Patient Information Resources

1089 Spadina Road
Toronto, AL M5N 2M7
Ph: 416-483-2654
Fax: 416-483-2654

Child Orthopedics
Spine - Cervical
Spine - Lumbar
Spine - Thoracic

View Web RX

« Back

I have a severe case of patellofemoral arthritis in one knee. The surgeons have hemmed and hawed over the years about what to do for me. As the pain increases, I've become more disabled. I'm ready to do just about anything. What are my options?

Treatment for this problem has not been very successful in the past. But new understanding of the biomechanics (anatomy and function) of the joint have opened up new management techniques. The first step is to see a physical therapist. The therapist will design a therapy program to restore full, balanced strength and function of the hip and knee muscles. Activity modification will be required. Avoiding stairs, squatting, jumping, and biking can reduce the load on the patellofemoral joint. Weight loss is always advised for anyone who is overweight. Reducing the stress, pressure, and load on the joint can be very helpful. Medications such as pain relievers and antiinflammatories may be prescribed. Occasionally, the use of steroid or hyaluronic injections is beneficial. Some patients find relief from pain using a patellar unloading sleeve (a slip on neoprene support). Bracing or taping may also be helpful but studies are lacking in providing evidence that these measures really make a difference. Often, a combination of these nonsurgical treatment approaches works the best. But, if after three to six months, there's been no improvement, then some patients may be candidates for surgery. What can the surgeon do? Well, there are a variety of techniques that can be used. Which one is best differs for each patient and depends on the underlying cause of the condition. In some cases, it's just a matter of removing any bone spurs and smoothing the edges of the patella. Other patients benefit from the release of the lateral retinaculum. This is a fibrous band of connective tissue along the outside edge of the patella. When it gets bound down or tethered, it can create uneven pull and a restraint to the natural up and down movement of the patella. If there are holes in the articular cartilage called defects, it may be possible to repair the damage. A newer technique called autologous chondrocyte implantation (ACI) has had favorable results. Normal, healthy cartilage is removed from a nonweight-bearing portion of the knee joint. The cells are taken to a lab where they are used to grow more cells. The cells are then transplanted back into the patient to fill up the hole. Cartilage implantation has worked well for smoothing out the surface of the knee joint. It may not be as successful along the back of the patella. There are two main reasons for failure of this technique. The first is abnormal tracking of the patella. If the patella is not riding up and down in the center of the femoral groove, the same problem will develop again. Anything contributing to the malalignment of the patella must be addressed along with chondrocyte implantation. Secondly, resurfacing the patella may be successful but the patellofemoral joint takes quite a beating everyday. There is a lot of pressure and load on the surface of the patella. The mechanics of gliding up and down over the femur put a much greater demand on patellar articular cartilage than even on the knee joint itself. The implantation may not be able to hold up under such rigorous conditions. Other procedures that may help alleviate pressure from the patellofemoral include tibial tubercle transfer, patellectomy (remove the patella), and patellofemoral arthroplasty (replace the patella). Tibial tubercle transfer refers to the removal and relocation of the bump of bone called the tibial tubercle. This is the insertion point for the quadriceps muscle. The idea in transferring this area of bone is to change the pull of the quadriceps muscle on the patella and thereby reduce the load on the arthritic patella. The surgeon must plan this procedure carefully, using the results of X-rays, MRIs, and arthroscopy to determine what type of incision to use, where to make the incision, and how far to move the tubercle. Treatment of patellofemoral problems is difficult. Disabling knee pain and patellofemoral breakdown may not respond to any of these limited surgical interventions. Sometimes it's necessary to remove the patella completely. This is considered a more radical approach but it's a simple and safe procedure that works. The down side is that the patient is left with a big loss in knee extension strength. One alternative to just a patellectomy alone is a patellar replacement. A screw-on patellar shell is used to replace the patella once it is removed. Early efforts at patellofemoral replacement resulted in as many failures as successes. Newer designs and 3-D technology for designing the implant to fit the patient have improved overall results. If all efforts fail to improve symptoms, motion, and function, then a total knee replacement (TKR) may be the final choice. This procedure is not advised for younger patients but reserved for older adults. Because of the abnormal alignment and mechanics that led to the patellofemoral arthritis in the first place, surgeons must approach a total knee replacement carefully. Imbalances must be corrected during the procedure to ensure optimal results. You'll want to go over with your surgeon each of the options available to you. Your age, activity level, and the underlying cause(s) of your condition will factor into the decision about which approach is best for you.


« Back

*Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

All content provided by eORTHOPOD® is a registered trademark of Mosaic Medical Group, L.L.C.. Content is the sole property of Mosaic Medical Group, LLC and used herein by permission.