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J. Chouteau
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Summary
The patellofemoral replacement (PFR) is still a
subject of controversies because of non
consistent reported results in the literature and
because of high rate of early failures.
We report the results and the etiologies of
failures of the PFR. We studied separately two
different designs: the so called first generation
of PFR design (characterized by resurfacing
the patello femoral joint) and the recent
optimized designs of PFR with anterior femoral
bone cut (similar to TKA).
The PFR results and etiologies of failures
change with the type of implant and design
used. The first generation of PFR showed high
failure rate leading to high revision rate up to
87%. The best results have been obtained with
recent PFR requiring anterior femoral bone cut.
Several series showed high patients satisfaction
rate, high post operative functional scores and
no post operative complications caused by the
implants.
Strict preoperative criteria of patient selection
increase significantly the results (no overweight
patient, patient age under 65 yrs, frequent
physical activity, good pre operative ROM, no
excessive preoperative varus/valgus malalign
ment, grade IV from the Iwanno’s classification,
patellofemoral osteoarthritis on dysplasia
rather than without dysplasia).
Optimization and increase in anatomical
implant designs will be obtained by means of
biomechanical studies on the trochlea and on
the patellar implants. Navigation and patient
specific 3D customized cutting guide could
allow an increase in the reproducibility and
reliability of the procedure and lead to higher
patient postoperative satisfaction.
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