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1、Patellar Femoral Replacement,Paul A Lotke MDHospital of the University of Pennsylvania,The patella has always been a problem,Patello-Femoral Osteoarthritis:Prevalence,High in patients with sx&OA Women24%Men11%,The treatment alternatives have not been good,PatellectomyTibial tubercle“unloading osteot
2、omies”Arthroscopic chondroplastyLateral releasesMicro-fractureAutogenous Chondrocyte Implant ACIMosaicplastyThe classic results:66%G/E,Therefore,the need for a good patellofemoral replacement,The first:a DePalma patellar prosthesis(early 70s),1973,Who is the best candidate for a PF replacement?,The
3、elderly with isolated patellar arthritisDo well with TKAThe young with patellar arthritisNo long term data availablebest forMiddle aged who can convert to TKA?,Patient selectionLonner JAAOS 2004,Isolated patellar arthritisSevere pain and functional disabilityMiddle agedAvoid inflammatory arthritisAv
4、oid severe mal-trackingAvoid any Fem-Tib arthritisAvoid laborers or high activity patientsAvoid elderly(use TKA),Surgical technique,53 yo female 10+yr hx increasing disbility,Surgical technique,Surgical technique:set trochlear component parallel to transepicondylar axis,Surgical technique:resect tro
5、chlear cartlage,Surgical technique:reproduce patellar thicknessassess patellar trackinglateral release if needed,Clinical Results,Scattered reports over past two decadesInconsistent indications and assessmentsHowever,results reasonably consistent75-86%G/E Most of the problems were fromPatellar insta
6、blityCartilage contact in flexion,Patellar Instability,Related toUncorrected malalignmentSoft tissue inbalanceComponent malpositionDesign flaws,Cartilage contactin flexion,32 yr(!)female with pain 1 yr after a PFA excellent exam,Cartilage contact,Patellar contact patterns,Cartilage contact,Clinical
7、results,good potential for relief painAre they predictable?,Clinical results,Lonner2003#25 44yr F/U 1 yr G/E 96%Lonner2003#3038yr F/U 4 yr G/E 84%Kooijman2003#45 50yr F/U 17 yr G/E 86%Smith 2002#45 72yr F/U 4 yr G/E 69%Ackroyd 2003#95 na F/U 4 yr G/E 83%DeWinter 2001#26 59yr F/U 11yr G/E 76%,Summary PF replacement,Relatively high prevalence PF arthritisNeed for reliable PF replacementNewer designs yielding G/E results in75%to 86%in the well selected patientNext generation prosthesis to improve current designs,
