The results of a multi-surgeon, multi-implant series of patellofemoral joint arthroplasty performed over a ten year period are presented. All patellofemoral joint arthroplasty performed from the years 1996 to 2006 were retrospectively reviewed using case notes, radiographs and clinic appointments until their latest follow-up period.

101 arthroplasties in 91 patients were followed up for average period of 48 months (range 6–96 months). The average age was 57 years with female patients thrice as common as male patients. There were 5 (5%) complications with 1 deep infection and 4 stiff knees. 35 subsequent procedures were performed in 28 patients including arthroscopic debridement in 18, arthroscopic lateral retinacular release in 8, tibial tuberosity transfer in 3, manipulation for stiffness in 2, and revision to total knee arthroplasty in 4 patients (3 for progression of tib-iofemoral osteoarthritis and 1 for infection).

The necessity of further surgeries in one third of the study group suggests that close follow-up of these patients is needed to address any concerns that can be easily resolved.

Purpose: Isolated patellofemoral joint (PFJ) osteoarthritis has long been a common observation as an important source of knee pain. Once non-operative treatment modalities have been exhausted, the surgical options available are transposition/elevation of tibial tubercle, drilling, realignment procedures, patellectomy, patellar resurfacing, patellofemoral arthroplasty (PFA) and total knee arthroplasty (TKA). Among these, PFA is an established treatment of isolated PFJ osteoarthritis. We present our multi-surgeon, multi-implant series of patellofemoral joint arthroplasty performed over a 10 year period.

Method: This study was a retrospective review of all PFA performed in the Knee Arthroplasty Unit at our hospital over a ten year period from 1997 to 2006. The unit comprises seven specialist surgeons, each with considerable experience in knee arthroplasty and numerous trainee surgeons. One hundred and one PFA performed in 91 patients were identified from the theatre records. Three different implant models were used: the Lubinus implant (Waldemar Link), the FPV system (Wright Medical) and the Avon system (Stryker Howmedica Osteonics).

Results: 101 arthroplasties in 91 patients were followed up for average period of 48.8 months (6–96 months). Of these, none were lost to follow up. The average age was 57 years with female patients thrice as common as male patients. Concomitant procedures in the form of 23 lateral retinacular release or 6 osteochondral autograft transfer system (OATS) were performed. There were 6 complications with 2 infections and 4 stiff knees. 31 arthroplasties had subsequent procedures including arthroscopic debridement (18), arthroscopic lateral retinacular release (8), tibial tuberosity transfer (3) and manipulation for stiffness (2). A total of 4 arthroplasties underwent revision to total knee arthroplasty, 2 for infection and 2 for progression of tibiofemoral osteoarthritis.

Conclusion: The necessity of revision surgeries in one third of the cases suggests that close follow-up of the patients is needed to address any concerns that can be easily resolved. A majority of the patients in our study had very good outcomes and did not need subsequent procedures in the medium term. Our study reiterates the importance of proper patient selection, surgeon experience and correct surgical technique in successful outcomes from PFA.

Introduction: We have come across a subset of patients with advanced patellofemoral osteoarthritis who also had well defined full thickness cartilage loss lesions on the weight bearing femoral condyle. In these patients the findings or the symptoms are not severe enough to warrant a total knee replacement. In this select group of patients, a combination of patellofemoral arthroplasty (PFA) and Osteochondral Autograft Transfer System (OATS) can be performed to address this unique problem.

Method& Results: Out of 38 PFA procedures performed by the senior author, a concomitant OATS was performed in 6 knees in 5 patients. A retrospective analysis of these patients was carried out with the average follow up being 3.8 years (18 months to 84 months). The average age of the patients in our case study was 48.2 years (36 to 59 years) at the time of surgery. Four of the six knees are doing well in the medium term. One patient had progression of tibiofemoral arthritis and underwent a total knee replacement. The only poor result was a young male, who two years following the PFA, developed a deep infection of the knee. Except for this patient awaiting a second stage revision for an infected knee, all the others have achieved their desired level of activity.

Conclusion: The advantage of this combination is that, the donor tubes for the OATS can be harvested from the trochlea or just adjacent to it, which happens to be the bed for the trochlear implant. This area provides good quality thick donor articular cartilage. As the surgical exposure has already been done for the PFA, the operative time is extended by approximately ten minutes for the OATS procedure. This combination procedure offers an alternative to more invasive options such as total knee replacement in younger patients in whom it is preferable to delay such major surgery.

Introduction: Patellofemoral arthroplasty (PFA) is an established treatment of isolated patellofemoral osteoarthritis. We present our multi-surgeon, multi-implant series of patellofemoral joint arthroplasty performed over a ten year period.

Material & Results: his study was a retrospective review of all PFA performed in our unit over a ten year period from 1997 to 2006. The unit comprises seven specialist knee surgeons and numerous trainee surgeons. A total of 46 knees had the Lubinus implant (Waldemar Link), 30 knees had the FPV system (Wright Medical) and 25 knees had the Avon system (Stryker Howmedica).

101 arthroplasties in 91 patients were followed up for average period of 48.8 months (6–96 months). The average age was 57 years with female patients thrice as common as male patients. Concomitant procedures in the form of 23 lateral retinacular release or 6 osteochondral autograft transfer system (OATS) were performed. There were 6 complications with 2 infections and 4 stiff knees. Subsequent procedures included arthroscopic debridement (18), arthroscopic lateral retinacular release (8), tibial tuberosity transfer (3) and manipulation for stiffness (2). A total of 4 arthroplasties underwent revision to TKA, 2 for infection and 2 for progression of tibiofemoral osteoarthritis.

Conclusion: Thorough clinical history, physical examination and radiological investigation are essential before embarking on PFJ replacement. Other concomitant procedures like joint debridement, menisectomy or lateral retinacular release may be necessary to obtain optimum results. The necessity of revision surgeries in 31% of the cases of our study suggests that close follow-up of the patients is needed to address any concerns which can be easily resolved. PFJ replacement effectively addresses anterior knee pain, preserves the joint integrity, involves lesser surgical dissection and has good results of revision to TKA.