The Knee 21 S1 (2014) S43–S46
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The Knee
Partial knee arthroplasty: patellofemoral arthroplasty and combined unicompartmental and patellofemoral arthroplasty implants – general considerations and indications, technique and clinical experience Francesco Benazzo, Stefano M.P. Rossi*, Matteo Ghiara Clinica Ortopedica e Traumatologica, Università degli Studi di Pavia Fondazione IRCCS Policlinico San Matteo Pavia
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Article history: Received 11 June 2014 Received in revised form 12 August 2014 Accepted 26 August 2014 Keywords: Unicompartmental Patellofemoral Combined implants Techique
abstract
Background: Unicompartmental and patellofemoral arthroplasty (PFA) are not new concepts as shown by different authors, and nowadays surgical solutions other than total knee arthroplasty (TKA) must be considered, exploiting the technical possibilities offered by the new designs of prostheses which have improved the results of already used, old fashioned implants. The aim of our study was to present our experience with PFA and its combination with unicompartmental knee arthroplasty (UKA). Methods: From March 2007 to May 2012 we have treated 55 patients with a patellofemoral joint arthroplasty; in 25 cases we have performed an isolated PFA and in 30 cases a combined UKA and PFA. The mean follow-up in the group of isolated patellofemoral joint arthroplasty was 56.5 months; in the combined implant the mean follow-up was 59 months. Results: In both group we found an significant improvement of HSS, KSS and OKS scores with results at final follow-up ranging from good to excellent. Conclusions: Partial knee arthroplasty shows promising results at mid-term follow-up. © 2014 Elsevier B.V. All rights reserved.
1. Introduction Osteoarthritic changes of the knee, whether primary or post traumatic, do not always involve all three of the compartments (the two tibiofemoral and the patellofemoral). Furthermore, there is more focus on the patellofemoral joint as, intrinsic to simple acts such as going up and down stairs, standing up from a chair and keeping the knee bent whilst sitting, it alone can impair normal everyday living. When conservative treatments such as hyaluronan injections, orthotics, rehabilitation/physiotherapy, minor surgical procedures such as arthroscopy or preventive surgery such as osteotomy are no longer suitable, the traditional total knee arthroplasty (TKA) is still the most common way to treat such degenerative changes even when associated with uni- or bicompartmental disease. TKA is widely reported in the literature as giving reliable and long lasting results in 85 to 95% of cases. Patient satisfaction, however, does not always meet expectations, and is not as good as other surgical procedures for various reasons. Healthy portions of the knee are sacrificed as are, even more importantly, one or both cruciates eliminating normal knee kinematics and proprioception. For both young, active patients and elderly patients with “normal” functional demand, proprioception is essential for the knee to function well. TKA, therefore, can be considered overkill. As the literature confirms, unicompartmental
* Corresponding author at: Clinica Ortopedica e Traumatologica Fondazione IRCCS Policlinico San Matteo P.le Golgi 19, 27100 Pavia Italy. E-mail address:
[email protected] (S.M.P. Rossi). 0968-0160/© 2014 Elsevier B.V. All rights reserved.
and patellofemoral arthroplasty (PFA) are not new concepts and, nowadays, surgical solutions alternative to TKA must be taken into consideration, exploiting the technical possibilities offered by the new designs of prostheses which have improved the results of already used, old fashioned implants [1-4]. In other words, we are entering a new phase in which partial osteoarthritic changes can be treated with partial resurfacing prosthetic solutions such as unicompartmental, bi-unicompartmental or PFA alone or unicompartmental combined, which respects the cruciates and achieves maximal bone preservation which is vital, particularly for young patients [5-8]. New materials, designs, instruments and level of skill (very much improved in the orthopaedic community) render these options accessible to more patients and the age range is wider. We therefore advocate a different approach to surgical treat ment of the osteoarthritic knee with first consideration given to partial resurfacing prior to considering TKA. In this paper we present our experience with PFA and its combination with unicompartmental knee arthroplasty (UKA). 1.1. Indications and contraindications 1.1.1 Unicompartmental Indications • Unicompartmental disease (medial or lateral) with mild degeneration of one or both of the other compartments. • Deformity of the anatomical axis of the limb caused by narrowing of the joint line due to degenerative disease, not
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deformity of the tibia (schuss or Rosenberg x-rays view of the knee: PA weight-bearing views with the knee taken in 30° of flexion). • “One finger” sign positive: the patient indicates the painful area of the knee with one finger on the medial (or lateral) side. • Varus/valgus deformity 60 years. • Weight
