complex kinematics of the patellofemoral joint.

Indications: Symptomatic, isolated patellofemoral osteoarthritis or isolated osteochondral lesions, failed conservative and cartilage regeneration procedures. No or concurrently corrected ligament instability, tibiofemoral and patellofemoral malalignment.

Contraindications: Symptomatic patellofemoral osteoarthritis, inflammatory joint disease, chondrocalcinosis, chronic pain syndromes, active infections or knee ankylosis.

Surgical technique: Following a medial arthrotomy, coronal and sagittal curvatures of the trochlea are measured. Based on these measurements, corresponding surface reamers create an implant bed by removing damaged cartilage of the trochlea. A central fixation screw is placed to the desired depth and the inlay prosthesis is tapped carefully onto it. Final placement of the prosthesis is targeted slightly recessed to the surrounding joint surface.

Postoperative management: Free passive range of motion exercises of the knee joint are recommended starting on postoperative day 1. Depending on symptoms (e.g., pain and joint effusion), partial weight-bearing of 20 kg is allowed during postoperative weeks 1 and 2, which is increased by 20 kg/week thereafter.

Results: In a prospective study of 29 patients (mean age: 42 years) treated with inlay arthroplasty, 2‑year follow-up results showed significant improvements (p < 0.05) in WOMAC, IKDC and VAS (pain) scores when compared to baseline. Compared to onlay PF arthroplasty modern inlay prosthetic placement showed a better preservation of the tibiofemoral joint without progression of tibiofemoral degeneration. This may be due to possible avoidance of patellofemoral overstuffing using a more physiological placement of the inlay prosthesis.

Keywords: Arthroplasty, knee replacement; Bone malalignment; Osteoarthritis, knee; Patellofemoral joint; Prostheses and implants.