Patellofemoral Jointspace Replacement.... or not

The debate, for surgeons and patients, continues.  Is it really better to do a partial knee replacement or jump right into a total knee replacement?  And now, something new to add - the patellofemoral jointspace replacement.  The three major areas of the knee can be replaced all at once, or individually.  The choice must be based on an individual situation.

By entering the knee you cause damage, scar tissue if nothing else. Obviously you want to open the knee as few times as possible.  If one area of the knee is damaged, it makes sense to replace that area.  But if one area is damaged can we know for sure how long until other areas deteriorate to a point of needing replacement as well?  This is what we must somehow be able to determine.  How fast does the surgery of   replacement speed the process of arthritis throughout the joint?  In some cases this can happen quite quickly and lead to multiple surgeries.

Addressing the Patellofemoral Jointspace  Replacement specifically, you have also the added factor of patella dislocation.  As the patella dislocates and moves over the femur it becomes worn.  A replacement of this area seems logical.  But does it address the issue of dislocation… or just the worn surfaces?  From experience we now know it addresses only worn surfaces.  You now have a resurfaced patella… dislocating in the same way as the original, and the added trauma of surgery.  This type of surgery is usually accompanied by lateral release and /or medial advancement so the “damage” to the knee is extensive.

In many cases, the surgeon does not want to replace healthy bone as you would expect.  It will take time to understand  if it is actually more beneficial in the long run to move forward and replace the entire knee joint and thus reduce the overall trauma by reducing the number of times one must undergo major surgery.

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