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Article Dans Une Revue Journal of ISAKOS Année : 2024

Patello-femoral arthroplasty- indications and contraindications

Résumé

Patellofemoral arthroplasty (PFA) is emerging as an attractive alternative to total knee arthroplasty (TKA) for isolated patellofemoral-osteoarthritis (PF-OA) for selected patients. The success of PFA is highly dependent on patient selection. This intervention is still burdened with a higher rate of revisions and a lower survival rate than TKA when the indications or the surgical technique are not optimal. We highlight the indications and contraindications of PFA to obtain satisfying functional outcomes and survivorship. Preoperative clinical and radiological assessment is critical to determine the presence of PFA indications, the absence of contraindications and the necessity of any associated procedures, particularly for the tibial tubercle. The typical indications are patients with isolated symptomatic PF-OA, with trochlear dysplasia, when bone-onbone Iwano 4 osteoarthritis is observed, without significant malalignment and with the absence of risk factors for developing progressive tibiofemoral-OA. The three main causes of isolated PF-OA are primary OA, trochlear dysplasia and posttraumatic OA following patellar fracture. Trochlear dysplasia is the preferred indication for PFA. Lack of experience with arthroplasty or realignment of the extensor mechanism is a relative contraindication to performing PFA. Future perspectives Evaluate advanced implanting guides like robotics, PSI, and computer-assisted surgery for PFA. Require large-scale and long-term clinical studies for accuracy in surgical precision, implant positioning, and patient satisfaction. Develop and validate AI algorithms for precise patient selection in PFA. Incorporate diverse patient factors to guide personalized treatment strategies. Continue research with larger populations to refine patient selection criteria, surgical techniques, and implant designs in PFA. Prospective studies are needed for long-term outcome validation. Current concepts PFA emerges as an alternative to TKA for isolated PF-OA. Success relies on meticulous patient selection. Isolated PF-OA secondary to trochlear dysplasia is a key indication for PFA. Preoperative assessments crucial for optimal outcomes.
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Dates et versions

hal-04465111 , version 1 (19-02-2024)

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Cécile Batailler, Thibaut Libert, Sam Oussedik, Stefano Zaffagnini, Sébastien Lustig. Patello-femoral arthroplasty- indications and contraindications. Journal of ISAKOS, 2024, ⟨10.1016/j.jisako.2024.01.003⟩. ⟨hal-04465111⟩
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