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Introduction
Isolated osteoarthritis of the patellofemoral
joint can be a cause of severe anterior knee pain
and may limit daily activities such as standing
up from a chair or climbing stairs. Although
physical therapy and other nonoperative
methods have a role in the treatment, surgery
may be necessary in patients with persistent
knee pain and several surgical options have
been proposed. These include debridement of
the patellofemoral joint, elevation of the
anterior tibial tubercle, spongialization of the
patella, prosthetic resurfacing of the patella
alone, or patellectomy. Total knee arthroplasty
(TKA) has also been reported for patients with
arthritis confined to the patellofemoral joint.
Patellofemoral arthroplasty (PFA), defined as
resurfacing both sides of the patellofemoral
joint, has been proposed as a treatment option.
There have been several studies published on
PFA during the past 25 years and the reported
results at mid-term follow-ups are variable
with favorable results ranging from 72 to 85%.
We published our experience with PFA in 1995,
with 84% of satisfactory results at mid-term
follow-up (range 2-10 years). In this paper, the
long terms results will be presented as well as
the quality of the outcomes according to the
pre-operative diagnosis.
Materialand Methods
We retrospectively reviewed 66 consecutive
patients (66 knees) who had isolated unilateral
PFA between 1972 and 1990. Nine patients
died for causes unrelated to the knee surgery
and all of these patients had well functioning
PFA implanted knees at the time of death. The
remaining 57 patients were evaluated at a mean
follow-up of 16.2 years (range, 12-20 years).
There were 31 women and 26 men studied who
had a mean age at operation of 57 years (range,
21-82 years). The etiologies of osteoarthritis
were: instability with a history of patellar
dislocation (21 patients), and posttraumatic
osteoarthritis primarily attributable to patellar
fractures(18patients),andprimaryosteoarthritis
of the patellofemoral joint (18 patients).
At operation all patients had clinical and
radiographic evidence of severe osteoarthritis
of the patellofemoral joint with preserved
medial and lateral tibiofemoral joints. Eighteen
patients had a previous surgical procedure on
the involved joint, which included 12 cases of
patellar open reduction and internal fixation
and six cases of elevation of the anterior tibial
tubercle.
The indication for PFAwas failure for previous
nonoperative or surgical treatment.
The long-term results
of patello-fermoral
arthroplasty
S. Parratte, M. Ollivier, X. Flecher,
J.M. Aubaniac, J.N. Argenson