An alternative patellar resurfacing technique in knee replacement: patellofemoral fascial interposition arthroplasty

  • Volkan OztunaEmail author
  • Vasfi Karatosun
  • Bayram Unver
  • Irfan Ayan
  • Fehmi Kuyurtar


The present study reports the early clinical results of 38 osteoarthritic patients (38 knees) who were treated by total knee replacement in conjunction with patellofemoral fascial interposition arthroplasty (PFIA). After the femoral and tibial components were inserted, a fasciotendinous graft was harvested from the anterior surface of the quadriceps tendon and sutured around the articular surface of the patella. The patients were followed-up for a minimum of 24 months. The durability of the fascial graft was assessed radiographically by addition of a wire suture marker placed into the fascia in the first five patients. Patients were evaluated using the Hospital for Special Surgery (HSS) knee-rating system, and anterior knee pain was assessed using specific patellofemoral-related questions. The average HSS knee score improved from 61 points preoperatively to 92 points at 24 months’ follow-up (P < 0.001). Twenty-five patients (65.7%) had anterior knee pain preoperatively, and seven patients (18.4%) revealed anterior knee pain at their last visits (P < 0.001). The position of the markers in the fascial grafts did not show any change during radiological follow-ups. Our data suggest that, PFIA provides good pain relief and it may be an alternative resurfacing technique avoiding the complications of patellar components.


Knee prosthesis Patella Fascial interposition arthroplasty 


  1. 1.
    Abraham W, Buchanan JR, Daubert H, Greer RB III, Keefer J (1988) Should the patella be resurfaced in total knee arthroplasty? Efficacy of patellar resurfacing. Clin Orthop Relat Res 236:128–134PubMedGoogle Scholar
  2. 2.
    Azar FM, Wright PE (1998) Arthroplasty of shoulder and elbow. In: Terry Canale (eds) Campbell’s operative orthopaedics. Mosby, St Louis, pp 473–518Google Scholar
  3. 3.
    Barrack RL, Bertot AJ, Wolfe MW, Waldman DA, Milicic M, Myers L (2001) Patellar resurfacing in total knee arthroplasty. A prospective, randomized, double-blind study with five to seven years of follow-up. J Bone Joint Surg Am 83:1376–1381PubMedGoogle Scholar
  4. 4.
    Boyd AD Jr, Ewald FC, Thomas WH, Poss R, Sledge CB (1993) Long-term complications after total knee arthroplasty with or without resurfacing of the patella. J Bone Joint Surg Am 75:674–681PubMedGoogle Scholar
  5. 5.
    Brick GW, Scott RD (1988) The patellofemoral component of total knee arthroplasty. Clin Orthop Relat Res 231:163–178PubMedGoogle Scholar
  6. 6.
    Burkhead WZ, Hutton KS (1995) Biologic resurfacing of the glenoid with hemiarthroplasty of the shoulder. J Shoulder Elbow Surg 4:263–270PubMedCrossRefGoogle Scholar
  7. 7.
    Burnett RS, Haydon CM, Rorabeck CH, Bourne RB (2004) Patella resurfacing versus nonresurfacing in total knee arthroplasty: results of a randomized controlled clinical trial at a minimum of 10 years’ followup. Clin Orthop Relat Res 428:12–25PubMedCrossRefGoogle Scholar
  8. 8.
    Cameron HU, Fedorkow DM (1992) The patella in total knee arthroplasty. Clin Orthop Relat Res 165:197–199Google Scholar
  9. 9.
    Campbell DG, Mintz AD, Stevenson TM (1995) Early patellofemoral revision following total knee arthroplasty. J Arthroplasty 10:287–291PubMedCrossRefGoogle Scholar
  10. 10.
    Campbell DG, Duncan WW, Ashworth M, et al (2006) Patellar resurfacing in total knee replacement: a ten-year randomised prospective trial. J Bone Joint Surg Br 88:734–739PubMedCrossRefGoogle Scholar
  11. 11.
    Cheng SL, Morrey BF (2000) Treatment of the mobile, painful arthritic elbow by distraction interposition arthroplasty. J Bone Joint Surg Br 82:233–238PubMedCrossRefGoogle Scholar
  12. 12.
    Goldberg VM, Figgie HE III, Figgie MP (1989) Technical considerations in total knee surgery. Management of patella problems. Orthop Clin North Am 20:189–199PubMedGoogle Scholar
  13. 13.
    Hanssen AD (2001) Bone-grafting for severe patellar bone loss during revision knee arthroplasty. J Bone Joint Surg Am 83:171–176PubMedCrossRefGoogle Scholar
  14. 14.
    Harwin SF (1998) Patellofemoral complications in symmetrical total knee arthroplasty. J Arthroplasty 13:753–762PubMedCrossRefGoogle Scholar
  15. 15.
    Hasegawa M, Ohash T (2002) Long-term clinical results and radiographic changes in the nonresurfaced patella after total knee arthroplasty: 78 knees followed for mean 12 years. Acta Orthop Scand 73:539–545PubMedCrossRefGoogle Scholar
  16. 16.
    Holt GE, Dennis DA (2003) The role of patellar resurfacing in total knee arthroplasty. Clin Orthop Relat Res 416:76–83PubMedCrossRefGoogle Scholar
  17. 17.
    Hsu HP, Walkers PS (1989) Wear and deformation of patellar components in total knee arthroplasty. Clin Orthop Relat Res 246:260–265PubMedGoogle Scholar
  18. 18.
    Kennedy JG, Chow FY, Dines J, Gardner M, Bohne WH (2006) Outcomes after interposition arthroplasty for treatment of hallux rigidus. Clin Orthop Relat Res 445:210–215PubMedGoogle Scholar
  19. 19.
    Kim BS, Reitman RD, Schai PA, Scott RD (1999) Selective patellar nonresurfacing in total knee arthroplasty. 10 year results. Clin Orthop Relat Res 367:81–88PubMedCrossRefGoogle Scholar
  20. 20.
    Koga Y, Kono S, Mabuchi K (1988) A long term follow up of resection interposition arthroplasty of the knee using chromicized fascia lata. Int Orthop 12:9–15PubMedCrossRefGoogle Scholar
  21. 21.
    Muoneke HE, Khan AM, Giannikas KA, Hagglund E, Dunningham TH (2003) Secondary resurfacing of the patella for persistent anterior knee pain after primary knee arthroplasty. J Bone Joint Surg Br 85:675–678PubMedGoogle Scholar
  22. 22.
    Nizard RS, Biau D, Porcher R, Ravaud P, Bizot P, Hannouche D (2005) A meta-analysis of patellar replacement in total knee arthroplasty. Clin Orthop Relat Res 432:196–203PubMedCrossRefGoogle Scholar
  23. 23.
    Oh IS, Kim MK, You DS, Kang SB, Lee KH (2006) Total knee arthroplasty without patellar resurfacing. Int Orthop 6 [Epub ahead of print]Google Scholar
  24. 24.
    Pakos EE, Ntzani EE, Trikalinos TA (2005) Patellar resurfacing in total knee arthroplasty. A meta-analysis. J Bone Joint Surg Am 87:1438–1445PubMedCrossRefGoogle Scholar
  25. 25.
    Picetti GD III, McGann WA, Welch RB (1990) The patellofemoral joint after total knee arthroplasty without patellar resurfacing. J Bone Joint Surg Am 72:1379–1382PubMedGoogle Scholar
  26. 26.
    Ranawat CS (1986) The patellofemoral joint in total condylar knee arthroplasty. Pros and cons based on five- to ten-year follow-up observations. Clin Orthop Relat Res 205:93–99PubMedGoogle Scholar
  27. 27.
    Tabutin J, Banon F, Cattone Y, Grobost J, Tessier JL, Tillie B (2005) Should we resurface the patella in total knee replacement? Experience with the Nex Gen prothesis. Knee Surg Sports Traumatol Arthrosc 13:534–538PubMedCrossRefGoogle Scholar
  28. 28.
    Waters TS, Bentley G (2003) Patellar resurfacing in total knee arthroplasty. A prospective, randomized study. J Bone Joint Surg Am 85:212–217PubMedGoogle Scholar
  29. 29.
    Wood DJ, Smith AJ, Collopy D, White B, Brankov B, Bulsara MK (2002) Patellar resurfacing in total knee arthroplasty: a prospective, randomized trial. J Bone Joint Surg Am 84:187–193PubMedGoogle Scholar
  30. 30.
    Yamamoto S, Nakata S, Kondoh Y (1989) A follow-up study of an uncemented knee replacement. The results of 312 knees using the Kodama-Yamamoto prosthesis. J Bone Joint Surg Br 71:505–508PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Volkan Oztuna
    • 1
    Email author
  • Vasfi Karatosun
    • 2
  • Bayram Unver
    • 3
  • Irfan Ayan
    • 1
  • Fehmi Kuyurtar
    • 1
  1. 1.Department of OrthopaedicsMersin University School of MedicineMersinTurkey
  2. 2.Department of OrthopaedicsDokuz Eylul University School of MedicineIzmirTurkey
  3. 3.Dokuz Eylul University School of Physical Therapy and RehabilitationIzmirTurkey

Personalised recommendations