髕股關(guān)節(jié)置換

1、髕股關(guān)節(jié)置換髕股關(guān)節(jié)置換The patella has always been a problemPatello-Femoral Osteoarthritis:Prevalence High in patients with sx & OA Women24 % Men11%The treatment alternatives have not been good Patellectomy Tibial tubercle “unloading osteotomies” Arthroscopic chondroplasty Lateral releases Micro-fracture A

2、utogenous Chondrocyte Implant ACI MosaicplastyThe classic results: 66% G/ETherefore, the need for a good patellofemoral replacement The first: a DePalma patellar prosthesis (early 70s)1973Who is the best candidate for a PF replacement? The elderly with isolated patellar arthritis Do well with TKA Th

3、e young with patellar arthritis No long term data availablebest for Middle aged who can convert to TKA? Patient selectionLonner JAAOS 2004 Isolated patellar arthritis Severe pain and functional disability Middle aged Avoid inflammatory arthritis Avoid severe mal-tracking Avoid any Fem-Tib arthritis

4、Avoid laborers or high activity patients Avoid elderly (use TKA)Surgical technique53 yo female 10 + yr hx increasing disbilitySurgical techniqueSurgical technique:set trochlear component parallel to transepicondylar axisSurgical technique:resect trochlear cartlageSurgical technique:reproduce patella

5、r thicknessassess patellar trackinglateral release if neededClinical 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 flexionPatellar Ins

6、tability Related to Uncorrected malalignment Soft tissue inbalance Component malposition Design flawsCartilage contactin flexion32 yr (!) female with pain 1 yr after a PFA excellent examCartilage contactPatellar contact patternsCartilage contactClinical results good potential for relief pain Are the

7、y predictable ?Clinical results Lonner2003 # 25 44yr F/U 1 yr G/E 96 % Lonner2003 # 3038yr F/U 4 yr G/E 84 % Kooijman 2003 # 45 50yr F/U 17 yr G/E 86% Smith 2002 # 45 72yr F/U 4 yr G/E 69% Ackroyd 2003 # 95 na F/U 4 yr G/E 83 % DeWinter 2001 # 26 59yr F/U 11yr G/E 76 %Summary PF replacement Relatively high prevalence PF arthritis Need for reliable PF replacement Newer designs yielding G/E results in 75 % to 86 % in the well selected patient Next generation prosthesis to improve current designsThe patella has always been a problemSurgical tech