Abstract
Purpose: Patello-femoral arthritis presents a considerable challenge to the orthopaedic surgeon. Traditionally, surgical options have produced unsatifactory results. Arthroscopic debridement, patellectomy, isolated patellar resurfacing and grafting have a poor long term clinical outcome. Patello-femoral arthroplasty is an alternative to total knee arthroplasty and patellectomy for anterior compartment osteoarthritis. Patello-femoral arthroplasty provides a more conservative approach in younger and more active patients especially. Advances in component design and biomechanics have led to many new generation replacements. The aim of this study was to look at the long term functional outcome of patello-femoral arthroplasty.
Methods: From a prospective database 36 patients were identified having a patello-femoral arthroplasty between 1990 – 2000. Four patients were lost to followup. Eighteen patients (56%) underwent an additional procedure for patella re-alignment (patella tendon transfer or lateral release) at the time of the patello-femoral arthroplasty. Mean followup was 72 months (range 24 – 149 mo). Clinical data was collected from a personal questionnaire and physical examination. All data was processed and all patients were evaluated using the Hungerford-Kenna score and the modified Lysholm score. Radiographs were assessed pre-operatively and at the most recent follow up. Peri-operative documentation was evaluated for etiology, pre-operative functional and subjective impairment, intra-operative technical difficulties or complications, early and late post-operative complications and post-operative functional outcomes.
Results: At the time of the most recent follow up, 22 knees had good or excellent result, 4 had fair result and 4 had a poor result. The remaining 2 knees were revised to a total knee arthrplasty due to progression of osteoarthritis. No loosening of the components was observed. The mean Lysholm knee score improved from 35.4 (range 9–68) pre-operatively to 76.1(range 37–100) post-operatively and the mean Hungerford-Kenna knee score improved from 29.6(range 10–65) pre-operatively to 78.1(range 45–100) post-operatively.
Conclusion: With proper patient selection, patello-femoral arthroplasty is a reliable procedure for the treatment of the patello-femoral arthritis. This procedure delays the need for further surgical procedures such as total knee arthroplasty with good results.
Correspondence should be addressed to: Orah Naor, IOA Secretary and Co-ordinator (email: ioanaor@netvision.net.il)
