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Treating Patellofemoral Osteoarthritis in Young Patients

Patients younger than 50 years old with severe patellofemoral (PF) osteoarthritis (OA) aren't good candidates for a knee replacement. Loosening from wear and tear in active younger people often leads to implant failure. Cartilage and bone transplantation may be the answer.

In this study 11 patients with severe disability from PF OA were given a layer of cartilage and bone from a donor. The graft is called an osteochondral allograft. The graft forms a shell that is transplanted into the damaged area of the joint.

All patients in the study had an average of four surgeries already. In this operation two patients received a new patella (kneecap). This is a unipolar graft. The rest were given a bipolar graft, which included the patella and the surface of the femoral (thigh bone) side of the joint.

Patients were followed for years afterward. X-rays were used to measure the thickness of the cartilage. Testing of joint motion and function were also done. Eight of the 11 patients were able to delay getting a total knee replacement (TKR) by two to 10 years. The symptoms of arthritis (pain, stiffness, loss of function) were improved for these eight patients during that time.

Allograft of bone and cartilage may be an acceptable alternative to TKR in younger adults with PF OA. This small study offers hope for the use of biologic resurfacing with allografts as a treatment option. If this operation fails, a TKR is still possible.

References: Roger Torga Spak, MD, and Robert A. Teitge, MD. Fresh Osteochondral Allografts for Patellofemoral Arthritis. In Clinical Orthopaedics and Related Research. March 2006. No. 444. Pp. 193-200.

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