Skip to main content

Main menu

  • Home
  • Content
    • Current
    • Ahead of print
    • Archive
  • Info for
    • Authors
    • Reviewers
  • About Us
    • About the Ochsner Journal
    • Editorial Board
  • More
    • Alerts
    • Feedback
  • Other Publications
    • Ochsner Journal Blog

User menu

  • My alerts
  • Log in

Search

  • Advanced search
Ochsner Journal
  • Other Publications
    • Ochsner Journal Blog
  • My alerts
  • Log in
Ochsner Journal

Advanced Search

  • Home
  • Content
    • Current
    • Ahead of print
    • Archive
  • Info for
    • Authors
    • Reviewers
  • About Us
    • About the Ochsner Journal
    • Editorial Board
  • More
    • Alerts
    • Feedback
Case ReportCASE REPORTS AND CLINICAL OBSERVATIONS

Patellofemoral Arthroplasty

Brian Godshaw, Nicholas Kolodychuk, Gerard K. Williams, Benjamin Browning and Deryk Jones
Ochsner Journal September 2018, 18 (3) 280-287; DOI: https://doi.org/10.31486/toj.18.0009
Brian Godshaw
1Ochsner Sports Medicine Institute, Ochsner Clinic Foundation, New Orleans, LA
2The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA
MD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Nicholas Kolodychuk
2The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA
MBBS
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Gerard K. Williams Jr.
1Ochsner Sports Medicine Institute, Ochsner Clinic Foundation, New Orleans, LA
MD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Benjamin Browning
1Ochsner Sports Medicine Institute, Ochsner Clinic Foundation, New Orleans, LA
MD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Deryk Jones
1Ochsner Sports Medicine Institute, Ochsner Clinic Foundation, New Orleans, LA
2The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA
MD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: djones@ochsner.org
  • Article
  • Figures & Data
  • References
  • Info & Metrics
  • PDF
Loading

Abstract

Background: Patellofemoral arthritis is a common cause of anterior knee pain and limits flexion-related activities of daily living and exercise. While frequently present in bicompartmental and tricompartmental osteoarthritis, patellofemoral arthritis can occur in isolation. Patellofemoral arthroplasty as a treatment option is gaining in popularity, especially with new implant designs. We report a case in which new inlay implants were used to resurface the patellofemoral joint in a patient with contralateral compromise secondary to a previous below-knee amputation.

Case Report: A 37-year-old female with a contralateral right below-knee amputation and progressive left patellofemoral arthritis had failed multiple conservative treatment modalities. She underwent isolated patellofemoral arthroplasty using an inlay-designed implant. The patient was followed for 2 years postoperatively. She noticed an immediate increase in her knee range of motion and her pain scores improved. Two years postoperatively, she demonstrated drastic improvement in all outcome measures: International Knee Documentation Committee score (16.1 to 88.5), Lysholm Knee Scoring Scale (22 to 100), Knee Injury and Osteoarthritis Outcome Score (KOOS) Symptoms (7.14 to 96.43), KOOS Pain (2.78 to 100), KOOS Activities of Daily Living (0 to 100), KOOS Sports (0 to 100), and KOOS Quality of Life (12.5 to 93.75).

Conclusion: Inlay patellofemoral arthroplasty is a valid treatment option for isolated patellofemoral arthritis. Successful results can be achieved with this procedure after failure of conservative measures in patients with limited or no evidence of tibiofemoral arthritis.

Keywords:
  • Amputation
  • arthritis
  • arthroplasty–replacement–knee
  • patellofemoral joint

INTRODUCTION

Patellofemoral arthritis is a common cause of anterior knee pain. Anterior knee pain is a frequent chief complaint in orthopedic patients. In a study of 204 knees, Davies et al found that patellofemoral joint space narrowing occurred in 33.7% of men and 36.1% of women >60 years of age. This area was involved in isolation in 15.4% of men and 13.6% of women in the same study.1 In a retrospective review of 31,516 knee arthroscopies evaluating for cartilage lesions, grade III lesions of the patella were prevalent in 20% of patients.2 Many conservative and surgical treatment options are available for patients with isolated patellofemoral arthritis. Initial conservative management is preferred and typically involves activity modification with isometric quadriceps strengthening, while limiting open-chain exercises at the patellofemoral joint. Nonsteroidal antiinflammatory medications and steroid injections can be beneficial as well.3 Since the early 2000s, biologic injections have also been used during conservative management and include platelet-rich plasma (typically leukocyte poor), viscosupplementation (a hyaluronic acid preparation of variable molecular weights), stem cells (various sources), or placental growth factors.4-9 All of these options have demonstrated mixed results.

If adequate symptomatic relief is not achieved with these measures, surgical options are considered. Arthroscopic chondroplasty can theoretically help remove inflammatory mediators, mechanical cartilage fragments, and loose bodies, and some studies have shown short-term relief for a 2-year period.10-12 Other studies evaluating arthroscopic treatment have demonstrated questionable results.13,14 Advancements in cartilage restoration and arthroplasty techniques have led to improved outcomes following more invasive surgical interventions.15

The optimal intervention is ultimately determined by patient-specific factors. The presence of patellofemoral malalignment as assessed by the tibial tubercle-trochlear groove (TT-TG) distance is important. Articular cartilage lesion size, location, depth, and the involvement of the adjacent surface—the kissing lesion—must be considered. Patient comorbidities, particularly body mass index, should help guide the clinician's decision tree as well. Social factors such as the patient's occupation, desired postoperative activity level, and ability to comply with rehabilitation protocols are equally important.

Surgical Options for Lesions <2 cm2

Microfracture has traditionally been an option for small trochlear lesions <2 cm2 in size; however, because of the lack of high-quality evidence and variable outcomes in the patellofemoral joint, this procedure should be used cautiously.16

An option for patellar maltracking involving bony realignment is tibial tubercle anteromedialization as described by Fulkerson.17 This procedure has been shown to achieve symptomatic relief by diminishing the load transmitted over an arthritic patellofemoral joint. Successful outcomes have been reported in patients with grade IV lateral facet arthritis and a TT-TG distance >20 mm.18 Poorer outcomes with the Fulkerson osteotomy have been seen in patients with crush or dashboard-type injuries; consequently, the procedure is not recommended for these patients.19

Surgical Options for Lesions 2-4 cm2

Autologous chondrocyte implantation (ACI) is a surgical option used with full-thickness cartilage defects >3-4 cm2 in the femoral condyles or trochlear groove. This 2-step procedure involves harvesting 200-300 mg of articular cartilage and associated subchondral bone. The tissue is subsequently used to culture and proliferate chondrocytes. At the second stage, cells are implanted with a collagen patch, allowing the cells to adhere to and grow on the subchondral bone surface. ACI has shown good to excellent results in several studies with extended follow-up.20-22 In the largest of these studies, Gomoll et al prospectively followed 110 patients who underwent ACI in the patella for a minimum of 4 years; 92% of the patients stated they would undergo ACI again.22 However, the average age of the patients in the Gomoll et al study was 30-35 years.

A modification of ACI is matrix-induced autologous chondrocyte implantation (MACI) in which cells are seeded on a type I/III porcine collagen membrane that is implanted, allowing cells to adhere to the subchondral bone plate.23 In a 2015 study of MACI outcomes, Ebert et al found 85% satisfaction at 24 months.24 This same group demonstrated that similar results could be obtained with the MACI procedure in the patellofemoral and tibiofemoral joints if concomitant patellar realignment surgery was performed to correct underlying malalignment.24

Osteochondral autograft and allograft transplantations are also options. Osteochondral autograft transplantation can be used to treat 2- to 4-cm2 defects. In a direct comparison between the ACI procedure and a mosaicplasty osteochondral autograft transplantation technique (4- to 6-mm diameter plugs), Bentley et al reported no good or excellent results in patients treated with the mosaicplasty technique for patellar defects.25 Although this procedure is an option, results are suboptimal. Osteochondral allograft transplantation for patellofemoral lesions limits donor site morbidity but can have issues with articular cartilage viability and bone incorporation. The current literature supports a limited role for the use of osteochondral allografts in patients with extensive patellofemoral arthritis. Graft survivorship and incorporation are concerns in chronic conditions in which large kissing lesions are noted preoperatively or intraoperatively. A study that followed patients undergoing allograft transplantation found <60% graft survival at 10 years.26 Despite these outcomes, osteochondral allograft transplantations have a niche, particularly in young patients. Young individuals with diffuse defects who have failed conservative management and less invasive surgical treatments can have good results with a biojoint procedure replacing both of the patellofemoral surfaces.27

Surgical Options for End-Stage Lesions

For end-stage patellofemoral arthritis, joint arthroplasty can be an excellent option. Debate and controversy center on the most appropriate joint replacement option for these patients. Choices include isolated patellofemoral arthroplasty (PFA), bicompartmental knee arthroplasty (BKA), and total knee arthroplasty (TKA). PFA is indicated for isolated patellofemoral arthritis when chondral and meniscal damage in the medial and lateral compartments is limited and ligamentous stability is appropriate.28 The presence of extensive tibiofemoral joint disease with or without varus/valgus malalignment is a contraindication to PFA. The surgeon should use clinical evaluation, radiographic studies, and magnetic resonance imaging in the patient selection process.29

Arthroscopic confirmation should be performed at the time of surgical intervention to verify clinical suspicions and exclude patients with potential early and intermediate-term failure rates with PFA.30 Isolated PFA, BKA, and TKA have shown similar outcomes for pain relief; however, improved function, earlier return to activities, less intraoperative blood loss, and less surgical time have been seen with PFA and BKA compared to TKA procedures. Dahm et al used the Kellgren-Lawrence radiographic assessment of the tibiofemoral joint and Iwano scoring assessment of the patellofemoral joint to compare the use of PFA and TKA in patients with isolated patellofemoral disease.31 At a mean follow-up of 27-29 months, the mean postoperative Knee Society Clinical Rating System scores were 89 following PFA and 90 following TKA. Knee Society Clinical Rating System scores range from 0 to 100, with higher scores indicating better knee conditions. Similarly, mean University of California-Los Angeles (UCLA) activity scores were better in the PFA cohort (6.6) than in the TKA cohort (4.2) (P<0.0001), demonstrating that patients who underwent PFA were able to regularly participate in moderate activities such as bicycling, whereas the TKA patients could not do so regularly. Blood loss (P = 0.03) and hospital stay (P = 0.001) were lower in the PFA population compared with the TKA population. Blood loss, hospital stay, and functional outcomes were not impacted by age as an independent variable when assessed by linear regression analysis. An additional benefit is the maintenance of normal knee kinematics with PFA and BKA compared to TKA as a result of retention of the anterior/posterior cruciate ligament central pivot, proprioception, and bone structure maintaining the radius of curvature of the femoral condyles.32-35

Despite these benefits, progression of osteoarthritis in the remaining compartments is a possibility; therefore, the patient should be warned of the potential need for a future TKA. One retrospective study demonstrated a 21% conversion rate of PFA to TKA at an average of 5.5 years.36 Revision from PFA to a TKA at a later date has been performed without complication, making PFA an attractive alternative for young patients who would likely outlive the lifetime of their total knee implant.37

We present a unique case of a patient who underwent a PFA in the setting of a contralateral BKA.

CASE REPORT

A 37-year-old female who had been involved in a motor vehicle collision 13 years prior that led to a right below-knee amputation presented with complaints of significant left anterior knee pain. Her pain had progressed to the point that she was having frequent episodes of nocturnal pain that aroused her from sleep. Her below-knee amputation in the opposite knee placed increased stress on the patellofemoral joint in the involved knee during activities of daily living. She had undergone extensive conservative treatment modalities, including activity modification, physical therapy, and oral nonsteroidal antiinflammatory medications. She received intraarticular corticosteroid injections that provided brief symptomatic relief. Despite these interventions, she continued to have severe and debilitating pain.

On physical examination, her range of motion in the left knee was 0-100 degrees with audible and palpable crepitus at the patellofemoral joint. The patellofemoral grind test replicated her pain. The patient had no patellar malalignment, a negative J sign, and no patella alta. She had no evidence of patellar instability, with patellar glide 1 quadrant laterally and 2 quadrants medially at 30 degrees flexion. The patient demonstrated no apprehension on provocative testing at 30-45 degrees flexion. Radiographs revealed minimal changes in the medial and lateral compartments with preservation of the joint space radiographically on anterior-posterior and lateral standing views (Figures 1A and 1B, respectively) but severe degenerative changes in the left patellofemoral joint with sclerosis and hypertrophic bone formation on Merchant view (Figure 1C). Magnetic resonance imaging demonstrated intact meniscal and ligamentous structures. These images showed intact articular cartilage surfaces in the medial and lateral compartments. Given the patient's young age, lack of medical comorbidities, preserved medial and lateral compartments, and failure of extensive conservative treatment, the decision was to proceed with PFA. Prior to intervention, several baseline outcome scores were obtained: International Knee Documentation Committee (IKDC) score, the Lysholm Knee Scoring Scale, and Knee Injury and Osteoarthritis Outcome Score (KOOS) components (Symptoms, Pain, Activities of Daily Living, Sports, and Quality of Life). For all 3 scales, higher scores indicate better function.

Figure 1.
  • Download figure
  • Open in new tab
  • Download powerpoint
Figure 1. Preoperative radiographs from (A) anterior-posterior, (B) lateral, and (C) Merchant views demonstrate severe left patellofemoral arthritis with preserved tibiofemoral joint spaces and a right below-knee amputation stump with open reduction internal fixation hardware in place.

Surgical Procedure

Arthroscopy was first performed using standard anterolateral and anteromedial portals. An International Cartilage Repair Society (ICRS) grade IV 4 × 3-cm lesion was noted along the entire trochlear area; an additional 3 × 3-cm ICRS grade IV kissing lesion was noted in the central eminence of the patella (Figures 2A and 2B). The patella demonstrated significant lateral tilt and diffuse synovitic changes. Scarring in the intercondylar notch was evident and subsequently debrided.

Figure 2.
  • Download figure
  • Open in new tab
  • Download powerpoint
Figure 2. Intraoperative arthroscopic images demonstrate severe osteoarthritis with complete cartilage loss on the undersurface of the (A) patella and (B) the trochlea.

Cruciate ligament (Figure 3A), menisci (Figures 3B and 3C), and remaining articular cartilage structures were visualized arthroscopically and demonstrated no significant pathology. A 1-cm2 ICRS grade II cartilage lesion of the medial femoral condyle was treated with gentle arthroscopic debridement to stable borders.

Figure 3.
  • Download figure
  • Open in new tab
  • Download powerpoint
Figure 3. Intraoperative images of the (A) anterior cruciate ligament, (B) medial meniscus, and (C) lateral meniscus demonstrate no concomitant pathology.

The medial portal was closed and a lateral incision was made, incorporating the anterolateral portal. A lateral subvastus approach was utilized through a miniarthrotomy (4 cm). Bone spurs were removed as encountered. The trochlear lesion was exposed. The Arthrosurface joint replacement system (Arthrosurface) provides several sizing guides that assess the patient's trochlear groove bone geometry in the sagittal and coronal planes. Measurements revealed that an 8.5 × 4-mm femoral implant was most appropriate for our patient. The femoral lesion was reamed centrally, proximally, and distally using the Arthrosurface guides and reamers. Further contouring of the proximal-distal and medial-lateral lesion edges with a high-speed burr was performed to prevent prominence of the trochlear implant on flexion and extension at 30-60 degrees postoperatively. The central hole was tapped to appropriate depth using the Arthrosurface guide to limit bone penetration. In the Arthrosurface system, the central screw maintains the appropriate depth of the implant, avoiding subsidence (Figure 4A). The trochlear implant was impacted into the screw using a modular technique (Figure 4B). Bleeding bone was maintained along the surface, and a press-fit HemiCAP (Arthrosurface) trochlear implant was placed in anatomic position.

Figure 4.
  • Download figure
  • Open in new tab
  • Download powerpoint
Figure 4. Intraoperative images show (A) preparation of the trochlea, (B) final trochlear groove implant with inlayed implant lying flush with the native femoral cartilage, (C) undersurface of the patella with severe arthritis changes and complete loss of cartilage, (D) undersurface of the patella after preparation with all of the arthritic cartilage removed, and (E) final patella implant.

Attention then turned to the patellar lesion. The center of the lesion was visualized (Figure 4C), and the central pin was applied using the Arthrosurface 9-mm dome patella trial as a guide. Care was taken to maintain bone geometry while maximizing coverage of the patellar lesion. With the pin in position, an Arthrosurface reamer was used to remove the damaged articular surface to the appropriate depth. The 9-mm dome patella trial was applied. The inlay patella implant requires further contouring of the peripheral edges of the remaining bone structure to prevent impingement on the trochlear implant with flexion and extension. Contouring of the patella periphery was performed with a rongeur. The knee was ranged, and adequate patellofemoral tracking was noted; in particular, smooth central tracking with no mechanical palpable or audible irregularities was demonstrated on passive flexion and extension from 0-130 degrees. The 9-mm dome patella polyethylene implant was cemented into position (Figure 4D). A final assessment after cement hardening demonstrated excellent patellar tracking (Figure 4E). The wound was irrigated, and deep/superficial lateral knee layer closure was performed in standard fashion.

Postoperative Care and Follow-Up

Postoperatively, the patient was immediately placed in a continuous passive motion machine from −10 to 120 degrees flexion for 6-8 hours per day for 4 weeks. Immediate full weight-bearing as tolerated was allowed with walker assistance. The patient began physical therapy 1 week after surgery. On her first postoperative visit at 2 weeks, she had 0-110 degrees of motion and was progressed to crutches. On her second postoperative visit at 6 weeks, her flexion had improved to 115 degrees. At 8 months postoperatively, she demonstrated knee flexion to 130 degrees and showed improvement in all outcome measures. Two years postoperatively, she was contacted via telephone to complete outcome scoring. She continued to show great improvement in all outcome measures. The Table shows the patient's baseline, 8-month, and 2-year outcomes scores. She was pain free 2 years postoperatively (KOOS Pain 100). Radiographs taken 2 years postoperatively (Figure 5) demonstrate well-positioned components without evidence of loosening and appropriate tracking of the patella.

Figure 5.
  • Download figure
  • Open in new tab
  • Download powerpoint
Figure 5. Two years postoperatively, radiographs from (A) anterior-posterior, (B) lateral, and (C) Merchant views demonstrate patellofemoral arthroplasty implants in good position with excellent patellofemoral tracking.
View this table:
  • View inline
  • View popup
Table. Patient Outcome Scores at Baseline and Follow-Up

DISCUSSION

Based on the change in her outcome scores, our patient had a dramatic improvement in quality of life after her PFA. PFA declined in popularity in the 1980s and 1990s, but the technique has seen a resurgence for treatment of isolated patellofemoral arthritis refractory to conservative modalities.38 PFA dates to 1955 with the report by McKeever of patellar resurfacing for patellofemoral arthritis.39-41 When continued follow-up at 22 years after implantation showed satisfactory results in 39 of 45 patients with McKeever prostheses, the efficacy of PFA gained increased traction.41 Advances in PFA technique and the development of new inlay hardware components have made this procedure a useful alternative to TKA in select patients. Given the select role of PFA in the patellofemoral arthritis treatment algorithm, it is important to reiterate its specific indications: failure of conservative treatment measures, absence of or corrected malalignment, intact medial and lateral menisci, and intact cruciate and collateral ligaments.42

Compared to TKA, PFA is an excellent option for young patients as it extends function, reduces pain, and preserves significant native bone stock.28,43 If tibiofemoral arthritis subsequently develops, the conversion to TKA can be accomplished with removal of the PFA hardware without compromising the integrity of the remaining bone.42 In a study assessing functional scores at 24-month follow-up, Imhoff et al found that 81% of patients were either satisfied or very satisfied with their outcomes.44 In a direct comparison of TKA to PFA for treatment of isolated patellofemoral arthritis, PFA had equivocal clinical outcomes while decreasing both intraoperative blood loss and hospital length of stay.31

The original onlay PFA implant designs did not place the trochlear implant flush with the femoral surface. This design may have led to the initially higher rates of reoperation for instability, patellar maltracking, and progression of tibiofemoral arthritis.45 Second-generation inlay designs lie flush with the surrounding cartilage and allow for individualized anatomic trochlear resurfacing, offering several advantages described by Lonner in 2007.46 The new design increases implant stability, leads to less overstuffing of the patellofemoral joint, and has less patellofemoral mechanical complications, but these design improvements have not been clearly reflected in the current literature.47 However, patients with the second-generation inlay designs have been found to be less likely to have progression of tibiofemoral arthritis at 26 months, suggesting that this design can lead to superior long-term outcomes.47

CONCLUSION

Anterior knee pain because of patellofemoral arthritis is a common cause of patient visits to orthopedic surgeons. After failure of conservative measures, several operative techniques provide options for managing patellofemoral arthritis. The current literature demonstrates that PFA using second-generation inlay designs is a safe and effective option. This procedure offers several benefits compared to TKA and onlay-designed PFA. Despite the superiority of PFA, the long-term follow-up literature for this design can lead to limited, and thus further studies are warranted to fully explore its benefits and efficacy.

This article meets the Accreditation Council for Graduate Medical Education and the American Board of Medical Specialties Maintenance of Certification competencies for Patient Care and Medical Knowledge.

ACKNOWLEDGMENTS

The authors have no financial or proprietary interest in the subject matter of this article.

  • © Academic Division of Ochsner Clinic Foundation

REFERENCES

  1. 1.↵
    1. Davies AP,
    2. Vince AS,
    3. Shepstone L,
    4. Donell ST,
    5. Glasgow MM
    . The radiologic prevalence of patellofemoral osteoarthritis. Clin Orthop Relat Res. 2002 Sep;(402):206-212.
  2. 2.↵
    1. Curl WW,
    2. Krome J,
    3. Gordon ES,
    4. Rushing J,
    5. Smith BP,
    6. Poehling GG
    . Cartilage injuries: a review of 31,516 knee arthroscopies. Arthroscopy. 1997 Aug;13(4):456-460.
    OpenUrlCrossRefPubMed
  3. 3.↵
    1. Kolettis GT,
    2. Stern SH
    . Patellar resurfacing for patellofemoral arthritis. Orthop Clin North Am. 1992 Oct;23(4):665-673.
    OpenUrlPubMed
  4. 4.↵
    1. Hunter DJ
    . Viscosupplementation for osteoarthritis of the knee. N Engl J Med. 2015 Jun 25;372(26):2570. doi: 10.1056/NEJMc1505801.
    OpenUrlCrossRef
  5. 5.↵
    1. Halpern B,
    2. Chaudhury S,
    3. Rodeo SA,
    4. et al.
    Clinical and MRI outcomes after platelet-rich plasma treatment for knee osteoarthritis. Clin J Sport Med. 2013 May;23(3):238-239. doi: 10.1097/JSM.0b013e31827c3846.
    OpenUrlCrossRefPubMed
  6. 6.↵
    1. Orozco L,
    2. Munar A,
    3. Soler R,
    4. et al.
    Treatment of knee osteoarthritis with autologous mesenchymal stem cells: a pilot study. Transplantation. 2013 Jun 27;95(12):1535-1541. doi: 10.1097/TP.0b013e318291a2da.
    OpenUrlCrossRefPubMed
  7. 7.↵
    1. Orozco L,
    2. Munar A,
    3. Soler R,
    4. et al.
    Treatment of knee osteoarthritis with autologous mesenchymal stem cells: two-year follow-up results. Transplantation. 2014 Jun 15;97(11):e66-e68. doi: 10.1097/TP.0000000000000167.
    OpenUrlCrossRefPubMed
  8. 8.↵
    1. Vega A,
    2. Martín-Ferrero MA,
    3. Del Canto F,
    4. et al.
    Treatment of knee osteoarthritis with allogeneic bone marrow mesenchymal stem cells: a randomized controlled trial. Transplantation. 2015 Aug;99(8):1681-1690. doi: 10.1097/TP.0000000000000678.
    OpenUrlCrossRefPubMed
  9. 9.↵
    1. Willett NJ,
    2. Thote T,
    3. Lin AS,
    4. et al.
    Intra-articular injection of micronized dehydrated human amnion/chorion membrane attenuates osteoarthritis development. Arthritis Res Ther. 2014 Feb 6;16(1):R47. doi: 10.1186/ar4476.
    OpenUrlCrossRefPubMed
  10. 10.↵
    1. Aichroth PM,
    2. Patel DV,
    3. Moyes ST
    . A prospective review of arthroscopic debridement for degenerative joint disease of the knee. Int Orthop. 1991;15(4):351-355.
    OpenUrlPubMed
  11. 11.↵
    1. Merchan EC,
    2. Galindo E
    . Arthroscope-guided surgery versus nonoperative treatment for limited degenerative osteoarthritis of the femorotibial joint in patients over 50 years of age: a prospective comparative study. Arthroscopy. 1993;9(6):663-667.
    OpenUrlCrossRefPubMed
  12. 12.↵
    1. Krych AJ,
    2. Bert JM,
    3. Levy BA
    . Treatment of OA of the knee in the middle-aged athlete: the role of arthroscopy. Sports Med Arthrosc Rev. 2013 Mar;21(1):23-30. doi: 10.1097/JSA.0b013e318270d1bd.
    OpenUrlCrossRef
  13. 13.↵
    1. Kirkley A,
    2. Birmingham TB,
    3. Litchfield RB,
    4. et al.
    A randomized trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med. 2008 Sep 11;359(11):1097-1107. doi: 10.1056/NEJMoa0708333.
    OpenUrlCrossRefPubMed
  14. 14.↵
    1. Moseley JB,
    2. O'Malley K,
    3. Petersen NJ,
    4. et al.
    A controlled trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med. 2002 Jul 11;347(2):81-88.
    OpenUrlCrossRefPubMed
  15. 15.↵
    1. Mosier BA,
    2. Arendt EA,
    3. Dahm DL,
    4. Dejour D,
    5. Gomoll AH
    . Management of patellofemoral arthritis: from cartilage restoration to arthroplasty. J Am Acad Orthop Surg. 2016 Nov;24(11):e163-e173.
    OpenUrl
  16. 16.↵
    1. Mithoefer K,
    2. McAdams T,
    3. Williams RJ,
    4. Kreuz PC,
    5. Mandelbaum BR
    . Clinical efficacy of the microfracture technique for articular cartilage repair in the knee: an evidence-based systematic analysis. Am J Sports Med. 2009 Oct;37(10):2053-2063. doi: 10.1177/0363546508328414.
    OpenUrlCrossRefPubMed
  17. 17.↵
    1. Chen H,
    2. Zhao D,
    3. Xie J,
    4. et al.
    The outcomes of the modified Fulkerson osteotomy procedure to treat habitual patellar dislocation associated with high-grade trochlear dysplasia. BMC Musculoskelet Disord. 2017 Feb 8;18(1):73. doi: 10.1186/s12891-017-1417-4.
    OpenUrlCrossRef
  18. 18.↵
    1. Fulkerson JP
    . Alternatives to patellofemoral arthroplasty. Clin Orthop Relat Res. 2005 Jul;(436):76-80.
  19. 19.↵
    1. Pidoriano AJ,
    2. Weinstein RN,
    3. Buuck DA,
    4. Fulkerson JP
    . Correlation of patellar articular lesions with results from anteromedial tibial tubercle transfer. Am J Sports Med. 1997 Jul-Aug;25(4):533-537.
    OpenUrlCrossRefPubMed
  20. 20.↵
    1. Gobbi A,
    2. Kon E,
    3. Berruto M,
    4. et al.
    Patellofemoral full-thickness chondral defects treated with second-generation autologous chondrocyte implantation: results at 5 years' follow-up. Am J Sports Med. 2009 Jun;37(6):1083-1092. doi: 10.1177/0363546509331419.
    OpenUrlCrossRefPubMed
  21. 21.↵
    1. Mandelbaum B,
    2. Browne JE,
    3. Fu F,
    4. et al.
    Treatment outcomes of autologous chondrocyte implantation for full-thickness articular cartilage defects of the trochlea. Am J Sports Med. 2007 Jun;35(6):915-921.
    OpenUrlCrossRefPubMed
  22. 22.↵
    1. Gomoll AH,
    2. Gillogly SD,
    3. Cole BJ,
    4. et al.
    Autologous chondrocyte implantation in the patella: a multicenter experience. Am J Sports Med. 2014 May;42(5):1074-1081. doi: 10.1177/0363546514523927.
    OpenUrlCrossRefPubMed
  23. 23.↵
    1. Gigante A,
    2. Bevilacqua C,
    3. Ricevuto A,
    4. Mattioli-Belmonte M,
    5. Greco F
    . Membrane-seeded autologous chondrocytes: cell viability and characterization at surgery. Knee Surg Sports Traumatol Arthrosc. 2007 Jan;15(1):88-92.
    OpenUrlCrossRefPubMed
  24. 24.↵
    1. Ebert JR,
    2. Fallon M,
    3. Smith A,
    4. Janes GC,
    5. Wood DJ
    . Prospective clinical and radiologic evaluation of patellofemoral matrix-induced autologous chondrocyte implantation. Am J Sports Med. 2015 Jun;43(6):1362-1372. doi: 10.1177/0363546515574063.
    OpenUrlCrossRefPubMed
  25. 25.↵
    1. Bentley G,
    2. Biant LC,
    3. Carrington RW,
    4. et al.
    A prospective, randomised comparison of autologous chondrocyte implantation versus mosaicplasty for osteochondral defects in the knee. J Bone Joint Surg Br. 2003 Mar;85(2):223-230.
    OpenUrlCrossRefPubMed
  26. 26.↵
    1. Torga Spak R,
    2. Teitge RA
    . Fresh osteochondral allografts for patellofemoral arthritis: long-term followup. Clin Orthop Relat Res. 2006 Mar;444:193-200.
    OpenUrlCrossRefPubMed
  27. 27.↵
    1. Vansadia DV,
    2. Heltsley JR,
    3. Montgomery S,
    4. Suri M,
    5. Jones DG
    . Osteochondral allograft transplantation for femoral trochlear dysplasia. Ochsner J. 2016 Winter;16(4):475-480.
    OpenUrlAbstract/FREE Full Text
  28. 28.↵
    1. Leadbetter WB
    . Patellofemoral arthroplasty in the treatment of patellofemoral arthritis: rationale and outcomes in younger patients. Orthop Clin North Am. 2008 Jul;39(3):363-380, vii. doi: 10.1016/j.ocl.2008.04.001.
    OpenUrlCrossRefPubMed
  29. 29.↵
    1. Yamabe E,
    2. Ueno T,
    3. Miyagi R,
    4. Watanabe A,
    5. Guenzi C,
    6. Yoshioka H
    . Study of surgical indication for knee arthroplasty by cartilage analysis in three compartments using data from Osteoarthritis Initiative (OAI). BMC Musculoskelet Disord. 2013 Jun 25;14:194. doi: 10.1186/1471-2474-14-194.
    OpenUrlCrossRefPubMed
  30. 30.↵
    1. Oni JK,
    2. Hochfelder J,
    3. Dayan A
    . Isolated patellofemoral arthroplasty. Bull Hosp Jt Dis (2013). 2014;72(1):97-103.
    OpenUrl
  31. 31.↵
    1. Dahm DL,
    2. Al-Rayashi W,
    3. Dajani K,
    4. Shah JP,
    5. Levy BA,
    6. Stuart MJ
    . Patellofemoral arthroplasty versus total knee arthroplasty in patients with isolated patellofemoral osteoarthritis. Am J Orthop (Belle Mead NJ). 2010 Oct;39(10):487-491.
    OpenUrlPubMed
  32. 32.↵
    1. Wünschel M,
    2. Lo J,
    3. Dilger T,
    4. Wülker N,
    5. Müller O
    . Influence of bi- and tri-compartmental knee arthroplasty on the kinematics of the knee joint. BMC Musculoskelet Disord. 2011 Jan 27;12:29. doi: 10.1186/1471-2474-12-29.
    OpenUrlCrossRefPubMed
  33. 33.↵
    1. Chung JY,
    2. Min BH
    . Is bicompartmental knee arthroplasty more favourable to knee muscle strength and physical performance compared to total knee arthroplasty? Knee Surg Sports Traumatol Arthrosc. 2013 Nov;21(11):2532-2541. doi: 10.1007/s00167-013-2489-9.
    OpenUrlCrossRefPubMed
  34. 34.↵
    1. Lonner JH
    . Patellofemoral arthroplasty: pros, cons, and design considerations. Clin Orthop Relat Res. 2004 Nov;(428):158-165.
  35. 35.↵
    1. Parratte S,
    2. Ollivier M,
    3. Opsomer G,
    4. Lunebourg A,
    5. Argenson JN,
    6. Thienpont E
    . Is knee function better with contemporary modular bicompartmental arthroplasty compared to total knee arthroplasty? Short-term outcomes of a prospective matched study including 68 cases. Orthop Traumatol Surg Res. 2015 Sep;101(5):547-552. doi: 10.1016/j.otsr.2015.03.019.
    OpenUrlCrossRef
  36. 36.↵
    1. Hoogervorst P,
    2. de Jong RJ,
    3. Hannink G,
    4. van Kampen A
    . A 21% conversion rate to total knee arthroplasty of a first-generation patellofemoral prosthesis at a mean follow-up of 9.7 years. Int Orthop. 2015 Sep;39(9):1857-1864. doi: 10.1007/s00264-015-2941-1.
    OpenUrlCrossRef
  37. 37.↵
    1. Gupta RR,
    2. Zywiel MG,
    3. Leadbetter WB,
    4. Bonutti P,
    5. Mont MA
    . Scientific evidence for the use of modern patellofemoral arthroplasty. Expert Rev Med Devices. 2010 Jan;7(1):51-66. doi: 10.1586/erd.09.53.
    OpenUrlCrossRefPubMed
  38. 38.↵
    1. Arciero RA,
    2. Toomey HE
    . Patellofemoral arthroplasty. A three- to nine-year follow-up study. Clin Orthop Relat Res. 1988 Nov;(236):60-71.
  39. 39.↵
    1. McKeever DC
    . Patellar prosthesis. J Bone Joint Surg Am. 1955 Oct;37-A(5):1074-1084.
    OpenUrlFREE Full Text
  40. 40.↵
    1. Kooijman HJ,
    2. Driessen AP,
    3. van Horn JR
    . Long-term results of patellofemoral arthroplasty. A report of 56 arthroplasties with 17 years of follow-up. J Bone Joint Surg Br. 2003 Aug;85(6):836-840.
    OpenUrlPubMed
  41. 41.↵
    1. Krajca-Radcliffe JB,
    2. Coker TP
    . Patellofemoral arthroplasty. A 2- to 18-year followup study. Clin Orthop Relat Res. 1996 Sep;(330):143-151.
  42. 42.↵
    1. Cannon A,
    2. Stolley M,
    3. Wolf B,
    4. Amendola A
    . Patellofemoral resurfacing arthroplasty: literature review and description of a novel technique. Iowa Orthop J. 2008;28:42-48.
    OpenUrlPubMed
  43. 43.↵
    1. Lonner JH,
    2. Bloomfield MR
    . The clinical outcome of patellofemoral arthroplasty. Orthop Clin North Am. 2013 Jul;44(3):271-280, vii. doi: 10.1016/j.ocl.2013.03.002.
    OpenUrlCrossRefPubMed
  44. 44.↵
    1. Imhoff AB,
    2. Feucht MJ,
    3. Meidinger G,
    4. Schöttle PB,
    5. Cotic M
    . Prospective evaluation of anatomic patellofemoral inlay resurfacing: clinical, radiographic, and sports-related results after 24 months. Knee Surg Sports Traumatol Arthrosc. 2015 May;23(5):1299-1307. doi: 10.1007/s00167-013-2786-3.
    OpenUrlCrossRef
  45. 45.↵
    1. van Jonbergen HP,
    2. Werkman DM,
    3. Barnaart LF,
    4. van Kampen A
    . Long-term outcomes of patellofemoral arthroplasty. J Arthroplasty. 2010 Oct;25(7):1066-1071. doi: 10.1016/j.arth.2009.08.023.
    OpenUrlCrossRefPubMed
  46. 46.↵
    1. Lonner JH
    . Patellofemoral arthroplasty. J Am Acad Orthop Surg. 2007 Aug;15(8):495-506.
    OpenUrlCrossRefPubMed
  47. 47.↵
    1. Feucht MJ,
    2. Cotic M,
    3. Beitzel K,
    4. et al.
    A matched-pair comparison of inlay and onlay trochlear designs for patellofemoral arthroplasty: no differences in clinical outcome but less progression of osteoarthritis with inlay designs. Knee Surg Sports Traumatol Arthrosc. 2017 Sep;25(9):2784-2791. doi: 10.1007/s00167-015-3733-2.
    OpenUrlCrossRef
PreviousNext
Back to top

In this issue

Ochsner Journal: 18 (3)
Ochsner Journal
Vol. 18, Issue 3
Sep 2018
  • Table of Contents
  • Table of Contents (PDF)
  • About the Cover
  • Index by author
  • Advertising (PDF)
  • Back Matter (PDF)
  • Ed Board (PDF)
  • Front Matter (PDF)
Print
Download PDF
Email Article

Thank you for your interest in spreading the word on Ochsner Journal.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Patellofemoral Arthroplasty
(Your Name) has sent you a message from Ochsner Journal
(Your Name) thought you would like to see the Ochsner Journal web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Patellofemoral Arthroplasty
Brian Godshaw, Nicholas Kolodychuk, Gerard K. Williams, Benjamin Browning, Deryk Jones
Ochsner Journal Sep 2018, 18 (3) 280-287; DOI: 10.31486/toj.18.0009

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Patellofemoral Arthroplasty
Brian Godshaw, Nicholas Kolodychuk, Gerard K. Williams, Benjamin Browning, Deryk Jones
Ochsner Journal Sep 2018, 18 (3) 280-287; DOI: 10.31486/toj.18.0009
del.icio.us logo Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Abstract
    • INTRODUCTION
    • CASE REPORT
    • DISCUSSION
    • CONCLUSION
    • ACKNOWLEDGMENTS
    • REFERENCES
  • Figures & Data
  • References
  • Info & Metrics
  • PDF

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Management of Spontaneous Renal Arteriovenous Fistula in Pregnancy
  • Cerebellar Ataxia With Neuropathy and Bilateral Vestibular Areflexia Syndrome Coexisting With JAK2-Positive Polycythemia Vera and Myelofibrosis
  • Excessive Ingestion of Almond Milk Causes Severe Hypercalcemia and Acute Kidney Injury in a Patient With Chronic Kidney Disease
Show more CASE REPORTS AND CLINICAL OBSERVATIONS

Similar Articles

Keywords

  • Amputation
  • arthritis
  • arthroplasty–replacement–knee
  • patellofemoral joint

Ochsner Journal Blog

Current Post

Be Careful Where You Publish -- Part 2

Our Content

  • Home
  • Current Issue
  • Ahead of Print
  • Archive
  • Featured Contributors
  • Ochsner Journal Blog
  • Archive at PubMed Central

Information & Forms

  • Instructions for Authors
  • Instructions for Reviewers
  • Submission Checklist
  • FAQ
  • License for Publishing-Author Attestation
  • Patient Consent Form
  • Submit a Manuscript

Services & Contacts

  • Permissions
  • Sign up for our electronic table of contents
  • Feedback Form
  • Contact Us

About Us

  • Editorial Board
  • About the Ochsner Journal
  • Ochsner Health
  • University of Queensland-Ochsner Clinical School
  • Alliance of Independent Academic Medical Centers

© 2025 Ochsner Clinic Foundation

Powered by HighWire