髌股关节置换.pptx

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1、The patella has always been a problem第1页/共22页Patello-Femoral Osteoarthritis:Prevalence High in patients with sx&OA Women 24%Men11%第2页/共22页The treatment alternatives have not been good PatellectomyTibial tubercle“unloading osteotomies”Arthroscopic chondroplastyLateral releasesMicro-fractureAutogenous

2、 Chondrocyte Implant ACIMosaicplastyThe classic results:66%G/E第3页/共22页Therefore,the need for a good patellofemoral replacementThe first:a DePalma patellar prosthesis (early 70s)1973第4页/共22页Who is the best candidate for a PF replacement?The elderly with isolated patellar arthritisDo well with TKAThe

3、young with patellar arthritisNo long term data availablebest forMiddle aged who can convert to TKA?第5页/共22页Patient selectionLonner JAAOS 2004Isolated patellar arthritisSevere pain and functional disabilityMiddle agedAvoid inflammatory arthritisAvoid severe mal-trackingAvoid any Fem-Tib arthritisAvoi

4、d laborers or high activity patientsAvoid elderly (use TKA)第6页/共22页Surgical technique53 yo female 10+yr hx increasing disbility第7页/共22页Surgical technique第8页/共22页Surgical technique:set trochlear component parallel to transepicondylar axis第9页/共22页Surgical technique:resect trochlear cartlage第10页/共22页Su

5、rgical technique:reproduce patellar thicknessassess patellar trackinglateral release if needed第11页/共22页Clinical Results Scattered reports over past two decadesInconsistent indications and assessmentsHowever,results reasonably consistent75-86%G/E Most of the problems were fromPatellar instablityCarti

6、lage contact in flexion第12页/共22页Patellar InstabilityRelated toUncorrected malalignmentSoft tissue inbalanceComponent malpositionDesign flaws第13页/共22页Cartilage contactin flexion32 yr(!)female with pain 1 yr after a PFA excellent exam第14页/共22页Cartilage contact第15页/共22页Patellar contact patterns第16页/共22

7、页Cartilage contact第17页/共22页Clinical resultsgood potential for relief painAre they predictable?第18页/共22页Clinical resultsLonner2003#25 44yr F/U 1 yr G/E 96%Lonner2003#3038yr F/U 4 yr G/E 84%Kooijman 2003#45 50yr F/U 17 yr G/E 86%Smith 2002#45 72yr F/U 4 yr G/E 69%Ackroyd 2003#95 na F/U 4 yr G/E 83%DeWinter 2001#26 59yr F/U 11yr G/E 76%第19页/共22页Summary PF replacementRelatively high prevalence PF arthritisNeed for reliable PF replacementNewer designs yielding G/E results in75%to 86%in the well selected patientNext generation prosthesis to improve current designs第20页/共22页第21页/共22页感谢您的观看！第22页/共22页