Skip to main content
Log in

Surgical Treatment of Isolated Patellofemoral Osteoarthritis

  • Review Article
  • Published:
HSS Journal ®



Isolated patellofemoral (PF) osteoarthritis (OA) affects 9% of persons older than 40 years. Nonoperative treatment should be exhausted fully before surgical treatment.


The purpose of this article is to review the literature after 2008 with the aim of answering the following question: Which of the following surgical procedures has the highest survival rate and the lowest revision rate in advanced isolated PF OA: patellofemoral arthroplasty (PFA), total knee arthroplasty (TKA) or lateral facetectomy.


The search engine was MedLine. The keywords used were: PF OA and PFA. Three hundred and fifty-three articles were found between 2008 and 25 July 2013. Of those, only 23 were selected and reviewed because they were strictly focused on the topic and the question of this article.


The types of studies reported so far have a low level of evidence (levels III and IV). Most of them are prospective case series (level IV). Some are systematic reviews of level III studies. Reported survival rate of lateral facetectomy is 85% at 5 years, 67% at 10 years and 47% at 20 years. Reported failure rate of lateral facetectomy is 26% at 10 years and 16% at 12 years. The reported average time of reoperation is 8 years and 37% of such procedures fail. Survival rate of PFA has been reported to be 87.5% on average (range, 60–100%). The revision rate of PFA is 20%. Recent improvements in PFA design have resulted in improvements in short-and medium-term results, similar to those of TKA.


There is still no gold standard for the surgical treatment of isolated PF OA. However, PFA or TKA appear to be the most recommendable treatment in cases that do not respond to conservative treatment.

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

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

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

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others


  1. Arumilli BR, Ng AB, Ellis DJ, Hirst P. Unusual mechanical complications of unicompartmental low contact stress mobile bearing patellofemoral arthroplasty: a cause for concern? The Knee. 2010; 17: 362-4.

    Article  CAS  PubMed  Google Scholar 

  2. Becker R, Röpke M, Krull A, Musahl V, Nebelung W. Surgical treatment of isolated patellofemoral osteoarthritis. Clinical Orthopaedics and Related Research. 2008; 466: 443-9.

    Article  PubMed  Google Scholar 

  3. Beitzel K, Schöttle PB, Cotic M, Dharmesh V, Imhoff AB. Prospective clinical and radiological two-year results after patellofemoral arthroplasty using an implant with an asymmetric trochlea design. Knee Surgery, Sports Traumatology, Arthroscopy. 2013; 21: 332-9.

    Article  PubMed  Google Scholar 

  4. Dahm DL, Al-Rayashi W, Dajani K, Shah JP, Levy BA, Stuart MJ. Patellofemoral arthroplasty versus total knee arthroplasty in patients with isolated patellofemoral osteoarthritis. Am J Orthop (Belle Mead NJ). 2010; 39: 487-91.

    Google Scholar 

  5. Delanois RE, McGrath MS, Ulrich SD, et al. Results of total knee replacement for isolated patellofemoral arthritis: when not to perform a patellofemoral arthroplasty. The Orthopedic Clinics of North America. 2008; 39: 381-8.

    Article  PubMed  Google Scholar 

  6. Duncan R, Peat G, Thomas E, Wood L, Hay E, Croft P. Does isolated patellofemoral osteoarthritis matter? Osteoarthritis and Cartilage. 2009; 17: 1151-5.

    Article  CAS  PubMed  Google Scholar 

  7. Dy CJ, Franco N, Ma Y, Mazumdar M, McCarthy MM, Gonzalez Della Valle A. Complications after patello-femoral versus total knee replacement in the treatment of isolated patello-femoral osteoarthritis. a meta-analysis. Knee Surgery, Sports Traumatology, Arthroscopy. 2012; 20: 2174-90.

    Article  CAS  PubMed  Google Scholar 

  8. Hutt J, Dodd M, Bourke H, Bell J. Outcomes of total knee replacement after patellofemoral arthroplasty. The Journal of Knee Surgery. 2013; 26: 219-24.

    PubMed  Google Scholar 

  9. Lonner JH. Patellofemoral arthroplasty. Orthopedics. 2010; 33: 653.

    PubMed  Google Scholar 

  10. Lonner JH. Patellofemoral arthroplasty. Instructional Course Lectures. 2010; 59: 67-84.

    PubMed  Google Scholar 

  11. Lonner JH, Bloomfield MR. The clinical outcome of patellofemoral arthroplasty. The Orthopedic Clinics of North America. 2013; 44: 271-80.

    Article  PubMed  Google Scholar 

  12. Lüring C, Tingart M, Drescher W, Springorum HR, Kraft CN, Rath B. Therapy of isolated arthritis in the patellofemoral joint: are there evidence-based options? (Article in German). Orthopade. 2011; 40: 902-6.

    Article  PubMed  Google Scholar 

  13. Lustig S, Magnussen RA, Dahm DL, Parker D. Patellofemoral arthroplasty, where are we today? Knee Surgery, Sports Traumatology, Arthroscopy. 2012; 20: 1216-26.

    Article  PubMed  Google Scholar 

  14. Mont MA, Johnson AJ, Naziri Q, Kolisek FR, Leadbetter WB. Patellofemoral arthroplasty: 7-year mean follow-up. The Journal of Arthroplasty. 2012; 27: 358-61.

    Article  PubMed  Google Scholar 

  15. Montserrat F, Alentorn-Geli E, León V, Ginés-Cespedosa A, Rigol P. Partial lateral facetectomy plus insall’s procedure for the treatment of isolated patellofemoral osteoarthritis: survival analysis. Knee Surg Sports Traumatol Arthrosc. 2012. doi:10.1007/s00167-012-2286-x

  16. Montserrat F, Alentorn-Geli E, León V, Ginés-Cespedosa A, Rigol P. Treatment of isolated patellofemoral osteoarthritis with lateral facetectomy plus insall’s realignment procedure: long-term follow-up. Knee Surg Sports Traumatol Arthrosc. 2013; 21(11): 2572-2577.

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  18. Sarda PK, Shetty A, Maheswaran SS. Medium term results of Avon patellofemoral joint replacement. Indian J Orthop. 2011; 45: 439-44.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Tarassoli P, Punwar S, Khan W, Johnstone D. Patellofemoral arthroplasty: a systematic review of the literature. Open Orthop J. 2012; 6: 340-7.

    Article  PubMed Central  PubMed  Google Scholar 

  20. van Jonbergen HP, Poolman RW, van Kampen A. Isolated patellofemoral osteoarthritis. Acta Orthopaedica. 2010; 81: 199-205.

    Article  PubMed  Google Scholar 

  21. Walker T, Perkinson B, Mihalko WM. Patellofemoral arthroplasty: the other unicompartmental knee replacement. Journal of Bone and Joint Surgery (American). 2012; 94: 1712-20.

    Article  Google Scholar 

  22. Wetzels T, Bellemans J. Patellofemoral osteoarthritis treated by partial lateral facetectomy: results at long-term follow up. The Knee. 2012; 19: 411-5.

    Article  CAS  PubMed  Google Scholar 

  23. Yadav B, Shaw D, Radcliffe G, Dachepalli S, Kluge W. Mobile-bearing, congruent patellofemoral prosthesis: short-term results. Journal of Orthopaedic Surgery (Hong Kong). 2012; 20: 348-52.

    Google Scholar 

Download references


Conflict of Interest

E. Carlos Rodriguez-Merchan, MD, PhD has declared that he has no conflict of interest.

Human/Animal Rights

This article does not contain any studies with human or animal subjects performed by the author.

Informed Consent:


Required Author Forms

Disclosure forms provided by the authors are available with the online version of this article.

Author information

Authors and Affiliations


Corresponding author

Correspondence to E. Carlos Rodriguez-Merchan MD, PhD.

Electronic supplementary material

Below is the link to the electronic supplementary material.


PDF 1,224 kb

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rodriguez-Merchan, E.C. Surgical Treatment of Isolated Patellofemoral Osteoarthritis. HSS Jrnl 10, 79–82 (2014).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: