髌股关节置换.ppt

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1、PatellarFemoralReplacementPaulALotkeMDHospitaloftheUniversityofPennsylvaniaThepatellahasalwaysbeenaproblemPatello-FemoralOsteoarthritis:PrevalenceHighinpatientswithsx&OAWomen24%Men11%ThetreatmentalternativeshavenotbeengoodPatellectomyTibialtubercle“unloadingoste

2、otomies”ArthroscopicchondroplastyLateralreleasesMicro-fractureAutogenousChondrocyteImplant–ACIMosaicplastyTheclassicresults:66%G/ETherefore,theneedforagoodpatellofemoralreplacementThefirst:aDePalmapatellarprosthesis(early70’s)1973WhoisthebestcandidateforaPFreplace

3、ment?TheelderlywithisolatedpatellararthritisDowellwithTKATheyoungwithpatellararthritisNolongtermdataavailablebestforMiddleagedwhocanconverttoTKA?PatientselectionLonnerJAAOS2004IsolatedpatellararthritisSeverepainandfunctionaldisabilityMiddleagedAvoidinflammatoryarth

4、ritisAvoidseveremal-trackingAvoidanyFem-TibarthritisAvoidlaborersorhighactivitypatientsAvoidelderly(useTKA)Surgicaltechnique53yofemale10+yrhxincreasingdisbilitySurgicaltechniqueSurgicaltechnique:settrochlearcomponentparalleltotransepicondylaraxisSurgicaltechnique:r

5、esecttrochlearcartlageSurgicaltechnique:reproducepatellarthicknessassesspatellartrackinglateralreleaseifneededClinicalResultsScatteredreportsoverpasttwodecadesInconsistentindicationsandassessmentsHowever,resultsreasonablyconsistent75-86%G/EMostoftheproblemswerefr

6、omPatellarinstablityCartilagecontactinflexionPatellarInstabilityRelatedtoUncorrectedmalalignmentSofttissueinbalanceComponentmalpositionDesignflawsCartilagecontactinflexion32yr(!!)femalewithpain1yrafteraPFAexcellentexamCartilagecontactPatellarcontactpatternsCartila

7、gecontactClinicalresultsgoodpotentialforreliefpainAretheypredictable?ClinicalresultsLonner2003#2544yrF/U1yrG/E96%Lonner2003#3038yrF/U4yrG/E84%Kooijman2003#4550yrF/U17yrG/E86%Smith2002#4572yrF/U4yrG/E69%Ackroyd2003#95naF/U4yrG/E83%DeWinter2001#2659yrF/U11yrG/E76%Sum

8、maryPFreplacementRelativelyhighprevalencePFarthritisNeedforreliablePFreplacementNewerdesignsyieldingG/Eresultsin75%to86%inthewellselectedpatient