A preliminary report of patellofemoral arthroplasty in isolated patellofemoral arthritis

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Author:
GAO Xiang(Department of Orthopaedics, the Second Affiliated Hospital,Medical School of Zhejiang University, Hangzhou, Zhejiang 310009, China)
XU Zheng-jian(Department of Orthopaedics, the Second Affiliated Hospital,Medical School of Zhejiang University, Hangzhou, Zhejiang 310009, China)
HE Rong-xin(Department of Orthopaedics, the Second Affiliated Hospital,Medical School of Zhejiang University, Hangzhou, Zhejiang 310009, China)
YAN Shi-gui(Department of Orthopaedics, the Second Affiliated Hospital,Medical School of Zhejiang University, Hangzhou, Zhejiang 310009, China)
WU Li-dong(Department of Orthopaedics, the Second Affiliated Hospital,Medical School of Zhejiang University, Hangzhou, Zhejiang 310009, China)
Journal Title:
CHINESE MEDICAL JOURNAL
Issue:
Volume 123, Issue 21, 2010
DOI:
10.3760/cma.j.issn.0366-6999.2010.21.013
Key Word:
patellofemoral arthroplasty;knee prosthesis;osteoarthritis

Abstract: Background Isolated patellofemoral osteoarthritis is not uncommon. Surgical treatment of isolated patellofemoral arthritis remains controversial and poses a challenging treatment dilemma. The present study aimed to evaluate the short-term results of patellofemoral arthroplasty for patients with isolated patellofemoral osteoarthritis.Methods We analyzed 11 patellofemoral arthroplasties performed from March 2006 to September 2009 in 11 patients with isolated patellofemoral arthritis. The patients comprised 2 males and 9 females with an average age of 53.7 years (range, 46-74 years). Standard weightbearing radiographs were taken in the anteroposterior, lateral, and 45° axial views.The knee pain and functional status were evaluated by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scales and American Knee Society (AKS) scores. For comparison, 23 total knee arthroplasties in 23 patients with primary tibiofemoral osteoarthritis were matched according to age, gender, bilaterality and body mass index.The duration of follow-up was 23.7 months (range, 12-47 months).Results The majority of the 11 patients experienced improvement in their patellofemoral symptoms after patellofemoral arthroplasty. The WOMAC scores improved considerably by 7.4 points with respect to pain and by 5.2 points with respect to function. The AKS scores also improved considerably by 23.9 points with respect to pain and 44.3 points with respect to function. Although the clinical outcomes after patellofemoral arthroplasty were not better than those after total knee arthroplasty, patellofemoral arthroplasty exhibited advantages in the shorter operation time, lower blood loss and increased postoperative range of motion. At the latest follow-up, there was no clinical or radiographic evidence of patellofemoral maltracking, loosening or wear.Conclusions On the basis of our experience in this relatively small series of patients with a short-term follow-up,patellofemoral arthroplasty is an effective treatment alternative to total knee arthroplasty in isolated patellofemoral arthritis. MRI and arthroscopy may contribute to define those patients with isolated patellofemoral degeneration.

  • [1]McAlindon TE,Snow S,Cooper C,Dieppe PA.Radiographic patterns of osteoarthritis of the knee joint in the community:the importance of the patellofemoral joint.Ann Rheum Dis 1992; 51:844-849.
  • [2]Davies AP,Vince AS,Shepstone L,Donell ST,Glasgow MM.The radiologic prevalence of patellofemoral osteoarthritis.Clin Orthop Relat Res 2002; (402):206-212.
  • [3]Parvizi J,Stuart MJ,Pagnano MW,Hanssen AD.Total knee arthroplasty in patients with isolated patellofemoral arthritis.Clin Orthop Relat Res 2001; (392):147-152.
  • [4]Meding JB,Wing JT,Keating EM,Ritter MA.Total knee arthroplasty for isolated patellofemoral arthritis in younger patients.Clin Orthop Relat Res 2007; (464):78-82.
  • [5]Gross JB.Estimating allowable blood loss:corrected for dilution.Anesthesiology 1983; 58:277-280.
  • [6]Hinman RS,Crossley KM.Patellofemoral joint osteoarthritis:an important subgroup of knee osteoarthritis.Rheumatology (Oxford) 2007; 46:1057-1062.
  • [7]Federico DJ,Reider B.Results of isolated patellar debridement for patellofemoral pain in patients with normal patellar alignment.Am J Sports Med 1997; 25:663-669.
  • [8]Gomes JL,Marczyk LR,Ruthner RP.Arthroscopic exposure of the patellar articular surface.Arthroscopy 2001; 17:98-100.
  • [9]Aderinto J,Cobb AG.Lateral release for patellofemoral arthritis.Arthroscopy 2002; 18:399-403.
  • [10]Kuroda R,Kambic H,Valdevit A,Andrish JT.Articular cartilage contact pressure after tibial tuberosity transfer.A cadaveric study.Am J Sports Med 2001; 29:403-409.
  • [11]Becker R,R(o)pke M,Krull A,Musahl V,Nebelung W.Surgical treatment of isolated patellofemoral osteoarthritis.Clin Orthop Relat Res 2008; (466):443-449.
  • [12]Lonner JH.Patellofemoral arthroplasty:pros,cons,and design considerations.Clin Orthop Relat Res 2004; (428):158-165.
  • [13]Tauro B,Ackroyd CE,Newman JH,Shah NA.The Lubinus patellofemoral arthroplasty.A five-to ten-year prospective study.J Bone Joint Surg Br 2001; 83:696-701.
  • [14]Board TN,Mahmood A,Ryan WG,Banks AJ.The Lubinus patellofemoral arthroplasty:a series of 17 cases.Arch Orthop Trauma Surg 2004; 124:285-287.
  • [15]Ackroyd CE,Chir B.Development and early results of a new patellofemoral arthroplasty.Clin Orthop Relat Res 2005; (436):7-13.
  • [16]Back DL,Cannon SR,Hilton A,Bankes MJ,Briggs TW.The Kinemax total knee arthroplasty.Nine years' experience.J Bone Joint Surg Br 2001; 83:359-363.
  • [17]Ackroyd CE,Newman JH,Evans R,Eldridge JD,Joslin CC.The Avon patellofemoral arthroplasty:five-year survivorship and functional results.J Bone Joint Surg Br 2007; 89:310-315.
  • [18]Lang P,Noorbakhsh F,Yoshioka H.MR imaging of articular cartilage:current state and recent developments.Radiol Clin North Am 2005; 43:629-639.
  • [19]Friemert B,Oberl(a)nder Y,Schwarz W,H(a)berle HJ,B(a)hren W,Gerngross H,et al.Diagnosis of chondral lesions of the knee joint:can MRI replace arthroscopy? A prospective study.Knee Surg Sports Traumatol Arthrosc 2004; 12:58-64.
  • [20]von Engelhardt LV,Kraft CN,Pennekamp PH,Schild HH,Schmitz A,von Falkenhausen M.The evaluation of articular cartilage lesions of the knee with a 3-Tesla magnet.Arthroscopy 2007; 23:496-502.
  • [21]Yoshioka H,Stevens K,Genovese M,Dillingham MF,Lang P.Articular cartilage of knee:normal patterns at MR imaging that mimic disease in healthy subjects and patients with osteoarthritis.Radiology 2004; 231:31-38.
  • [22]Lonner JH,Jasko JG,Booth RE Jr.Revision of a failed patellofemoral arthroplasty to a total knee arthroplasty.J Bone Joint Surg Am 2006; 88:2337-2342.
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