Custom patellofemoral arthroplasty of the knee

Background: The treatment of isolated patellofemoral arthritis is controversial. Several surgical procedures have been used to treat the severely degenerated patellofemoral joint, with varying degrees of success. The purpose of this study was to determine the clinical results of a custom patellofemoral arthroplasty for the treatment of isolated patellofemoral degenerative arthritis of the knee. Methods: From 1995 through 2002, twenty-five patellofemoral replacements, three of which were bilateral, were performed in twenty-two patients for the treatment of isolated patellofemoral arthritis of the knee. According to the Ahl-back radiographic evaluation scale, the mean preoperative score for the severity of the arthritis was 4.65 points in the patellofemoral compartment and 0.5 point in both the medial and the lateral compartment. The patients included sixteen women (two of whom had a bilateral replacement) and six men (one of whom had a bilateral replacement) with a mean age of forty-five years at the time of the index arthroplasty. Seventeen patients (nineteen knees) had had a prior procedure on the knee. The mean preoperative Knee Society functional score was 49 points, and the mean preoperative Knee Society objective score was 52 points. Results: At a mean of seventy-three months (range, thirty-two to 119 months) postoperatively, all twenty-five implants were in place and functioning well. There were eighteen excellent and seven good results. The mean Knee Society functional score was 89 points, and the mean Knee Society objective score was 91 points. No patient had required additional surgery or had component loosening. Conclusions: On the basis of our relatively short-term follow-up study, custom patellofemoral arthroplasty appears to be a safe and effective treatment for isolated patellofemoral arthritis of the knee. We believe that the results presented in this paper justify the additional cost associated with the custom device.