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Patellofemoral osteoarthritis is arthritis in the joint between the kneecap and the groove for the kneecap. Sometimes isolated arthritis leads to anterior knee pain. One typical problem is pain during stairclimbing. There are several treatments option for this problem.
Patellofemoral osteoarthritis
If you are troubled by anterior knee pain due to patellofemoral osteoarthritis, you should generally try out non operative treatment before you consider surgery. What is happening is the cartilage in either (or both) on the back site of the kneecap or in groove for the kneecap has weared away to some degree.
Surgery patellofemoral osteoarthritis
The exist many different types of surgery for patellofemoral osteoarthrisis. The right choice of surgery dependens on several factors. Below you can read about some of the surgical possibilities.
Arthroscopic debridement - meaning smoothening by pinhole surgery.
Sometimes an arthroscopy, with smoothening of uneven cartilage and with removal of inflammed synovial tissue, can reduce the catching sensation and reduce pain. However this procedure can´t bring in a new layer of cartilage. Sometimes there is malalignment, meaning the the tracking of the patella into the trochlea is crooked. If this is the case, this eventually need to be fixed concomitantly.
Lateral facetectomy. Means to take away a piece of the outer part of the kneecap.
Often is the osteoarthritis localised almost on the outsite of the patella. By removing the weared outer part of the patella, the pain can be resolved. This can be done either by open or arthroscopic surgery. On the picture on the right you see such and example. The left picture is before suregery.
Fulkerson osteotomy
By this special surgery, the tibial tubercle (the point of attachment of the patellar tendon) is moved more to the inner site and to the front. This surgery is planned if the patellofemoral joint has nice cartilage on the inner half of the joint and the tibial tubercle is outwards placed. This can be seen on an axial MRI. Often the surgery is combined with a lengthening of the lateral retinaculum.
Patellofemoral Arthroplasty
If you have significant osteoarthritis between the kneecap a Hemicap Wave prosthesis can be a good option. Just to avoid confusion Patellofemoral arthroplasty, prosthesis or replacement are the same.
In stead of doing a total knee prosthesis this smaller surgery can work out great. Actually the results are better with this lesser surgery, than for a total knee replacement, if you have isolated patellofemoral osteoarthritis. Especially if you osteoarthritis is due to trochlear dysplasia. You can say that the Hemicap Wave is a metal deepening trochleoplasty (a deepening of the groove surgery).
If the kneecap is unstable it can be stabilized by a concomitant MPFL reconstruction using an artificial ligament (FiberTape).
After treatment Patellofemoral prosthesis
After a surgery you are allowed fully weightbearing and free range of movement. You will leave hospital the same day.
Physiotherapy normally starts after 2 weeks. Car driving can normally be optained after 3-4 weeks. The knee will often be weakened by swolling and pain for several month. You can expect the knee to be better than preoperatively after 3 month.
How long does a Patellofemoral prosthesis last?
Normally about 75% of patient will not have been given neither a patellofemoral replacement or at total knee replacement within 15 Years. Those data are related to so called onlay prosthesis, hopefully inlay prosthesis like the Hemicap Wave will last even longer
This i a knee model demonstrating a Hemicap Wave prosthesis
Patellofemoral prosthesis
Hemicap Wave patellofemoral protese
At left you see an axial MRI view of a 36 year old women. It demonstrate severe trochlear dysplasia and patellofemoral osteoarthritis. She had severe anterior knee pain for 20 years, before she had a Hemicap Wave. It´s likely that she could have had 20 year with less pain, and perhaps also postponed the time for a PF arthroplasty, if she had undergone a trochleoplasty back in time.
X-Ray demonstrating a Hemicap Wave Patellofemoral prothesis