Arthritis is a general term covering numerous conditions where the joint surface or cartilage wears out. The joint surface is covered by a smooth articular surface that allows pain free movement in the joint. This surface can wear out for a number of reasons; often the definite cause is not known.
When the articular cartilage wears out the bone ends rub on one another and cause pain. This condition is referred to as Osteoarthritis or “wear and tear” arthritis as it occurs with aging and use. It is the most common type of arthritis.
When arthritis affects the knee joint, it commonly occurs in two compartments, usually the medial and patellofemoral compartment. It is not common for a patient to have arthritis isolated to the patellofemoral compartment, but it does occur and is more commonly seen in women. Patellofemoral arthritis is diagnosed when the arthritic damage is only located in the patellofemoral compartment, affecting the back of the knee cap.
Causes of Arthritis
There are numerous conditions that can cause arthritis but often the exact cause is never known. In general, but not always, it affects people as they get older (Osteoarthritis).
Other causes include:
Patellofemoral Arthritis or knee cap arthritis causes pain and decreased mobility that is usually localised to the front of the knee joint. The patellofemoral compartment is involved in activities such as walking up and down hills or stairs, kneeling or squatting and standing back up. These activities can become almost impossible to do when the pain from the arthritic damage is severe enough. Patients with this type of arthritis usually have no pain when walking on flat surfaces even when walking long distances.
Evaluating the source of knee pain is critical in determining your treatment options for relief of the pain. Knee pain should be evaluated by an Orthopaedic specialist for proper diagnosis and treatment.
Your physician will perform the following:
Depending on what the history and exam reveal, your doctor may order medical tests to determine the cause of your knee pain and to rule out other conditions.
Diagnostic Studies may include:
The diagnosis of osteoarthritis is made on history, physical examination & X-rays. There is no blood test to diagnose Osteoarthritis (wear & tear arthritis).
Conservative Treatment Options
Conservative treatment options refer to management of the problem without surgery.
Some conservative treatment measures for knee osteoarthritis include:
Patellofemoral Knee Replacement surgery may be recommended by your surgeon if you have osteoarthritis contained to the patellofemoral compartment and you have not obtained adequate relief with conservative treatment options.
Traditionally, a patient with only one compartment of knee arthritis would undergo a Total Knee Replacement surgery. Patellofemoral Knee Replacement is a minimally invasive surgical option that preserves the knee parts not damaged by arthritis as well as the stabilising anterior and posterior cruciate ligaments, ACL and PCL. This less invasive bone and ligament preserving surgery is especially useful for younger, more active patients as the implant placed more closely mimics actual knee mechanics than does a total knee surgery.
The smaller implants used with a partial knee replacement surgery are customised to the patient’s anatomy based upon CT scans of the patient’s knee. A surgical Robotic Arm assists the surgeon with preoperative planning and intraoperative component placement, positioning, and alignment. Patellofemoral Knee Arthroplasty surgery will not alter the ability of the patient to eventually move to a Total Knee Replacement in the future should that become necessary.
Partial Knee Replacement surgery is performed in an operating room under sterile conditions with the patient under general anaesthesia or spinal anaesthesia with sedation. It is usually performed on an outpatient basis as day surgery.
Post Operative Recovery
Common Post Operative guidelines include:
Risks and Complications
Specific Complications related to Patellofemoral Knee Replacement surgery include: