Isolated disease is amenable to cemented custom patellofemoral arthroplasty
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WAILEA, Hawaii — Custom patellofemoral knee arthroplasty is a simple and effective procedure indicated for women and patients with isolated patellofemoral arthritis involving the patella, a speaker at Orthopedics Today Hawaii said.
“We would think about doing patellofemoral arthroplasty for severe diseases involving the patella with good overall tibiofemoral Ahlback scores and, usually, it’s 75% of women who have the problem [of diseases involving the patella],” Adolph V. Lombardi Jr., MD, FACS, said.
The patient-specific patellofemoral arthroplasty device, which is manufactured for each patient who undergoes custom patellofemoral arthroplasty, is used as a template for the surgical procedure and for the trial implantation.
According to Lombardi, the 4- to 6-week process from patient examination to receipt and implantation of the final implant begins with a CT scan of the patient’s patellofemoral joint. Once the manufacturer receives the CT scan, the manufacturer makes a 3D reconstruction of the patient’s patellofemoral joint and a rapid prototype model of the distal femur from which the custom implant is designed. The surgeon reviews and approves the implant design plan.
“Then, I get the actual implant” and a patient-specific guide, Lombardi said.
With the implant positioned in place intraoperatively as a template, Lombardi said he marks along the perimeter of the device around which he does a sharp dissection. He then cleans up the cartilage.
“So, you’re not taking any bone. This is a procedure where you’re removing the diseased cartilage,” Lombardi said.
“It’s a simple straightforward procedure in the correct patient, and I think you should think about it,” he said.
The patella is also treated during custom patellofemoral knee arthroplasty, according to Lombardi.
“You have to use the actual implant as your trial because that’s all you have. I remove some osteophytes, make some small little drill holes in the sclerotic bone and then cement,” he said.
Crepitation, effusion, a positive apprehension sign, peripatellar facet tenderness and some quadriceps atrophy may be seen during the initial examination of a patient for whom custom patellofemoral replacement arthroplasty is indicated. However, conservative, nonoperative management should always be attempted prior to custom patellofemoral arthroplasty, he said.
Contraindications include “an enlarged Q angle or complex regional pain syndrome or if they have inflammatory arthritis,” Lombardi said.
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Lombardi AV. Custom patellofemoral arthroplasty. Presented at: Orthopedics Today Hawaii 2021; May 30-June 3, 2021; Wailea, Hawaii.
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