髌股关节置换.pptxVIP

髌股关节置换第1页/共23页 Patellar Femoral Replacement第2页/共23页 The patella has always been a problem第3页/共23页 Patello-Femoral Osteoarthritis:Prevalence High in patients with sx OA Women 24 % Men 11% 第4页/共23页 The treatment alternatives have not been good PatellectomyTibial tubercle “unloading osteotomies”Arthroscopic chondroplastyLateral releasesMicro-fractureAutogenous Chondrocyte Implant –ACIMosaicplastyThe classic results: 66% G/E第5页/共23页 Therefore, the need for a good patellofemoral replacementThe first: a DePalma patellar prosthesis (early 70’s)1973第6页/共23页 Who is the best candidate for a PF replacement?The elderly with isolated patellar arthritisDo well with TKAThe young with patellar arthritisNo long term data available best for Middle aged who can convert to TKA? 第7页/共23页 Patient selection Lonner JAAOS 2004Isolated patellar arthritisSevere pain and functional disabilityMiddle agedAvoid inflammatory arthritisAvoid severe mal-trackingAvoid any Fem-Tib arthritisAvoid laborers or high activity patientsAvoid elderly (use TKA)第8页/共23页 Surgical technique53 yo female 10 + yr hx increasing disbility第9页/共23页 Surgical technique第10页/共23页 Surgical technique:set trochlear component parallel to transepicondylar axis第11页/共23页 Surgical technique:resect trochlear cartlage第12页/共23页 Surgical technique:reproduce patellar thicknessassess patellar trackinglateral release if needed第13页/共23页 Clinical Results Scattered reports over past two decadesInconsistent indications and assessmentsHowever, results reasonably consistent75-86 % G/E Most of the problems were fromPatellar instablityCartilage contact in flexion第14页/共23页 Patellar InstabilityRelated to Uncorrected malalignmentSoft tissue inbalanceComponent malpositionDesign flaws第15页/共23页 Cartilage contactin flexion32 yr (!!) female with pain 1 yr after a PFA excellent exam第16页/共23页 Cartilage contact第17页/共23页 Patellar contact patterns第18页/共23页 Cartilage contact第19页/共23页 Clinical resultsgood potential for