Patello-femoral Joint Replacement

Mr Prakash is a knee specialist in Birmingham

Patello-femoral Joint Replacement in Birmingham

Mr Prakash specialises predominantly in knee and hip joint surgery especially for young adults (age 20-65). He routinely performs surgery related to sports injuries and arthritis and one of his key focuses is on Patello-femoral Joint Replacement.

mr divya prakash specialist in knee and hip surgery, specialist knee surgeon in Birmingham, UK

Patello-femoral Joint Replacement

A person experiencing pain going up and down stairs, may be suffering from arthritis of the front of the knee (which in medical terms is known as the patello-femoral or PFJ) compartment. Such a problem is fairly common. Although other surgical procedures may be performed to off-load this part of the joint, none give the patient relief from pain as consistently as replacement of this part of the joint. The patient is freed from the pain of their condition promptly after surgery. Full range of movement is achieved without too much trouble, and patients are able to negotiate stairs normally.

Procedure

In this procedure, the damaged part of the joint is prepared to accept the prosthesis. The replacement for the removed kneecap is made of plastic, while that for the thigh bone is made of metal. Bone cement is used to fix the prosthesis in place.

There is greater than 90% chance of survival of the prosthesis for ten years. If arthritis develops in the remaining (natural) part of the knee, or if the prosthesis fails, it can be removed and replaced with a standard total knee replacement without too much technical difficulty.

The advantages of a PFJ replacement are very similar to that of UKR:

A ‘natural’ feel of the joint
Much greater conservation of bone
Prompt relief of pain
Much less blood loss
A shorter hospital stay (usually no more than two or three days)
The disadvantages of a PFJ replacement:

Suitable only for selected patients
Should be performed only by experienced surgeons
It may need to be converted to a total knee replacement eventually
Mr Prakash’s approach: I encourage my patients to lose weight if they are overweight, as this will increase the life span of the replaced joint. To ensure the suitability of the patient for PFJ replacement, I like to perform arthroscopy (keyhole surgery) initially; the PFJ replacement may then follow later. I also try and preserve the patella and not replace it, instead replace only the trochlea which is the area where the patella sits.

Treatment

A torn ACL does not heal spontaneously. To stabilise the joint, a new ligament has to be reconstructed using a graft using one of the following materials:

  • Patellar tendon graft
  • Hamstring graft
  • Synthetic graft
  • Allograft
  • Quadriceps tendon graft

A tunnel is drilled first through the shin bone and then through the thigh bone. An appropriate sized graft is passed through the tunnels and fixed very securely in each bone, using either large screws or other appropriate fixing devices. When tendon tissue is first harvested for a graft, it loses its blood supply. As a result its strength deteriorates until a new blood supply is established in it. When the graft tissue is inserted into the knee, the healing process starts and gradually new blood vessels grow into it. New cells migrate into the tissue and begin to repair and re-model the graft.

Patient physical activity is restricted, particularly for the first six weeks. After that, the activity may be gradually increased. It is usually nine to 12 months before unrestricted activities are permitted.

Mr Prakash’s approach: I perform this surgery using the arthroscope via keyhole surgery, enabling me to make sure that any other injuries to the joint are assessed and treated. It also helps me optimise the position of the graft. I prefer to use the patellar tendon graft as it has stood the test of time. It is also the preferred graft material for professional athletes and sports persons. I have performed this routinely in soldiers who have been able to achieve the highest level of fitness to be able to be deployed to war zones. I therefore chose to use this graft in not only high performance individuals, including sportsmen, but all my patients. However, I also use the hamstring tendons as graft in low demand patients, and place the graft in anatomical position. My patients go home on the day after surgery, once pain control has been achieved.

*with crutches

Request an appointment