The appropriate use of patellofemoral arthroplasty: an analysis of reported indications, contraindications, and failures.
Patellofemoral arthroplasty is going through a recent resurgence in interest with various new designs being introduced for general orthopaedic use. With this renewed enthusiasm for the procedure, it is important to understand the various indications and contraindications for using patellofemoral arthroplasty devices with the expectation that proper patient selection will improve outcome. Our purpose was to analyze the appropriate usage of these prostheses based on published historical results. A literature search was done to review the indications, contraindications, and factors contributing to the failure of these devices. We analyzed 12 studies reporting results of patellofemoral arthroplasty between 1979 and 2005. Commonly cited contraindications for using these devices have been tibiofemoral arthritis, uncorrected patellofemoral or tibiofemoral malalignment, and inflammatory arthritis. The highest failure rates were in patients with progression of osteoarthritis in other compartments or persistence of congenital or surgically uncorrected malalignment. In analyzing the reasons for failures in these reports together with issues already known to affect total knee arthroplasty surgery, we suggest an expanded list of outcome-altering factors to consider when choosing to do a patellofemoral arthroplasty. Finally, based on these observations and our own experience, suggestions on the best approach to the patient with patellofemoral arthritis are made to avoid less than optimal results if patellofemoral arthroplasty is considered.


METHODS
Prognostic Study, Level II-3 (systematic review of Level-II studies. See the Guidelines for Authors for a complete description of levels of evidence.
Leadbetter
Wayne B
WB
Rubin Institute for Advanced Orthopaedics, Sinai Hospital of Baltimore, MD 21215, USA. leadbettermd@aol.com
Ragland
Phillip S
PS
Mont
Michael A
MA
D019645:Arthroplasty, Replacement, Knee / Q000379:methods; D002357:Cartilage Diseases / Q000601:surgery*; D002358:Cartilage, Articular / Q000473:pathology / Q000601:surgery*; D000075202:Contraindications; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D016239:MEDLINE; D008297:Male; D009985:Orthopedics / Q000379:methods*; D020370:Osteoarthritis, Knee / Q000601:surgery*; D017847:Patellar Ligament / Q000473:pathology / Q000601:surgery*; D017211:Treatment Failure