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Related Concept Videos

Bones of the Lower Limb: Femur and Patella01:16

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The femur is the body's longest and strongest bone spanning the thigh region. Its head articulates with the acetabulum of the hip bone to form the hip joint. A minor indentation on the medial side of the femoral head, called the fovea capitis, serves as the site of attachment for the ligament of the head of the femur. This weak ligament spans the femur and acetabulum and supports the hip joint. The narrowed region below the head is the neck of the femur. The inclination angle between the...
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The knee joint is the most complicated joint in the body. It consists of three articulations– two tibiofemoral and one patellofemoral. As is characteristic of synovial joints, the knee joint has a thin articular capsule that partially surrounds this joint cavity. Additionally, several ligaments, muscles, and cartilaginous structures support the movement of the knee.
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Replacement for patellofemoral arthritis.

David Sands Johnson1, Philip Gartside Turner1

  • 1Department of Trauma and Orthopaedics, Stockport NHS Foundation Trust, Aspen House, Stepping Hill Hospital, Poplar Grove, Stockport SK2 7JE, United Kingdom of Great Britain and Northern Ireland; School of Health and Society, Mary Seacole Building, University of Salford, Frederick Road Campus, Salford M6 6PU, United Kingdom of Great Britain and Northern Ireland.

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Summary

Patellofemoral osteoarthritis (PFOA) affects many older adults. Both total knee replacement (TKR) and patellofemoral replacement (PFR) can treat end-stage PFOA, with shared decision-making crucial for patient outcomes.

Keywords:
ArthroplastyOsteoarthritisPatellofemoralPatient related outcome measuresSurvivorship

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Area of Science:

  • Orthopedic surgery
  • Rheumatology
  • Biomedical engineering

Background:

  • Patellofemoral osteoarthritis (PFOA) is prevalent in individuals over 55, with higher incidence in females.
  • Conservative treatments are common, but arthroplasty is indicated for end-stage PFOA.
  • A debate exists regarding the superiority of total knee replacement (TKR) versus patellofemoral replacement (PFR) for PFOA.

Purpose of the Study:

  • To review current evidence comparing TKR and PFR for the surgical management of PFOA.
  • To inform clinical decision-making for patients with end-stage patellofemoral osteoarthritis.

Main Methods:

  • Systematic review of recent meta-analyses, systematic reviews, and cohort studies on PFOA surgical management.
  • Inclusion of institutional patient data.
  • Content based on a lecture presented at the British Association for Surgery of the Knee 2019.

Main Results:

  • PFOA is distinct from tibiofemoral osteoarthritis (TFOA).
  • Patellofemoral replacement (PFR) demonstrates a higher failure rate compared to total knee replacement (TKR).
  • Evidence suggests potentially better outcomes and recovery in the PFR group, though patient subsets show variable results.

Conclusions:

  • Both PFR and TKR are viable surgical options for PFOA.
  • Preoperative counseling and shared decision-making are essential for patient selection between TKR and PFR.
  • Further research is needed to elucidate outcome differences between procedures and within PFOA patient subsets.