Treating Patellofemoral Arthritis with Patellofemoral Arthroplasty

Abstract

Isolated patellofemoral osteoarthritis (PF OA) is a relatively uncommon disorder that may lead to significant pain and disability in affected patients. Patellofemoral arthroplasty (PFA) is effective for the treatment of patellofemoral OA. Historically, high failure rates were associated with PFA related to component malpositioning, soft-tissue imbalance, and poor trochlear implant designs. As a result, PFA had been underutilized in the treatment of isolated patellofemoral OA. The evolution of surgical indications, technique, and the development of onlay-style trochlear components have improved patellar tracking, functional outcomes, and longevity of modern PFA. In fact, studies have demonstrated improved function and survivorship, as well as a lower incidence of patellar maltracking, when utilizing modern onlay-style trochlear implants. The presence of Grade III or IV tibiofemoral chondromalacia or OA remains a contraindication to the performance of PFA in isolation; however, in select patients, combining PFA with UKA (the so-called modular bicompartmental knee arthroplasty [BiKA]) or condylar cartilage grafting may provide good outcomes and expand the role of partial knee arthroplasty, as an alternative to total knee arthroplasty (TKA). Ultimately, as with any limited arthroplasty procedure, careful attention to patient selection, surgical technique, and implant selection are critical to achieving success in PFA.