Midterm results of modern patellofemoral arthroplasty versus total knee arthroplasty for isolated patellofemoral arthritis: systematic review and meta-analysis of comparative studies.

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Abstract

[Indexed for MEDLINE] 16. Joints. 2018 Dec 10;6(3):204-210. doi: 10.1055/s-0038-1675845. eCollection 2018 Sep. The Challenge of Managing the "Third-Space" in Total Knee Arthroplasty: Review of Current Concepts. Antinolfi P(1), Manfreda F(2), Placella G(3), Teodori J(2), Cerulli G(4), Caraffa A(1)(2). Author information: (1)Service of Orthopedics and Trauma Surgery, Santa Maria della Misericordia Hospital, Perugia, Italy. (2)Department of Orthopedics and Traumatology, University of Perugia, Perugia, Italy. (3)Service of Orthopedics and Traumatology, Azienda Ospedaliera Regionale San Carlo, Potenza, Italy. (4)I.R.T.A.L. Istituto di Ricerca Traslazionale Apparato Locomotore, Nicola's Foundation, Arezzo, Italy. Total knee arthroplasty (TKA) is the best treatment for advanced knee osteoarthritis and it has proven to be durable and effective. Anterior knee pain (AKP) is still one of the most frequent complications after TKA, but sometimes no recognized macroscopic causes can be found. The correct treatment of patella is considered the key for a proper management of AKP. The inclusion of patellar resurfacing during TKA has been described as a potential method for the reduction of AKP. After surgeons started to resurface the patella, new complications emerged, such as component failure, instability, fracture, tendon rupture, and soft tissue impingement. Patelloplasty has been proposed as a good alternative to resurfacing but whether or not to resurface the patella is still a controversial topic in the literature. Therefore, patellofemoral joint is a complex critical aspect in TKA and choosing between the several options of treatment of patella could not be sufficient. In this review, evidence-based studies do not succeed in resolving this difficult argument. The accurate management of the so-called "third space" should include an accurate assessment of cartilage layers, balance of soft tissue, preoperative anterior tracking, and positioning of the femoral and tibial components. In fact, the selection of suitable implants and adherence to proper surgical technique are the fundamental principles for the success of TKA. DOI: 10.1055/s-0038-1675845 PMCID: PMC6301849