髌股关节置换.pptVIP

Patellar Femoral Replacement Paul A Lotke MD Hospital of the University of Pennsylvania The patella has always been a problem Patello-Femoral Osteoarthritis:Prevalence High in patients with sx OA Women 24 % Men 11% The treatment alternatives have not been good Patellectomy Tibial tubercle “unloading osteotomies” Arthroscopic chondroplasty Lateral releases Micro-fracture Autogenous Chondrocyte Implant –ACI Mosaicplasty The classic results: 66% G/E Therefore, the need for a good patellofemoral replacement The first: a DePalma patellar prosthesis (early 70’s) Who is the best candidate for a PF replacement? The elderly with isolated patellar arthritis Do well with TKA The young with patellar arthritis No long term data available best for Middle aged who can convert to TKA? Patient selection Lonner JAAOS 2004 Isolated patellar arthritis Severe pain and functional disability Middle aged Avoid inflammatory arthritis Avoid severe mal-tracking Avoid any Fem-Tib arthritis Avoid laborers or high activity patients Avoid elderly (use TKA) Surgical technique Surgical technique Surgical technique:set trochlear component parallel to transepicondylar axis Surgical technique:resect trochlear cartlage Surgical technique:reproduce patellar thicknessassess patellar trackinglateral release if needed Clinical Results Scattered reports over past two decades Inconsistent indications and assessments However, results reasonably consistent 75-86 % G/E Most of the problems were from Patellar instablity Cartilage contact in flexion Patellar Instability Related to Uncorrected malalignment Soft tissue inbalance Component malposition Design flaws Cartilage contactin flexion Cartilage contact Cartilage contact Clinical results good potential for relief pain Are they predictable ? Clinical results Lonner 2003 # 25 44yr F/U 1 yr G/E 96 % Lonner 2003 # 30 38yr F/U 4 yr G/E 84 % Kooijman 2003 # 45 50yr F/U 17 yr