Patello Femoral Replacement
Patello Femoral replacement is performed for osteoarthritis affecting the back of the kneecap. In about 10% of arthritis patients the majority of their knee symptoms are coming from a worn kneecap. These people suffer from pain when crouching, climbing and descending stairs, walking up slopes and getting out of low chairs. Patients with this condition are usually able to walk with minimal pain on the level.
Initially Patello Femoral Arthritis can be treated with painkillers, anti-inflammatories, physiotherapy and, in the earlier stages, arthroscopy (keyhole surgery) but as the knee progressively wears, joint replacement surgery may be required to relieve the pain and improve mobility. If the majority of the joint is free from arthritis (or displays minimal symptoms) it may be possible to replace the back of the patella and the front of the femur (thigh bone) to provide relief. If other parts of the knee are also affected a total knee replacement is the better option.
The component parts of the PFR
The Patello Femoral Replacement comes in 2 parts. The Femoral component is made of metal and is highly polished. The back of the patella is covered with a plastic button, which sits in a shallow groove on the front of the metal femoral component. Essentially a Patello Femoral Replacement is the front part of a Total Knee Replacement, but leaves the unworn cartilage over the rest of the joint intact.
Indications for Patellofemoral Replacement
- Degenerative osteoarthritis (ie.loss of joint space with osseous deformation ) limited to the patellofemoral joint
- Severe symptoms affecting daily activity referrable to patellofemoral joint degeneration unresponsive to lengthy(3 to 6 months) nonsurgical options and/or failed prior conservative procedures(eg.lateral release,arthroscopic debridement,cartilage transplantation)
- Post traumatic osteoarthritis
- Extensive Grade 3 chondrosis (ie.loss of joint space without osseous deformation of the patellofemoral,joint space , particularly pantrochlear,medial facet,or proximal half of patella
- Failed extensor unloading procedure(eg.Maquet,Fulkerson)
- Patellofemoral malalignment/dysplasia induced degeneration with or without instability
Operative approaches for patellofemoral arthritis :
- Arthroscopic debridement
- Microfracture articular restoration
- Lateral release
- Soft-tissue realignment of the extensor mechanism
- Osteotomies of the tibial tubercle
- Mosiacplasty/autologous chondrocyte implantation
- Lateral patella partial facetectomy
- Patellectomy (removal of the kneecap)
- Total knee replacement
Are there any contraindications to patellofemoral replacement surgery ? Yes,some patients cannot have this operation either because they wait too long and their knee is too damaged or they have one of the conditions listed
However,most patients should consider this procedure as a possible option for their patella arthritis and get evaluated before choosing a final solution. It is important to seek a surgeon who has experience with patellofemoral replacement,since opinions vary greatly depending upon the individual surgeon' s own preferences .
Contraindications to patellofemoral arthroplasty :
- No attempt at nonoperative care or to rule out other sources of pain
- Arthritis involving the tibiofemoral articulation greater than Kellgren Grade I/ II
- Systemic inflammatory arthropathy
- Osteoarthritis/chondrosis less than Grade 3/4
- Patella infera
- Uncorrected patellofemoral instability/malalignment
- Uncorrected tibiofemoral mechanical malalignment(valgus>80;varus >50)
- Active infection
- Evidence of chronic regional pain syndrome
- Fixed knee range of motion loss ( -100 ext.-1100 flex.minimum)
- Psychogenic pain
What does a patellofemoral replacement look like ?
Patellofemoral replacement ("kneecap replacement", patellofemoral arthroplasty) is one type of minimally invasive knee surgery. The parts (components) are very small compared to a standard total knee replacement.
What happens in surgery?
The surgery involves removing a small thickness of the damaged bone from the front of the femur (thigh bone) and the back of the patella (kneecap). The Patello Femoral replacement fits inside the space and is fixed to the bone with cement.
The operation takes about 40 minutes and involves a 10-15cm incision over the front of the knee. The wound is closed with either clips or an absorbable suture.
After a Patello Femoral Replacement
The day after the operation your exercise regime begins. With the aid of a physiotherapist you will get out of bed and begin to exercise your new knee replacement. With perseverance, you should be able to climb stairs by day 2 and go home the following day.
You will need to continue attending physiotherapy as an outpatient. This can be done closer to your home with one of our recommended group of physiotherapists.
For most people it will take around 6 weeks to be walking reasonably with only one stick. After four months you should be able to walk well without pain, climb stairs (leading with your operated leg) and be capable of a range of movement with your new knee from 0 degrees to at least 120 degrees.
It is important to remember that an artificial knee is not a normal knee; you may well be able to carry out many normal activities of daily living. However, this range of movement may not be as good as it was before surgery and you may never be able to kneel after your Patello Femoral Replacement.
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