Skip to main content
SpringerLink
Log in

Patellofemoral arthroplasty, where are we today?

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Patellofemoral arthroplasty remains controversial, primarily due to the high failure rates reported with early implants. Numerous case series have been published over the years detailing results of various first- and second-generation implants. The purpose of this work is to summarize results published to date and identify common themes regarding implants, surgical techniques, and indications in order to maximize results of future procedures.

Methods

A comprehensive review of the MEDLINE database was carried out to identify all clinical studies related to patellofemoral arthroplasty.

Results

First-generation resurfacing implants were associated with relatively high failure rates in the medium term. Second-generation implants, with femoral cuts based on TKA designs have yielded more promising medium-term results. Surgical indications are specific and must be carefully followed to minimize poor results. Short-term complications are generally related to patellar maltracking, while long-term complications are generally related to progression of osteoarthritis in the tibiofemoral joint. Implant loosening and polyethylene wear are rarely reported. Short-term results are favourable for new technology including custom implants and computer navigated surgery.

Conclusions

Overall, recent improvements in implant design and surgical techniques have resulted in improvements in short- and medium-term results. More work is required to assess the long-term outcomes of modern implant designs.

Level of evidence

IV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Ackroyd CE, Chir B (2005) Development and early results of a new patellofemoral arthroplasty. Clin Orthop Relat Res 436:7–13

    Article  PubMed  Google Scholar 

  2. Ackroyd CE, Newman JH (2003) The Avon patellofemoral arthroplasty: two to five year results. J Bone Joint Surg Br 85:162–163

    Article  Google Scholar 

  3. Ackroyd CE, Newman JH, Evans R, Eldridge JD, Joslin CC (2007) The Avon patellofemoral arthroplasty: five-year survivorship and functional results. J Bone Joint Surg Br 89:310–315

    PubMed  CAS  Google Scholar 

  4. Amis AA, Senavongse W, Darcy P (2005) Biomechanics of patellofemoral joint prostheses. Clin Orthop Relat Res 436:20–29

    Article  PubMed  Google Scholar 

  5. Arciero RA, Toomey HE (1988) Patellofemoral arthroplasty. A three- to nine-year follow-up study. Clin Orthop Relat Res 236:60–71

    PubMed  Google Scholar 

  6. Argenson JN, Flecher X, Parratte S, Aubaniac JM (2005) Patellofemoral arthroplasty: an update. Clin Orthop Relat Res 440:50–53

    Article  PubMed  Google Scholar 

  7. Argenson JN, Guillaume JM, Aubaniac JM (1995) Is there a place for patellofemoral arthroplasty? Clin Orthop Relat Res 321:162–167

    PubMed  Google Scholar 

  8. Arumilli BR, Ng AB, Ellis DJ, Hirst P (2010) Unusual mechanical complications of unicompartmental low contact stress mobile bearing patellofemoral arthroplasty: a cause for concern? Knee 17:362–364

    Article  PubMed  CAS  Google Scholar 

  9. Becker R, Ropke M, Krull A, Musahl V, Nebelung W (2008) Surgical treatment of isolated patellofemoral osteoarthritis. Clin Orthop Relat Res 466:443–449

    Article  PubMed  Google Scholar 

  10. Blazina ME, Fox JM, Del Pizzo W, Broukhim B, Ivey FM (1979) Patellofemoral replacement. Clin Orthop Relat Res 144:98–102

    PubMed  Google Scholar 

  11. Board TN, Mahmood A, Ryan WG, Banks AJ (2004) The Lubinus patellofemoral arthroplasty: a series of 17 cases. Arch Orthop Trauma Surg 124:285–287

    Article  PubMed  CAS  Google Scholar 

  12. Butler JE, Shannon R (2009) Patellofemoral arthroplasty with a custom-fit femoral prosthesis. Orthopedics 32:81

    PubMed  Google Scholar 

  13. Cartier P, Sanouiller JL, Grelsamer R (1990) Patellofemoral arthroplasty. 2–12-year follow-up study. J Arthroplasty 5:49–55

    Article  PubMed  CAS  Google Scholar 

  14. Cartier P, Sanouiller JL, Khefacha A (2005) Long-term results with the first patellofemoral prosthesis. Clin Orthop Relat Res 436:47–54

    Article  PubMed  Google Scholar 

  15. Charalambous CP, Abiddin Z, Mills SP, Rogers S, Sutton P, Parkinson R (2011) The low contact stress patellofemoral replacement: high early failure rate. J Bone Joint Surg Br 93:484–489

    Article  PubMed  CAS  Google Scholar 

  16. Cobb J, Henckel J, Gomes P, Harris S, Jakopec M, Rodriguez F, Barrett A, Davies B (2006) Hands-on robotic unicompartmental knee replacement: a prospective, randomised controlled study of the acrobot system. J Bone Joint Surg Br 88:188–197

    PubMed  CAS  Google Scholar 

  17. Cossey AJ, Spriggins AJ (2006) Computer-assisted patellofemoral arthroplasty: a mechanism for optimizing rotation. J Arthroplasty 21:420–427

    Article  PubMed  CAS  Google Scholar 

  18. Dahm DL, Al-Rayashi W, Dajani K, Shah JP, Levy BA, Stuart MJ (2010) Patellofemoral arthroplasty versus total knee arthroplasty in patients with isolated patellofemoral osteoarthritis. Am J Orthop (Belle Mead NJ) 39:487–491

    Google Scholar 

  19. Davies AP, Vince AS, Shepstone L, Donell ST, Glasgow MM (2002) The radiologic prevalence of patellofemoral osteoarthritis. Clin Orthop Relat Res 402:206–212

    Article  PubMed  Google Scholar 

  20. Dawson J, Fitzpatrick R, Murray D, Carr A (1998) Questionnaire on the perceptions of patients about total knee replacement. J Bone Joint Surg Br 80:63–69

    Article  PubMed  CAS  Google Scholar 

  21. De Cloedt P, Legaye J, Lokietek W (1999) Femoro-patellar prosthesis. A retrospective study of 45 consecutive cases with a follow-up of 3–12 years. Acta Orthop Belg 65:170–175

    PubMed  Google Scholar 

  22. de Winter WE, Feith R, van Loon CJ (2001) The Richards type II patellofemoral arthroplasty: 26 cases followed for 1–20 years. Acta Orthop Scand 72:487–490

    Article  PubMed  Google Scholar 

  23. Farr J 2nd, Barrett D (2008) Optimizing patellofemoral arthroplasty. Knee 15:339–347

    Article  PubMed  Google Scholar 

  24. Feller JA, Bartlett RJ, Lang DM (1996) Patellar resurfacing versus retention in total knee arthroplasty. J Bone Joint Surg Br 78:226–228

    PubMed  CAS  Google Scholar 

  25. Fulkerson JP, Shea KP (1990) Disorders of patellofemoral alignment. J Bone Joint Surg Am 72:1424–1429

    PubMed  CAS  Google Scholar 

  26. Gadeyne S, Besse JL, Galand-Desme S, Lerat JL, Moyen B (2008) Results of self-centering patellofemoral prosthesis: a retrospective study of 57 implants. Rev Chir Orthop Reparatrice Appar Mot 94:228–240

    Article  PubMed  CAS  Google Scholar 

  27. Hassaballa MA, Porteous AJ, Newman JH (2004) Observed kneeling ability after total, unicompartmental and patellofemoral knee arthroplasty: perception versus reality. Knee Surg Sports Traumatol Arthrosc 12:136–139

    Article  PubMed  CAS  Google Scholar 

  28. Hendrix MR, Ackroyd CE, Lonner JH (2008) Revision patellofemoral arthroplasty: three- to seven-year follow-up. J Arthroplasty 23:977–983

    Article  PubMed  Google Scholar 

  29. Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee society clinical rating system. Clin Orthop Relat Res 248:13–14

    PubMed  Google Scholar 

  30. Kooijman HJ, Driessen AP, van Horn JR (2003) Long-term results of patellofemoral arthroplasty. A report of 56 arthroplasties with 17 years of follow-up. J Bone Joint Surg Br 85:836–840

    PubMed  CAS  Google Scholar 

  31. Krajca-Radcliffe JB, Coker TP (1996) Patellofemoral arthroplasty. A 2- to 18-year followup study. Clin Orthop Relat Res 330:143–151

    Article  PubMed  Google Scholar 

  32. Leadbetter WB, Kolisek FR, Levitt RL, Brooker AF, Zietz P, Marker DR, Bonutti PM, Mont MA (2009) Patellofemoral arthroplasty: a multi-centre study with minimum 2-year follow-up. Int Orthop 33:1597–1601

    Article  PubMed  Google Scholar 

  33. Leadbetter WB, Mont MA (2009) Patellofemoral arthroplasty: a useful option for recalcitrant symptomatic patellofemoral arthritis. Semin Arthro 20:148–160

    Article  Google Scholar 

  34. Leadbetter WB, Ragland PS, Mont MA (2005) The appropriate use of patellofemoral arthroplasty: an analysis of reported indications, contraindications, and failures. Clin Orthop Relat Res 436:91–99

    Article  PubMed  Google Scholar 

  35. Leadbetter WB, Seyler TM, Ragland PS, Mont MA (2006) Indications, contraindications, and pitfalls of patellofemoral arthroplasty. J Bone Joint Surg Am 88(Suppl 4):122–137

    Article  PubMed  Google Scholar 

  36. Levitt RL (1973) A long-term evaluation of patellar prostheses. Clin Orthop Relat Res 97:153–157

    Article  PubMed  Google Scholar 

  37. Lonner JH (2004) Patellofemoral arthroplasty: pros, cons, and design considerations. Clin Orthop Relat Res 428:158–165

    Article  PubMed  Google Scholar 

  38. Lonner JH (2006) Patellofemoral arthroplasty. In: Scott N (ed) Insall and Scott surgery of the knee, 4th edn. Elsevier, Philadelphia, pp 1440–1454

    Google Scholar 

  39. Lonner JH (2007) Patellofemoral arthroplasty. J Am Acad Orthop Surg 15:495–506

    PubMed  Google Scholar 

  40. Lonner JH (2009) Modular bicompartmental knee arthroplasty with robotic arm assistance. Am J Orthop (Belle Mead NJ) 38:28–31

    Google Scholar 

  41. Lonner JH (2010) Patellofemoral arthroplasty. Instr Course Lect 59:67–84

    PubMed  Google Scholar 

  42. Lonner JH, Mehta S, Booth RE Jr (2007) Ipsilateral patellofemoral arthroplasty and autogenous osteochondral femoral condylar transplantation. J Arthroplasty 22:1130–1136

    Article  PubMed  Google Scholar 

  43. Lubinus HH (1979) Patella glide-bearing total replacement. Orthopedics 2:119–127

    Google Scholar 

  44. Lustig S, Fleury C, Goy D, Neyret P, Donell ST (2011) The accuracy of acquisition of an imageless computer-assisted system and its implication for knee arthroplasty. Knee 18:15–20

    Article  PubMed  CAS  Google Scholar 

  45. McKeever DC (1955) Patellar prosthesis. J Bone Joint Surg Am 37-A:1074–1084

    Google Scholar 

  46. Merchant AC (2005) A modular prosthesis for patellofemoral arthroplasty: design and initial results. Clin Orthop Relat Res 436:40–46

    Article  PubMed  Google Scholar 

  47. Mertl P, Van FT, Bonhomme P, Vives P (1997) Femoropatellar osteoarthritis treated by prosthesis. Retrospective study of 50 implants. Rev Chir Orthop Reparatrice Appar Mot 83:712–718

    PubMed  CAS  Google Scholar 

  48. Mofidi A, Bajada S, Holt MD, Davies AP (2011) Functional relevance of patellofemoral thickness before and after unicompartmental patellofemoral replacement. Knee PMID:21498901

  49. Morra EA, Greenwald AS (2006) Patellofemoral replacement polymer stress during daily activities: a finite element study. J Bone Joint Surg Am 88(Suppl 4):213–216

    Article  PubMed  Google Scholar 

  50. Newman JH (2007) Patellofemoral arthritis and its management with isolated patellofemoral replacement: a personal experience. Orthopedics 30:58–61

    PubMed  Google Scholar 

  51. Nicol SG, Loveridge JM, Weale AE, Ackroyd CE, Newman JH (2006) Arthritis progression after patellofemoral joint replacement. Knee 13:290–295

    Article  PubMed  Google Scholar 

  52. Odumenya M, Costa ML, Parsons N, Achten J, Dhillon M, Krikler SJ (2010) The Avon patellofemoral joint replacement: five-year results from an independent centre. J Bone Joint Surg Br 92:56–60

    Article  PubMed  CAS  Google Scholar 

  53. Oni OOA (1996) The Leicester patello-femoral joint prosthesis. Knee 3:81–82

    Article  Google Scholar 

  54. Parratte S, Pauly V, Aubaniac JM, Argenson JN (2010) Survival of bicompartmental knee arthroplasty at 5 to 23 years. Clin Orthop Relat Res 468:64–72

    Article  PubMed  Google Scholar 

  55. Parvizi J, Stuart MJ, Pagnano MW, Hanssen AD (2001) Total knee arthroplasty in patients with isolated patellofemoral arthritis. Clin Orthop Relat Res 392:147–152

    Article  PubMed  Google Scholar 

  56. Paxton EW, Fithian DC (2005) Outcome instruments for patellofemoral arthroplasty. Clin Orthop Relat Res 436:66–70

    Article  PubMed  Google Scholar 

  57. Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD (1998) Knee injury and osteoarthritis outcome score (KOOS)—development of a self-administered outcome measure. J Orthop Sports Phys Ther 28:88–96

    PubMed  CAS  Google Scholar 

  58. Sisto DJ, Sarin VK (2006) Custom patellofemoral arthroplasty of the knee. J Bone Joint Surg Am 88:1475–1480

    Article  PubMed  Google Scholar 

  59. Smith AM, Peckett WR, Butler-Manuel PA, Venu KM, d’Arcy JC (2002) Treatment of patello-femoral arthritis using the Lubinus patello-femoral arthroplasty: a retrospective review. Knee 9:27–30

    Article  PubMed  CAS  Google Scholar 

  60. Starks I, Roberts S, White SH (2009) The Avon patellofemoral joint replacement: independent assessment of early functional outcomes. J Bone Joint Surg Br 91:1579–1582

    Article  PubMed  CAS  Google Scholar 

  61. Tauro B, Ackroyd CE, Newman JH, Shah NA (2001) The Lubinus patellofemoral arthroplasty. A five- to ten-year prospective study. J Bone Joint Surg Br 83:696–701

    Article  PubMed  CAS  Google Scholar 

  62. van Jonbergen HP, Werkman DM, Barnaart AF (2009) Dissociation of mobile-bearing patellar component in low contact stress patellofemoral arthroplasty, its mechanism and management: two case reports. Cases J 2:7502

    Article  PubMed  Google Scholar 

  63. van Jonbergen HP, Werkman DM, Barnaart LF, van Kampen A (2010) Long-term outcomes of patellofemoral arthroplasty. J Arthroplasty 25:1066–1071

    Article  PubMed  Google Scholar 

  64. van Jonbergen HP, Werkman DM, van Kampen A (2009) Conversion of patellofemoral arthroplasty to total knee arthroplasty: A matched case-control study of 13 patients. Acta Orthop 80:62–66

    Article  PubMed  Google Scholar 

  65. van Wagenberg JM, Speigner B, Gosens T, de Waal Malefijt J (2009) Midterm clinical results of the Autocentric II patellofemoral prosthesis. Int Orthop 33:1603–1608

    Article  PubMed  Google Scholar 

  66. Vermeulen H, De Doncker E, Watillon M (1973) The Mac Keever patellar prosthesis in femoro-patellar arthrosis. Acta Orthop Belg 39:79–90

    PubMed  CAS  Google Scholar 

  67. Walls RJ, Eldridge JD, Mulhall KJ (2007) Patellofemoral arthroplasty: evolving indications, technique, and applications in younger patients. Semin Arthro 18:156–161

    Article  Google Scholar 

  68. Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30:473–483

    Article  PubMed  Google Scholar 

  69. Witjes S, Van den Broek C, Koeter S, Van Loon C (2009) Dislocation of the mobile bearing component of a patellofemoral arthroplasty: a report of two cases. Acta Orthop Belg 75:411–416

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Sydney Orthopaedic Research Institute, Suite 12, Level 1, 445 Victoria Avenue, Chatswood, NSW, 2067, Australia

    Sébastien Lustig & David Parker

  2. Department of Orthopaedic Surgery, The Ohio State University Medical Center, Columbus, OH, USA

    Robert A. Magnussen

  3. Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA

    Diane L. Dahm

Authors
  1. Sébastien Lustig
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robert A. Magnussen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Diane L. Dahm
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. David Parker
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sébastien Lustig.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lustig, S., Magnussen, R.A., Dahm, D.L. et al. Patellofemoral arthroplasty, where are we today?. Knee Surg Sports Traumatol Arthrosc 20, 1216–1226 (2012). https://doi.org/10.1007/s00167-012-1948-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-012-1948-z

Keywords

Search

Navigation