Coden Gloria, Schoeller Lauren, Smith Eric L
New England Baptist Hospital, Boston, Massachusetts.
JBJS Essent Surg Tech. 2024 Aug 22;14(3). doi: 10.2106/JBJS.ST.23.00042. eCollection 2024 Jul-Sep.
Patellofemoral arthroplasty is indicated in patients with isolated patellofemoral arthritis in whom nonoperative treatment has failed. The goal of the presently described procedure is to provide relief from patellofemoral arthritis pain while maintaining native knee kinematics.
Patient radiographs are carefully reviewed for isolated patellofemoral arthritis in order to determine the appropriateness of robotic-assisted patellofemoral arthroplasty. Magnetic resonance imaging can be performed preoperatively to help confirm isolated patellofemoral arthritis. We perform this procedure with use of the MAKO Surgical Robot (Stryker). Preoperative computed tomography is performed to plan the bone resection, the size of the implant, and the positioning of the device. The steps of the procedure include (1) medial parapatellar arthrotomy, (2) intraoperative inspection to confirm isolated patellofemoral arthritis, (3) patellar resurfacing, (4) placement of optical arrays and trochlear registration, (5) trochlear resection, (6) trialing of implants, (7) removal of the optical array, (8) impaction of final implants, (9) confirmation of appropriate patellar tracking, and (10) closure.
Alternatives to patellofemoral arthroplasty include standard nonoperative treatment, bicompartmental arthroplasty, total knee arthroplasty, tibial tubercle osteotomy, partial lateral facetectomy, and arthroscopy.
Patellofemoral arthroplasty is indicated in patients with isolated patellofemoral arthritis in whom nonoperative treatment has failed. Patellofemoral arthroplasty may be superior to total knee arthroplasty because it helps treat pain that affects patient quality of life and activities of daily living while also preserving greater tibiofemoral bone stock. We recommend against performing patellofemoral arthroplasty in patients with arthritis of the tibiofemoral joints.
In properly selected patients, outcomes include improvement in patient pain and function. One study found that robotic-assisted patellofemoral arthroplasty may result in improved patellar tracking compared with non-robotic-assisted patellofemoral arthroplasty; however, functional outcomes were found to be similar between procedures, and data for all non-robotic-assisted controls were retrospectively captured.
Confirm isolated patellofemoral arthritis on radiographs and/or magnetic resonance imaging.Review the preoperative plan for appropriate positioning of the trochlear implant.○ Confirm coverage of the trochlear groove.○ Avoid medial overhang.○ Avoid lateral overhang.○ Avoid anterior femoral notching.○ Avoid impingement of the trochlear component into the notch.○ Avoid excessive prominence of the trochlear component on the anterior femoral cortex.○ General principles are to place the trochlear component in 0° to 6° of flexion and 0° to 2° of external rotation.Robotic-assisted trochlear resurfacing is accurate and efficient.
CT = computed tomography.
髌股关节置换术适用于非手术治疗失败的孤立性髌股关节炎患者。当前所述手术的目标是缓解髌股关节炎疼痛，同时保持膝关节的自然运动学。
仔细查看患者的X线片以诊断孤立性髌股关节炎，从而确定机器人辅助髌股关节置换术的适用性。术前可进行磁共振成像以帮助确诊孤立性髌股关节炎。我们使用MAKO外科手术机器人（史赛克公司）进行此手术。术前进行计算机断层扫描以规划骨切除、植入物尺寸及设备定位。手术步骤包括：（1）髌旁内侧关节切开术；（2）术中检查以确认孤立性髌股关节炎；（3）髌骨表面置换；（4）放置光学阵列及滑车配准；（5）滑车切除；（6）植入物试模；（7）移除光学阵列；（8）最终植入物打压；（9）确认髌骨轨迹合适；（10）关闭切口。
髌股关节置换术的替代方案包括标准非手术治疗、双间室关节置换术、全膝关节置换术、胫骨结节截骨术、部分外侧小面切除术和关节镜检查。
髌股关节置换术适用于非手术治疗失败的孤立性髌股关节炎患者。髌股关节置换术可能优于全膝关节置换术，因为它有助于治疗影响患者生活质量和日常生活活动的疼痛，同时还能保留更多的胫股骨量。我们不建议对胫股关节关节炎患者进行髌股关节置换术。
在适当选择的患者中，结果包括患者疼痛和功能的改善。一项研究发现，与非机器人辅助的髌股关节置换术相比，机器人辅助的髌股关节置换术可能会改善髌骨轨迹；然而，发现两种手术的功能结果相似，且所有非机器人辅助对照组的数据均为回顾性收集。
通过X线片和/或磁共振成像确认孤立性髌股关节炎。
查看术前计划中滑车植入物的合适定位。
确认滑车沟的覆盖情况。
避免内侧悬垂。
避免外侧悬垂。
避免股骨前部切迹。
避免滑车部件撞击切迹。
避免滑车部件在股骨前部皮质上过度突出。
一般原则是将滑车部件置于屈曲0°至6°、外旋0°至2°的位置。
机器人辅助的滑车表面置换准确且高效。
CT = 计算机断层扫描
