Abstract
Introduction: We have come across a subset of patients with advanced patellofemoral osteoarthritis who also had well defined full thickness cartilage loss lesions on the weight bearing femoral condyle. In these patients the findings or the symptoms are not severe enough to warrant a total knee replacement. In this select group of patients, a combination of patellofemoral arthroplasty (PFA) and Osteochondral Autograft Transfer System (OATS) can be performed to address this unique problem.
Method& Results: Out of 38 PFA procedures performed by the senior author, a concomitant OATS was performed in 6 knees in 5 patients. A retrospective analysis of these patients was carried out with the average follow up being 3.8 years (18 months to 84 months). The average age of the patients in our case study was 48.2 years (36 to 59 years) at the time of surgery. Four of the six knees are doing well in the medium term. One patient had progression of tibiofemoral arthritis and underwent a total knee replacement. The only poor result was a young male, who two years following the PFA, developed a deep infection of the knee. Except for this patient awaiting a second stage revision for an infected knee, all the others have achieved their desired level of activity.
Conclusion: The advantage of this combination is that, the donor tubes for the OATS can be harvested from the trochlea or just adjacent to it, which happens to be the bed for the trochlear implant. This area provides good quality thick donor articular cartilage. As the surgical exposure has already been done for the PFA, the operative time is extended by approximately ten minutes for the OATS procedure. This combination procedure offers an alternative to more invasive options such as total knee replacement in younger patients in whom it is preferable to delay such major surgery.
Correspondence should be addressed to Mr T Wilton, c/o BOA, BASK at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE, England.
