Patellofemoral Arthritis How do we deal with it when all else - - PowerPoint PPT Presentation

Patellofemoral Arthritis How do we deal with it when all else fails?- Inlay Arthroplasty

Anthony Miniaci M.D. FRCSC Professor of Surgery Cleveland Clinic Sports Health

Conflicts of Interest

1. Royalties/stock/equity

• 1. Arthrosurface
• 2. Consulting/Honoraria

1.Stryker

• 2. Arthrosurface
• 3. Arthrex
• 4. Smith and Nephew
• 3. Educational/Research

Institutional

• 1. Stryker
• 2. Arthrex
• 3. Arthrosurface

Patellofemoral Arthrosis

• Treatment remains a

challenge –especially young patient

• Complex articulation
• High pressures across

the knee joint

• 3-5x body weight
• Pathology multifactorial
• Difficulties in achieving

a congruent surface

Anatomy trauma Instability

Type A Normal limb morphology

TypeB Abnormal

Joint Resurfacing

TREATMENT OPTIONS

• Marrow stimulation
• Osteochondral grafting
• Cellular therapies
• Biological scaffolds
• ? When all fails- frequent
• Prosthetic resurfacing

Patellofemoral Arthroplasty

• Good to excellent results in 50 - 80%

patients

• Sisto DJ, Sarin VK Custom Patellofemoral Arthroplasty of the Knee. JBJS Am.

2006;88:1475-80.

• Merchant AC. Early results with a total patellofemoral joint replacement

arthroplasty prosthesis. J Arthroplasty. 2004;19:829-36.

• Disadvantages
• Trochlear loosening
• Progressive tibio-femoral arthritis
• Residual anterior knee pain and

snapping

• Limitations in Instrumentation
• overstuffing

Patellofemoral arthroplasty-limitations The over stuffed joint

• Increased patellofemoral

pressure

• Increase in subchondral

pressure

• Postoperative pain

syndrome

• Earlv Loosening?

So what’s New in PF Arthroplasty ? Restore anatomy and Congruency Inlay Resurfacing

Concept- P-F Inlay Prosthesis Focal And Diffuse Options

• Anatomical
• Neither overstuffing nor

notching

• Minimal bone resection

Patellofemoral Kinematics After Limited Resurfacing of the Trochlea

The Journal of Knee Surgery Volume 22 Number 4

Matthew Provencher MD; Nikhil N. Verma MD; Brian J. Cole MD,

The Indications:

• 1. Focal Lesions
• 2. Diffuse Arthritis

1.- isolated to PF joint 2.Combination with

• ther compartments
• 3. OA with Dysplasia

and/or maltracking

.

Focal Trochlear Defects

• 36 yo old ACL injury
• Developed trochlear

pain and arthrosis

• 2 surgeries later-

Chondroplasty, microfracture failed

• Resurfacing trochlea

Diffuse Trochlear arthritis only

• 40 yo orthopedic

surgeon

• Very active biker,

mountain climbing

• Failed scope, MF,

cartilage restoration

• Intact patellar

cartilage, advanced trochlear disease

Diffuse Arthritis- Patella and trochlea

Diffuse Arthritis -PF

• With and without

lateral subluxation

• Most align with

proper patella positioning

• Often combined

with lateral facetectomy

Extended lateral facet

Young patient combined disease PF and Medial compartment

• 49 yo female, active
• Phys Ed teacher
• Years of pain,

conservative treatments

• PT, NSAIDS, injections
• arthroscopy

Medial compartment Patellofemoral joint

Young patient combined disease

Medial femoral condyle OA Patella OA Trochlea OA

Young patient combined disease Inlay resurfacing PF/medial

Dysplasia +Arthritis

• Very limited options for these patients
• instability
• System can recreate a trochlea groove- stability

Inlay Resurfacing Summary

• Failures of biologics in young

patients

• Inlay design reduces stresses and

eliminates overstuffing

• PF Inlay resurfacing good option

for trochlea lesions only small/large or with Patella

• Can be used in conjunction with
• ther implants in younger

patients before TKA

Anthony Miniaci M.D. FRCSC Professor of Surgery Cleveland Clinic Sports Health