Patellofemorale Inlay-Implantate – ein Fortschritt in der patellofemoralen Endoprothetik?

Patellofemoral inlay implants—an innovation in patellofemoral joint arthroplasty?

Zusammenfassung

Die isolierte Arthrose des Patellofemoralgelenkes stellt eine seltene und komplexe Erkrankung dar. Nach Ausschöpfen der konservativen Therapie stehen dem Orthopäden diverse weichteilige und knöcherne rekonstruktive Verfahren sowie knorpelregenerative Verfahren zur Verfügung. Bei fehlgeschlagener oder unbefriedigender Therapie wird die Patellofemoralprothese als Therapiealternative weiterhin kontrovers diskutiert. Bei genauerer Betrachtung der Studien zeigen sich vielversprechende Ergebnisse bei korrekter Indikationsstellung und Patientenselektion. Die unterschiedlichen Prothesendesigns liefern gute postoperative Ergebnisse bei Beachtung von generellen und spezifischen Risiken. Die aktuelle Generation der patellofemoralen Inlay-Prothesen zeigt eine hohe Patientenzufriedenheit mit signifikanten Verbesserungen der Kniefunktion und Schmerzlinderung in mittelfristen Ergebnissen, bei allerdings nicht unerheblicher Revisionsrate.

Abstract

Isolated arthrosis of the patellofemoral joint is a rare and complex disease. After conservative therapy has been exhausted, the orthopedist has various soft-tissue and bone reconstructive procedures as well as cartilage regenerative procedures at his hands. In cases of failed or unsatisfactory therapy, patellofemoral arthroplasty continues to be controversially discussed as an alternative therapy. A closer look at these studies reveals promising results with the correct indication and patient selection. The different prosthesis designs provide good postoperative results while considering general and specific risks. The current generation of patellofemoral inlay prostheses shows high patient satisfaction with significant improvements in knee function and pain relief in mid-term outcomes. However, a relatively high revision rate must be considered.

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Abbreviations

BMI:

Body-Mass-Index

KTEP :

Knietotalendoprothese

MPFL :

Mediales patellofemorales Ligament

PFTE :

Patellofemoraler Teilersatz

VAS :

Visuelle Analogskala

WOMAC :

Western Ontario and McMaster Universities Osteoarthritis Index

Literatur

  1. 1.

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

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  2. 2.

    Akhbari P, Malak T, Dawson-Bowling S et al (2015) The avon patellofemoral joint replacement: mid-term prospective results from an independent centre. Clin Orthop Surg 7:171–176

    PubMed  PubMed Central  Article  Google Scholar 

  3. 3.

    Arendt E (2005) Anatomy and malalignment of the patellofemoral joint: its relation to patellofemoral arthrosis. Clin Orthop Relat Res. https://doi.org/10.1097/01.blo.0000171543.60966.a6

    Article  PubMed  PubMed Central  Google Scholar 

  4. 4.

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

    PubMed  Article  Google Scholar 

  5. 5.

    Beckmann J, Merz C, Huth J et al (2019) Patella alta and patellar subluxation might lead to early failure with inlay patello-femoral joint arthroplasty. Knee Surg Sports Traumatol Arthrosc 27:685–691

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  6. 6.

    Beitzel K, Schottle PB, Cotic M et al (2013) Prospective clinical and radiological two-year results after patellofemoral arthroplasty using an implant with an asymmetric trochlea design. Knee Surg Sports Traumatol Arthrosc 21:332–339

    PubMed  Article  Google Scholar 

  7. 7.

    Bellamy N, Buchanan WW, Goldsmith CH et al (1988) Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 15:1833–1840

    CAS  PubMed  PubMed Central  Google Scholar 

  8. 8.

    Bendixen NB, Eskelund PW, Odgaard A (2019) Failure modes of patellofemoral arthroplasty-registries vs. clinical studies: a systematic review. Acta Orthop 90:473–478

    PubMed  PubMed Central  Article  Google Scholar 

  9. 9.

    Blazina ME, Fox JM, Del Pizzo W et al (1979) Patellofemoral replacement. Clin Orthop Relat Res 144(1979):98–102

    Google Scholar 

  10. 10.

    Borus T, Brilhault J, Confalonieri N et al (2014) Patellofemoral joint replacement, an evolving concept. Knee 21(Suppl 1):S47–S50

    PubMed  Article  Google Scholar 

  11. 11.

    Calliess T, Ettinger M, Schado S et al (2016) Patella tracking and patella contact pressure in modular patellofemoral arthroplasty: a biomechanical in vitro analysis. Arch Orthop Trauma Surg 136:849–855

    PubMed  Article  Google Scholar 

  12. 12.

    Cartier P, Sanouiller JL, Khefacha A (2005) Long-term results with the first patellofemoral prosthesis. Clin Orthop Relat Res. https://doi.org/10.1097/01.blo.0000171918.24998.d1

    Article  PubMed  Google Scholar 

  13. 13.

    Cotic M, Imhoff AB (2014) Patellofemoral arthroplasty: indication, technique and results. Orthopäde 43:898–904

    CAS  PubMed  Article  Google Scholar 

  14. 14.

    Dahm DL, Al-Rayashi W, Dajani K et al (2010) Patellofemoral arthroplasty versus total knee arthroplasty in patients with isolated patellofemoral osteoarthritis. Am J Orthop 39:487–491

    PubMed  Google Scholar 

  15. 15.

    Dahm DL, Kalisvaart MM, Stuart MJ et al (2014) Patellofemoral arthroplasty: outcomes and factors associated with early progression of tibiofemoral arthritis. Knee Surg Sports Traumatol Arthrosc 22:2554–2559

    PubMed  Article  Google Scholar 

  16. 16.

    Davies AP, Vince AS, Shepstone L et al (2002) The radiologic prevalence of patellofemoral osteoarthritis. Clin Orthop Relat Res. https://doi.org/10.1097/00003086-200209000-00020

    Article  PubMed  PubMed Central  Google Scholar 

  17. 17.

    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

    PubMed  Article  PubMed Central  Google Scholar 

  18. 18.

    Dy CJ, Franco N, Ma Y et al (2012) Complications after patello-femoral versus total knee replacement in the treatment of isolated patello-femoral osteoarthritis. A meta-analysis. Knee Surg Sports Traumatol Arthrosc 20:2174–2190

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  19. 19.

    Feucht MJ, Cotic M, Beitzel K et al (2017) A matched-pair comparison of inlay and onlay trochlear designs for patellofemoral arthroplasty: no differences in clinical outcome but less progression of osteoarthritis with inlay designs. Knee Surg Sports Traumatol Arthrosc 25:2784–2791

    PubMed  Article  PubMed Central  Google Scholar 

  20. 20.

    Fulkerson JP (2005) Alternatives to patellofemoral arthroplasty. Clin Orthop Relat Res. https://doi.org/10.1097/01.blo.0000172305.20156.ba

    Article  PubMed  Google Scholar 

  21. 21.

    Ghosh KM, Merican AM, Iranpour F et al (2009) The effect of overstuffing the patellofemoral joint on the extensor retinaculum of the knee. Knee Surg Sports Traumatol Arthrosc 17:1211–1216

    CAS  PubMed  Article  Google Scholar 

  22. 22.

    Gould D, Kelly D, Goldstone L et al (2001) Examining the validity of pressure ulcer risk assessment scales: developing and using illustrated patient simulations to collect the data. J Clin Nurs 10:697–706

    CAS  PubMed  Article  Google Scholar 

  23. 23.

    Grassi A, Compagnoni R, Ferrua P et al (2018) Patellar resurfacing versus patellar retention in primary total knee arthroplasty: a systematic review of overlapping meta-analyses. Knee Surg Sports Traumatol Arthrosc 26:3206–3218

    PubMed  Article  Google Scholar 

  24. 24.

    Grelsamer RP, Stein DA (2006) Patellofemoral arthritis. J Bone Joint Surg Am 88:1849–1860

    PubMed  Article  Google Scholar 

  25. 25.

    Grimberg A, Jansson V, Melsheimer O et al (2019) Endoprothesenregister Deutschland [EPRD] – Jahresbericht 2019

    Google Scholar 

  26. 26.

    Imhoff AB, Feucht MJ, Bartsch E et al (2019) High patient satisfaction with significant improvement in knee function and pain relief after mid-term follow-up in patients with isolated patellofemoral inlay arthroplasty. Knee Surg Sports Traumatol Arthrosc 27:2251–2258

    PubMed  Article  PubMed Central  Google Scholar 

  27. 27.

    Imhoff AB, Feucht MJ, Meidinger G et al (2015) Prospective evaluation of anatomic patellofemoral inlay resurfacing: clinical, radiographic, and sports-related results after 24 months. Knee Surg Sports Traumatol Arthrosc 23:1299–1307

    PubMed  Article  Google Scholar 

  28. 28.

    Joseph MN, Carmont MR, Tailor H et al (2020) Total knee arthroplasty reduces knee extension torque in-vitro and patellofemoral arthroplasty does not. J Biomech 104:109739

    PubMed  Article  PubMed Central  Google Scholar 

  29. 29.

    Kamikovski I, Dobransky J, Dervin GF (2019) The clinical outcome of patellofemoral Arthroplasty vs total knee Arthroplasty in patients younger than 55 years. J Arthroplasty 34:2914–2917

    PubMed  Article  Google Scholar 

  30. 30.

    Laursen JO (2017) High mid-term revision rate after treatment of large, full-thickness cartilage lesions and OA in the patellofemoral joint using a large inlay resurfacing prosthesis: HemiCAP-Wave. Knee Surg Sports Traumatol Arthrosc 25:3856–3861

    PubMed  Article  PubMed Central  Google Scholar 

  31. 31.

    Leadbetter WB, Kolisek FR, Levitt RL et al (2009) Patellofemoral arthroplasty: a multi-centre study with minimum 2‑year follow-up. Int Orthop 33:1597–1601

    PubMed  Article  Google Scholar 

  32. 32.

    Liow MH, Goh GS, Tay DK et al (2016) Obesity and the absence of trochlear dysplasia increase the risk of revision in patellofemoral arthroplasty. Knee 23:331–337

    PubMed  Article  PubMed Central  Google Scholar 

  33. 33.

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

  34. 34.

    Lonner JH (2008) Patellofemoral arthroplasty: the impact of design on outcomes. Orthop Clin North Am 39:347–354, vi

    PubMed  Article  Google Scholar 

  35. 35.

    Lonner JH, Bloomfield MR (2013) The clinical outcome of patellofemoral arthroplasty. Orthop Clin North Am 44:271–280, vii

    PubMed  Article  Google Scholar 

  36. 36.

    Lustig S, Magnussen RA, Dahm DL et al (2012) Patellofemoral arthroplasty, where are we today? Knee Surg Sports Traumatol Arthrosc 20:1216–1226

    PubMed  Article  Google Scholar 

  37. 37.

    Monk AP, Van Duren BH, Pandit H et al (2012) In vivo sagittal plane kinematics of the FPV patellofemoral replacement. Knee Surg Sports Traumatol Arthrosc 20:1104–1109

    CAS  PubMed  Article  Google Scholar 

  38. 38.

    Nicol SG, Loveridge JM, Weale AE et al (2006) Arthritis progression after patellofemoral joint replacement. Knee 13:290–295

    PubMed  Article  PubMed Central  Google Scholar 

  39. 39.

    Odgaard A, Madsen F, Kristensen PW et al (2018) The Mark Coventry award: patellofemoral Arthroplasty results in better range of movement and early patient-reported outcomes than TKA. Clin Orthop Relat Res 476:87–100

    PubMed  Article  PubMed Central  Google Scholar 

  40. 40.

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

    CAS  PubMed  Article  Google Scholar 

  41. 41.

    Pisanu G, Rosso F, Bertolo C et al (2017) Patellofemoral Arthroplasty: current concepts and review of the literature. Joints 5:237–245

    PubMed  PubMed Central  Article  Google Scholar 

  42. 42.

    Strickland SM, Bird ML, Christ AB (2018) Advances in patellofemoral Arthroplasty. Curr Rev Musculoskelet Med 11:221–230

    PubMed  PubMed Central  Article  Google Scholar 

  43. 43.

    Van Der List JP, Chawla H, Zuiderbaan HA et al (2017) Survivorship and functional outcomes of patellofemoral arthroplasty: a systematic review. Knee Surg Sports Traumatol Arthrosc 25:2622–2631

    Article  Google Scholar 

  44. 44.

    Van Jonbergen HP, Werkman DM, Barnaart LF et al (2010) Long-term outcomes of patellofemoral arthroplasty. J Arthroplasty 25:1066–1071

    PubMed  Article  Google Scholar 

  45. 45.

    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

    PubMed  PubMed Central  Article  Google Scholar 

  46. 46.

    Vandenneucker H, Labey L, Vander Sloten J et al (2016) Isolated patellofemoral arthroplasty reproduces natural patellofemoral joint kinematics when the patella is resurfaced. Knee Surg Sports Traumatol Arthrosc 24:3668–3677

    PubMed  Article  Google Scholar 

  47. 47.

    Zicaro JP, Yacuzzi C, Astoul Bonorino J et al (2017) Patellofemoral arthritis treated with resurfacing implant: Clinical outcome and complications at a minimum two-year follow-up. Knee 24:1485–1491

    PubMed  Article  Google Scholar 

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Correspondence to PD Dr. Jonas Pogorzelski MHBA.

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Interessenkonflikt

A.B. Imhoff gibt an, dass er eine beratende Funktion für die Firma Arthrosurface (Franklin, MA, USA) hat. H. Degenhardt, M.J. Feucht und J. Pogorzelski geben an, dass kein Interessenkonflikt besteht. Die Firma Arthrosurface (Franklin, MA, USA) hat keinen Einfluss auf Design, Datenerhebung und Ergebnisinterpretation dieser Arbeit.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Degenhardt, H., Imhoff, A.B., Feucht, M.J. et al. Patellofemorale Inlay-Implantate – ein Fortschritt in der patellofemoralen Endoprothetik?. Orthopäde (2020). https://doi.org/10.1007/s00132-020-04059-4

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Schlüsselwörter

  • Knorpel
  • Gelenkersatz
  • Knie
  • Arthrose
  • Patellofemoralgelenk

Keywords

  • Cartilage
  • Joint replacement
  • Knee
  • Osteoarthritis
  • Patellofemoral joint