Patellofemoral Arthroplasty: A Technical Note

Patellofemoral arthroplasty (PFA) is a salvage procedure for patients presenting with bone-on-bone isolated patellofemoral osteoarthritis. Previous studies comparing PFA with total knee arthroplasties found that patients recover more quickly and have better average knee function following PFA, as care is taken to spare healthy cartilage, bone, and ligaments during the procedure. This allows preservation of native knee kinematics, resulting in better patient-reported outcomes, as well as mid-term and long-term results.

PFA is indicated in patients with isolated primary or post-traumatic patellofemoral osteoarthritis. In some cases, the procedure may be indicated in patients suffering from patellar instability or trochlear dysplasia with associated arthritis. Contraindications for PFA include multicompartmental arthritis in the medial or lateral tibiofemoral compartments, inflammatory joint disease, tibiofemoral instability, malalignment, or lesions of 6 mm or more in diameter.

After the initial lateral patellofemoral approach, degenerative changes in the patellofemoral joint were observed. Following preparation of the patella and femur, the trochlear implant is impacted on the prepared femoral surface. Cement is digitally impacted into the reamed patella, followed by placement of the final patellar implant and compression until the cement is dried.

Within 2 years postoperatively, patients are expected to have improved overall knee-specific quality of life, reduced pain, and a successful return to activities.

New PFA techniques have yielded significant improvement in patient-reported outcomes and high rates of survivorship following surgery.