Computer-Assisted Navigation in Patellofemoral Arthroplasty: a New Technique to Improve Rotational Position of the Trochlea



Maltracking or subluxation is one of the complications of patellofemoral arthroplasty.


We questioned whether the computed navigation system can improve patellar tracking in patients with patellofemoral arthroplasty (PFA).


Between 2007 and 2010 we performed 15 patellofemoral arthroplasties using the Ceraver PFA and navigation assistance. Fifteen other patients underwent surgery without navigation during the same period and acted as a control group. The rotation of the native trochlea as measured using the epicondylar line as a reference before surgery and the rotation of the trochlear component and the trochlear twist angle were assessed with computed tomography (CT) scan after surgery.


The mean follow-up was 3 years (range, 2–5 years). The group with navigation had no patellofemoral complications and better clinical scores. The group without navigation had abnormal patellofemoral tracking in 5 of the 15 patients. CT scan demonstrated excessive internal component rotation, as compared with patients without complications. This excessive internal rotation was proportional to the severity of the patellofemoral maltracking.


The short-term results suggest that navigation can lead to better trochlear rotation which, in our hands, is associated with fewer cases of patellar maltracking and better overall clinical scores.

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  1. 1.

    Ackroyd CE. Development and early results of a new patellofemoral arthroplasty. Clin Orthop. 2005;436:7-13.

    PubMed  Google Scholar 

  2. 2.

    Ackroyd CE, Newman JH, Evans R, Eldridge JDJ, Joslin CC. The Avon patellofemoral arthroplasty. Five-year survivorship and functional results. J Bone Joint Surg. 2007;89B:310-315.

    Google Scholar 

  3. 3.

    Cossey AJ, Spriggins AJ. Computer-Assisted Patellofemoral Arthroplasty A Mechanism for Optimizing Rotation. J Arthroplast. 2006;21(3):420-427.

    Article  CAS  Google Scholar 

  4. 4.

    Crosby EB, Insall J. Recurrent dislocation of the patella. J Bone Joint Surg Am. 1976;58A:9-13.

    Google Scholar 

  5. 5.

    Digiulio M, Donaldson WR. Complications of Patello-Femoral Joint Surgery. Sports Med Arthrosc Rev. 2004;12(3):172-184.

    Article  Google Scholar 

  6. 6.

    Grelsamer RP. Patellar malalignment. J Bone Joint Surg Am. 2000;82-A(11):1639-1650.

    PubMed  CAS  Google Scholar 

  7. 7.

    Grelsamer RP. Stein Da: Patellofemoral arthritis. J Bone Joint Surg Am. 2006;88(8):1849-1860.

    PubMed  Article  Google Scholar 

  8. 8.

    Jenny J-Y, Borei C. Navigation implantation of total knee prosthesis. A comparative study with conventional techniques. Rev Chir Orthop Reparatrice Appar Mot. 2001;87:645.

    PubMed  CAS  Google Scholar 

  9. 9.

    Lonner JH. Patellofemoral arthroplasty. In: Lotke PA, Lonner JH, eds. Master Techniques in Orthopaedic Surgery: Knee Arthroplasty. 3rd ed. Philadelphia: Lippincott Williams and Wilkins; 2009.

    Google Scholar 

  10. 10.

    McKeever DC. Patellar prosthesis. J Bone Joint Surg. 1955;37A:1074-1084.

    Google Scholar 

  11. 11.

    Schutzer SF, Ramsby GR, Fulkerson JP. Computed tomographic classification of patellofemoral pain patients. Orthop Clin North Am. 1986;17:235-248.

    PubMed  CAS  Google Scholar 

  12. 12.

    Schutzer SF, Ramsby GR, Fulkerson JP. The evaluation of patellotemoral pain using computerized tomography. Clin Orthop. 1986;204:286-288.

    PubMed  Google Scholar 

  13. 13.

    Stulberg S, Loan P, Sarin V. Computer assisted navigation in total knee replacement. Results of an initial 35 patients. J Bone Joint Surg Am. 2002;84A(Suppl 2):90.

    Google Scholar 

  14. 14.

    Tauro B, Ackroyd CE, Newman JH, et al. The Lubinus patellofemoral arthroplasty. J Bone Joint Surg. 2001;83B:696-701.

    Article  Google Scholar 

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Conflict of Interest:

Philippe Hernigou, MD, Charles Henri Flouzat-Lachaniette, MD, William Delblond, MD, Pascal Duffiet MD, Didier Julian declare that they have no conflict of interest.

Human/Animal Rights:

All procedures followed were in accordance with the ethical standards of the responsible commiee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).

Informed Consent:

Informed consent was obtained from all patients for being included in the study.

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Correspondence to Philippe Hernigou MD.

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Level of Evidence:

Therapeutic Study Level III. Please see levels of evidence for a complete description.

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Hernigou, P., Flouzat-Lachaniette, C.H., Delblond, W. et al. Computer-Assisted Navigation in Patellofemoral Arthroplasty: a New Technique to Improve Rotational Position of the Trochlea. HSS Jrnl 9, 118–122 (2013).

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  • patellofemoral arthroplasty
  • computer-assisted navigation
  • knee
  • patella