From the Guidelines
Patella arthroplasty should be considered for patients with severe patellofemoral arthritis who have not responded to conservative treatments, as it can provide significant pain relief and improvement in knee function. When considering surgical options for patella arthopathy, it's essential to weigh the potential benefits against the risks and to explore all available treatment modalities. According to the American College of Rheumatology 2012 recommendations 1, nonpharmacologic modalities such as aerobic, aquatic, and/or resistance exercises, as well as weight loss for overweight patients, are strongly recommended for the management of knee OA.
Some key points to consider in the management of patella arthopathy include:
- Nonpharmacologic modalities conditionally recommended for knee OA, such as medial wedge insoles for valgus knee OA, subtalar strapped lateral insoles for varus knee OA, medially directed patellar taping, manual therapy, walking aids, thermal agents, tai chi, self-management programs, and psychosocial interventions 1.
- Pharmacologic modalities conditionally recommended for the initial management of patients with knee OA, including acetaminophen, oral and topical NSAIDs, tramadol, and intraarticular corticosteroid injections 1.
- The importance of a multidisciplinary approach to managing patella arthopathy, incorporating physical therapy, pain management, and potentially surgical intervention, to optimize patient outcomes and improve quality of life.
In terms of surgical options, patella arthroplasty can be an effective procedure for addressing severe patellofemoral arthritis, but it's crucial to carefully select patients who are likely to benefit from this intervention and to ensure that they are adequately prepared for the procedure and the subsequent rehabilitation process.
From the Research
Patella Arthopasty
- Patellofemoral arthroplasty is a treatment option for isolated patellofemoral arthritis, which can occur in isolation or as part of bicompartmental or tricompartmental osteoarthritis 2.
- The procedure involves resurfacing the patellofemoral joint with an implant, and has been shown to improve knee range of motion and reduce pain in patients with isolated patellofemoral arthritis 2, 3.
- Patient selection is critical to the success of patellofemoral arthroplasty, with typical indications including patients with isolated symptomatic patellofemoral osteoarthritis, trochlear dysplasia, and bone-on-bone osteoarthritis without significant malalignment or risk factors for developing progressive tibiofemoral osteoarthritis 3.
Indications and Contraindications
- Indications for patellofemoral arthroplasty include:
- Isolated symptomatic patellofemoral osteoarthritis
- Trochlear dysplasia
- Bone-on-bone osteoarthritis without significant malalignment or risk factors for developing progressive tibiofemoral osteoarthritis 3
- Contraindications for patellofemoral arthroplasty include:
- Significant malalignment or risk factors for developing progressive tibiofemoral osteoarthritis
- Lack of experience with arthroplasty or realignment of the extensor mechanism 3
Treatment Options
- Treatment options for patellofemoral arthritis include non-operative management, such as physical therapy, weight loss, and pharmacologic management, as well as surgical options, such as arthroscopic assessment, tibial tubercle osteotomy, and patellofemoral arthroplasty 4.
- Patellofemoral arthroplasty is a viable treatment option for patients with severe patellofemoral osteoarthritis who have failed non-operative management and are not candidates for total knee arthroplasty 4, 5.
Outcomes and Survivorship
- Patellofemoral arthroplasty has been shown to have improved short-term and midterm outcomes, with 5- and 10-year survivorships of 91.7% and 83.3%, respectively, and an annual revision rate of 2.18% 5.
- The most common reason for revising patellofemoral arthroplasty to total knee arthroplasty is progression of tibiofemoral arthritis, and conversion of patellofemoral arthroplasty to total knee arthroplasty has been shown to lead to successful outcomes with minimal bone loss 5.