髌股关节置换共23页.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 70s) 1973 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 2019 ? 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 53 yo female 10 + yr hx increasing disbility Surgical technique Surgical technique: set trochlear component parallel to transepicondylar axis Surgical technique: resect trochlear cartlage Surgical technique: reproduce patellar thickness assess patellar tracking lateral 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 contact in flexion 32 yr (!!) female with pain 1 yr af