Patient selection key for patellofemoral replacement for patients with degenerative conditions
Ormonde M. Mahoney
WAILEA, Hawaii – Patellofemoral replacement for patients with degenerative conditions depends on patient selection. Attention to surgical detail, such as external femoral rotation and patellar medialization, also reduces the risk of instability.
“Disease progression remains the most likely cause of reoperation, and patient selection is critical,” Ormonde M. Mahoney, MD, said at Orthopedics Today Hawaii 2012, here.
Mahoney said that grade IV chondromalacia is an indication for patellofemoral replacement.
“There are cases where patient characteristics may dedicate this. In my own practice, I may do it in earlier cases where people have had extensive treatments of other types. But they are judgment calls and have to be undertaken with a lot of education of the patient,” he said.
Contraindications include patella baja, fixed flexion contracture, inflammatory arthritis, leg malalignment and tibiofemoral disease.
“Disease progression is the hallmark failure of patellofemoral replacement by in large,” Mahoney said.
In his experience of 105 cases from August 2002 to January 2011, there were 10 reoperations, eight of which were due to disease progression. Four prosthesis designs (three onlay designs) were used in the study, and the patients had 12 months to 108 months of follow-up.
“These devices offer gratifying options short of total knee replacement in the treatment of isolated patellofemoral arthritis.”
- Mahoney OM. Patella replacement: Indications and longevity: When should it be considered. Presented at Orthopedics Today Hawaii 2012, Jan. 15-18. Wailea, Hawaii.
- Disclosure: Mahoney is a consultant for and receives royalty compensation and research support from Stryker Orthopedics, and receives research support from Arthrex.