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Is patellofemoral osteoarthritis a problem for unicompartmental knee arthroplasty?
311
for unicompartmental disease. In patients with
normal patellofemoral cartilage at the time of
UKA, Berger
et al.
reported a 10% rate of
symptomatic patellofemoral degenerative
disease at 15 years post-operative [8, 9].
Patellofemoral pain was the cause of both
revisions to TKAin their series [8, 9]. Similarly,
Kahn
et al.
, Argenson
et al.
and Weale
et al.
reported rates of radiographic evidence of
patellofemoral joint degenerative changes 5 to
10 years following UKA to be between 5 and
60% [3, 20, 37]. Argenson
et al.
and Weale
et
al.
both noted patellofemoral degenerative
change to be the most common reason for
revision to TKA [20, 37]. While these patients
represent a distinct clinical situation from that
explored in the current study, one could
consider partial lateral patellar facetectomy for
treatment of symptomatic lateral patellar
degenerative disease that develops after UKA.
Further research is needed in this area.
The strengths of our study include its long
follow-up period with no patents lost to follow-
up, its use of validated, patient reported
outcome measures, and presentation of a
successful method of treating a difficult clinical
problem. Weaknesses of the study include its
relatively small numbers and lack of a control
group. Consideration should be given to
comparing the treatment method outlines above
to TKA or bicompartmental arthroplasty for
patients with two-compartment disease.
Conclusions
Simultaneous UKA and partial lateral patellar
facetectomy is a viable treatment option for
symptomatic degenerative disease involving
one tibiofemoral compartment and the lateral
patellofemoral joint. Durable pain control and
functional improvement were noted at medium-
term follow-up. This treatment approach may
be a useful alternative to TKA or bicompart
mental arthroplasty in a carefully selected
patient population.
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