Thirty-one patients (33 knees) with symptomatic patello-femoral osteoarthritis and minimal tibiofemoral changes underwent LCS total knee replacement without patellar resurfacing.

Average age was 73 years (range, 58–89 years) with a female to male ratio of 5:1. Average follow-up was 20 months (range, 12–40 months). All except four patients had grade 3 or 4 patello-femoral osteoarthritis.

Preoperatively all patients had significant knee pain. Sleep disturbance was reported in 21 patients. All but 10 patients required walking aids. Average range of motion was 1080 (80–125).

At latest review, 21 knees are pain-free, the remaining 12 knees describing only occasional knee pain. Two patients continue to have night pain. Average range of motion was 1040 (70–1350). Lateral patellar tilt improved in all but five knees by an average of 70 (1–260). Patellar congruency improved in all but three knees by an average of 18% (3–63%). None of the patients to date have required revision surgery.

We suggest that knee arthroplasty without patellar resurfacing is an effective option in older patients with isolated patello-femoral osteoarthritis.

Isolated patello-femoral osteoarthritis has been reported to occur in approximately 5% of patients with gonarthrosis of the knee. We present the results of the surgical management of this disorder in our unit. Thirty-one patients (33 knees) with symptomatic patello-femoral osteoarthritis and minimal tibio-femoral changes underwent LCS total knee replacement without patellar resurfacing.

Average age was 73 years (range, 58–89 years) with a female to male ratio of 5: 1. Average follow-up was 20 months (range, 12–40 months). All except four patients had grade 3 or 4 patello-femoral osteoarthritis according to the classification by Sperner et al.

Preoperatively, all patients had significant knee pain. Sleep disturbance was reported in 21 patients. All but 10 patients required walking aids. Average range of motion was 108° (range, 80°–125°).

At latest review, 21 knees are pain-free, the remaining 12 knees describing only occasional knee pain. Two patients continue to have night pain. Average range of motion was 104° (range, 700 – 135°). Lateral patellar tilt improved in all but five knees by an average of 7° (range, 10–26°). Patellar congruency improved in all but three knees by an average of 18% (range, 3–63%). None of the patients to date have required revision surgery. We suggest that knee arthroplasty without patellar resurfacing is an effective option in older patients with isolated patello-femoral osteoarthritis.

Periprosthetic fractures are a recognised complication of total knee arthroplasty. They may occur intraoperatively or postoperatively and risk factors have been identified which may predispose an individual to such a complication.

We report seven cases of periprosthetic tibial fractures following LCS total knee arthroplasty, a complication only encountered by the senior author following a change in practice from a cemented implant to a cementless one.

In light of this previously unreported complication in our unit, we have attempted to identify common features within this group of patients, that may have contributed to fracture occurrence.

Statistical analysis revealed a highly significant risk of periprosthetic tibial fracture in those patients with a preoperative neutral or valgus knee. Age, gender and diagnosis did not appear to significantly increase the risk of fracture. All patients displayed evidence of reduced bone mineral density in the lumbar spine and femoral neck regions on dual energy x-ray absorptiometry scanning.

We feel that those patients with a preoperative neutral or valgus knee and local evidence of osteopenia represent a high-risk group, in whom particular care in alignment should be taken. In this group it may also be preferable to have the tibial component inserted with cement fixation.