Controversies and Techniques in the Surgical Management of Patellofemoral Arthritis by William M. Mihalko, Yaw Boachie-Adjei, Jeffrey T. Spang, John P.

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Presentation transcript:

Controversies and Techniques in the Surgical Management of Patellofemoral Arthritis by William M. Mihalko, Yaw Boachie-Adjei, Jeffrey T. Spang, John P. Fulkerson, Elizabeth A. Arendt, and Khaled J. Saleh J Bone Joint Surg Am Volume 89(12): December 1, 2007 ©2007 by The Journal of Bone and Joint Surgery, Inc.

Radiograph showing arthritis of the lateral facet accompanied by excessive lateral patellar tilt. William M. Mihalko et al. J Bone Joint Surg Am 2007;89: ©2007 by The Journal of Bone and Joint Surgery, Inc.

A large lateral osteophyte is visible on this Merchant radiograph. William M. Mihalko et al. J Bone Joint Surg Am 2007;89: ©2007 by The Journal of Bone and Joint Surgery, Inc.

Lateral and Merchant radiographs of a patient who underwent a Maquet osteotomy and had eighteen years of pain relief. William M. Mihalko et al. J Bone Joint Surg Am 2007;89: ©2007 by The Journal of Bone and Joint Surgery, Inc.

Figs. 4-A, 4-B, and 4-C Anteromedial tibial tubercle osteotomy. William M. Mihalko et al. J Bone Joint Surg Am 2007;89: ©2007 by The Journal of Bone and Joint Surgery, Inc.

The transfer requires exposure of the lateral aspect of the tibia by reflecting the anterior tibialis muscle. William M. Mihalko et al. J Bone Joint Surg Am 2007;89: ©2007 by The Journal of Bone and Joint Surgery, Inc.

The anteromedial tibial tubercle transfer is stabilized with two cortical lag screws. William M. Mihalko et al. J Bone Joint Surg Am 2007;89: ©2007 by The Journal of Bone and Joint Surgery, Inc.

Figs. 5-A through 5-E Patellofemoral arthroplasty. William M. Mihalko et al. J Bone Joint Surg Am 2007;89: ©2007 by The Journal of Bone and Joint Surgery, Inc.

Intraoperatively, the patellofemoral arthritis was seen to be severe and extensive. William M. Mihalko et al. J Bone Joint Surg Am 2007;89: ©2007 by The Journal of Bone and Joint Surgery, Inc.

With the Avon patellar replacement system (Stryker Orthopaedics, Mahwah, New Jersey), an anterior femoral cut guided by a cutting block with 2-mm shim adjustments is utilized to ensure that no notching occurs. William M. Mihalko et al. J Bone Joint Surg Am 2007;89: ©2007 by The Journal of Bone and Joint Surgery, Inc.

Trial components are utilized to outline the intercondylar extension, which is then prepared with use of osteotomes to remove the osteochondral bone. William M. Mihalko et al. J Bone Joint Surg Am 2007;89: ©2007 by The Journal of Bone and Joint Surgery, Inc.

The trochlear implant is cemented and fixed with four pegs, as can be seen in these postoperative radiographs. William M. Mihalko et al. J Bone Joint Surg Am 2007;89: ©2007 by The Journal of Bone and Joint Surgery, Inc.

A femoral cut made perpendicular to the mechanical axis will place the femoral component in approximately 6° of valgus angulation with respect to the anatomic axis of the femur. William M. Mihalko et al. J Bone Joint Surg Am 2007;89: ©2007 by The Journal of Bone and Joint Surgery, Inc.

Medialization of the femoral component may result in lateral patellar subluxation (Reproduced, with modification, from: Krackow KA. The technique of total knee arthroplasty. William M. Mihalko et al. J Bone Joint Surg Am 2007;89: ©2007 by The Journal of Bone and Joint Surgery, Inc.

Lateral patellar subluxation of the patella on the left following total knee arthroplasty. William M. Mihalko et al. J Bone Joint Surg Am 2007;89: ©2007 by The Journal of Bone and Joint Surgery, Inc.