Abstract
Patellofemoral, osteoarthritis, joint replacement, arthroplasty, anterior knee pain
Isolated patellofemoral joint osteoarthritis is a degenerative disorder of the knee estimated to occur in approximately 4% to 24% of patients with osteoarthritis of the knee. Mild isolated patellofemoral osteoarthritis is significantly associated with pain, stiffness, and functional limitations. Most patients can be successfully treated with nonoperative measures. In patients with disabling complaints who are unresponsive to non-surgical treatment, a multitude of operative treatment modalities have been used, and patellofemoral joint replacement can be considered for selected patients. In patellofemoral joint replacement, the femorotibial compartments, with cruciate ligaments and menisci, are spared, which may preserve the physiological kinematics of the femorotibial joint. The reported clinical results are related to patient selection, prosthetic design properties, and surgical technique. Development of painful femorotibial osteoarthritis is an important reason for converting a patellofemoral joint replacement to a total knee replacement, and predictive factors for developing femorotibial osteoarthritis remain unidentified. Using a matched case-control study, we found that patellofemoral joint replacement does not have a negative effect on the clinical outcome of later total knee replacement as assessed with standardised clinical and patient-relevant outcome measures. However, the stress-shielding effect of the femoral component in the Richards II patellofemoral joint replacement results in a decrease in the bone mineral density in the periprosthetic femur. Patellofemoral complications are the primary non-infectious indication for revision surgery after primary total knee replacement. Circumpatellar electrocautery in total knee replacement is used by approximately 50% of orthopaedic surgeons in The Netherlands. The use of electrocautery results in a lower prevalence of anterior knee pain and better functional results.
