髌股关节置换

nullPatellar Femoral Replacement Patellar Femoral Replacement Paul A Lotke MD Hospital of the University of PennsylvaniaThe patella has always been a problemThe patella has always been a problemPatello-Femoral Osteoarthritis: Prevalence Patello-Femoral Osteoarthritis: Prevalence High in patients with sx & OA Women 24 % Men 11% The treatment alternatives have not been good 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/ETherefore, the need for a good patellofemoral replacementTherefore, the need for a good patellofemoral replacementThe first: a DePalma patellar prosthesis (early 70’s)1973 Who is the best candidate for a PF replacement? 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 2004Patient selection Lonner JAAOS 2004Isolated 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 techniqueSurgical technique53 yo female 10 + yr hx increasing disbilitySurgical techniqueSurgical techniqueSurgical technique: set trochlear component parallel to transepicondylar axisSurgical technique: set trochlear component parallel to transepicondylar axisSurgical technique: resect trochlear cartlageSurgical technique: resect trochlear cartlageSurgical technique: reproduce patellar thickness assess patellar tracking lateral release if neededSurgical technique: reproduce patellar thickness assess patellar tracking lateral release if neededClinical Results 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 flexionPatellar InstabilityPatellar InstabilityRelated to Uncorrected malalignment Soft tissue inbalance Component malposition Design flaws Cartilage contact in flexionCartilage contact in flexion32 yr (!!) female with pain 1 yr after a PFA excellent examCartilage contactCartilage contactnullPatellar contact patternsCartilage contactCartilage contactClinical resultsClinical resultsgood potential for relief pain Are they predictable ?Clinical resultsClinical resultsLonner 2003 # 25 44yr F/U 1 yr G/E 96 % Lonner 2003 # 30 38yr 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 replacementSummary PF replacementRelatively 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 designsnull