AANA Lab Course 913 - Advanced Knee Course-Patellofemoral Arthroplasty_ Sometimes Best, Even in the Young Faculty Lecture

Patellofemoral Arthroplasty_ Sometimes Best, Even in the Young Faculty Lecture_ Jason L. Koh, MD

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This presentation by Dr. Jason L. Koh discusses patellofemoral arthroplasty (PFA) as an effective treatment for isolated patellofemoral (PF) arthritis, sometimes even in younger patients. PF arthritis accounts for about 10% of osteoarthritis cases and often results from abnormal joint loading. While joint preservation techniques like osteotomy and cartilage transplant can help, they have limitations, particularly in diffuse or bipolar lesions and in older patients.<br /><br />First-generation PF arthroplasties focused on replacing cartilage only, but they had high failure rates (up to 78%) due to issues like patella tracking and instability. Second-generation designs improved outcomes by replacing both bone and cartilage, featuring better instrumentation, deeper trochlear grooves, and improved tracking congruity. Inlay designs and customized implants have also emerged, with some studies reporting no revisions at 6 years.<br /><br />Clinical outcomes for modern PFAs are promising, with multiple studies showing 82-96% survivorship at 5 to 9 years, particularly in patients with trochlear dysplasia or specific PF abnormalities. Survivorship depends on implant design, progression of femorotibial osteoarthritis, and surgical technique.<br /><br />Robotic-assisted PFA is an emerging field that may improve surgical precision and implant positioning, though long-term results are not yet available.<br /><br />Compared to total knee arthroplasty (TKA), PFA generally involves less blood loss, shorter operative time, better knee mechanics, and cost-effectiveness. Revision PFA to primary TKA is feasible if needed.<br /><br />Key pitfalls include careful patient selection (isolated PF compartment involvement), correct prosthesis positioning to avoid impingement, and ensuring proper patellar tracking during surgery.<br /><br />In conclusion, while cartilage restoration remains important, PFA offers a valuable solution for patients with bipolar lesions, abnormal PF anatomy, or unsuccessful joint preservation, extending treatment possibilities to younger individuals.<br /><br />Disclosures include consulting and shareholder roles related to relevant orthopedic technology companies. Research funding was provided by ISAKOS and the Patellofemoral Foundation.

Keywords

patellofemoral arthroplasty

PF arthritis

osteoarthritis

joint preservation

osteotomy

cartilage transplant

prosthesis design

robotic-assisted surgery

total knee arthroplasty

patient selection