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 3. Educational/Research 1. Arthrosurface Institutional 1. Stryker 2. Arthrex 3. Arthrosurface 2. Consulting/Honoraria 1.Stryker 2. Arthrosurface 3. Arthrex 4. Smith and Nephew

Patellofemoral Arthrosis  Treatment remains a challenge –especially young patient  Complex articulation trauma  High pressures across Anatomy the knee joint Type A TypeB  3-5x body weight Normal limb Abnormal  Pathology multifactorial morphology  Difficulties in achieving a congruent surface Instability

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  Anatomical  Neither overstuffing nor notching  Minimal bone resection Focal And Diffuse Options

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 . other 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 Patellofemoral joint  49 yo female, active  Phys Ed teacher  Years of pain, conservative treatments  PT, NSAIDS, injections  arthroscopy Medial compartment

Young patient combined disease Patella OA Medial femoral condyle 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 other implants in younger patients before TKA

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