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Orthopaedic Proceedings
Vol. 84-B, Issue SUPP_II | Pages 157 - 157
1 Jul 2002
Peckett WRC Smith A Venu KM Butler-Manuel A d’Arcy JC
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Purpose of study: Sixty four patellofemoral (PF) arthroplasties in 48 patients were evaluated to assess the effectiveness of this procedure in patients with a preoperative diagnosis of patellofemoral osteoarthritis.

Methods: All patients who underwent patellofemoral arthroplasty for patellofemoral osteoarthritis between 1992 and 1998 in two district general hospitals were studied. Three authors not directly involved in the patients care assessed the patients by:

both a modified Hungerford and Kenna knee rating system and Insall and Crosby grading system, and

asking whether surgery had been worthwhile and whether they would go through it again.

Serial radiographs were assessed for patellar malalignment, mechanical failure and progressive arthritic change in the knee, and

failure was defined as a fairlpoor knee score or revision.

Results: Preoperative diagnosis included 53 patients with primary PF arthritis, 1 with post-traumatic arthritis and 1 with PF osteoarthritis secondary to recurrent subluxation. The average patient age at surgery was 73 (range 42–89) and the average length of follow-up was 41 months (range 6–90 months).

Preoperatively 17 knees had undergone arthroscopy. 36 Lubinus, 17 Cartier and 2 PFV prostheses were used. 5 patients died with 8 PF arthroplasties in situ, 1 patient lost to follow up (these patients are not included further in the analysis). 48 Patellofemoral arthroplasty knees were reviewed. 38 knees were classed as good or excellent, 10 had unsatisfactory results, and 7 were revised. 5 implants were revised to TKR and 2 were revised to PF arthroplasty (for maltracking). Subjectively 41 patients felt they were better, 5 unchanged and 2 worse.

Overall we had 69% good or excellent results, 18% poor, and 12% revised. There were no infections, no revision for loosening, and no documented difficulty in revisions. The worst results were obtained in patients with evidence of tiblo-femoral OA preoperatively and in patients with tracking problems.

Conclusion: PF arthroplasty is technically demanding. Nevertheless, providing one adheres to strict patient selection criteria, and the surgery is performed by a dedicated specialist knee surgeon, PF arthroplasty may be used to treat proven isolated patellofemoral arthritis.


The Journal of Bone & Joint Surgery British Volume
Vol. 81-B, Issue 5 | Pages 933 - 933
1 Sep 1999
D’ARCY JC WAKANKAR HM


The Journal of Bone & Joint Surgery British Volume
Vol. 81-B, Issue 5 | Pages 932 - 932
1 Sep 1999
D’ARCY JC WAKANKAR HM


The Journal of Bone & Joint Surgery British Volume
Vol. 81-B, Issue 5 | Pages 934 - 934
1 Sep 1999
D’ARCY JC WAKANKAR HM


The Journal of Bone & Joint Surgery British Volume
Vol. 81-B, Issue 1 | Pages 30 - 33
1 Jan 1999
Wakankar HM Nicholl JE Koka R D’Arcy JC

We assessed the influence of the use of a tourniquet in total knee arthroplasty in a prospective, randomised study. After satisfying exclusion criteria, we divided 77 patients into two groups, one to undergo surgery with a tourniquet and one without. Both groups were well matched. The mean change in knee flexion in the group that had surgery without a tourniquet was significantly better at one week (p = 0.03) than in the other group, but movement was similar at six weeks and at four months. There was no significant difference in the surgical time, postoperative pain, need for analgesia, the volume collected in the drains, postoperative swelling, and the incidence of wound complications or of deep-venous thrombosis.

We conclude that the use of a tourniquet is safe and that current practice can be continued.